title: Dosing of sublingual immunotherapy for allergic rhinitis: evidence-based review with recommendations.
abstract: BACKGROUND
  Since the mid 1980s, the clinical use of sublingual immunotherapy (SLIT) has dramatically increased. However, 1 of the primary barriers to providing SLIT is lack of a published dosing recommendations. The purpose of this work is to provide a range of effective SLIT dosing based upon a rigorous review of the existing evidence base. An appendix with SLIT dosing recommendations is also included.
  
  
  METHODS
  A comprehensive search of the past 25 years of the medical literature using PubMed was performed for specific antigens. Inclusion criteria for articles included: randomized, placebo-controlled studies of SLIT, studies with clinical allergic rhinitis outcomes, and dosing units available to determine the micrograms per month of major allergen administered. The extracted data was used to compile a range of effective SLIT dosing for individual antigens.
  
  
  RESULTS
  Seventy-five articles met the inclusion criteria, providing a range of effective dosing for some allergens. There was commonly a wide range in doses for particular antigens between the individual studies. For some antigens, there was significant overlap in dosage amount between studies showing efficacy and lack of efficacy. Clinical trials meeting inclusion criteria are not available for many allergens.
  
  
  CONCLUSIONS
  This study provided a comprehensive review of the published sublingual dosing ranges for specific antigens. The review provided a range of effective sublingual doses for some allergens, whereas for other allergens there was insufficient published data to determine specific doses. Recommendations for SLIT dosing were produced based on the data revealed in the review and expert opinion.
authors.affiliation: Coastal Sinus and Allergy Center, Gulfport, MS.|Coastal Ear Nose and Throat Associates, Gulfport, MS.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Leatherman
authors.affiliation: Massachusetts Eye And Ear Infirmary, Boston, MA.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Khalid
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Stella
authors.initials: S
authors.lastname: Lee
authors.affiliation: Otolaryngology, South Texas Veterans Health Care System, San Antonio, TX.
authors.forename: Kevin
authors.initials: K
authors.lastname: McMains
authors.affiliation: North Oaks ENT and Allergy, Hammond, LA.
authors.forename: Jacques
authors.initials: J
authors.lastname: Peltier
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Platt
authors.affiliation: Henry Ford Medical Group, Sterling Heights, MI.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stachler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Temple University, School of Medicine, Philadelphia, PA.
authors.forename: Elina
authors.initials: E
authors.lastname: Toskala
authors.affiliation: Avant Garde Medical Care, Boucherville, QC, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: Tropper
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Giri
authors.initials: G
authors.lastname: Venkatraman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Lin
mesh_terms: D000485:Allergens / Q000008:administration & dosage; D004306:Dose-Response Relationship, Immunologic; D006801:Humans; D065631:Rhinitis, Allergic / Q000628:therapy*; D063729:Sublingual Immunotherapy
chemical_list: D000485:Allergens
keywords: aeroallergens; allergic conjunctivitis; allergy injections; asthma; evidence-based medicine; subcutaneous immunotherapy; sublingual immunotherapy; type I allergy