title: Guiding principles of sublingual immunotherapy for allergic rhinitis in Japanese patients.
abstract: OBJECTIVE
  Sublingual immunotherapy (SLIT) appears to offer practical advantages for the treatment of allergic rhinitis (AR). Based on a review of the scientific literature, we present recommendations as guiding principles to administer SLIT safely.
  
  
  METHODS
  Clinical questions concerning SLIT were prepared. Literature published between January 2003 and December 2012 was searched from PubMed, the Cochrane Library, and Japana Centra Revuo Medicina. Qualified studies were analyzed and the results were evaluated, consolidated, and codified. We answered 17 clinical questions and, based on this, presented evidence-based recommendations.
  
  
  RESULTS
  Sublingual immunotherapy improved symptoms (e.g., quality of life [QOL]) and reduced medication scores in seasonal AR and perennial AR. Most SLIT-induced adverse effects were local oral reactions, although systemic adverse effects such as gastrointestinal symptoms, urticaria, and asthma are occasionally reported. There have been no reports of lethal anaphylactic reactions by SLIT. When SLIT is continued for 3-4 years, its effect persists long after discontinuation.
  
  
  CONCLUSIONS
  A correct diagnosis of AR and sufficient informed consent from patients are required before initiating SLIT. Sublingual immunotherapy should be continued for 3 years or longer. The initial administration of SLIT during the uptitration of an allergen vaccine and the general condition of patients are critical for the safe performance of SLIT.
authors.affiliation: Department of Otorhinolaryngology, University of Yamanashi, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Masuyama
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Nippon Medical School, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Goto
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Hiroshima University, Japan.
authors.forename: Sachio
authors.initials: S
authors.lastname: Takeno
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Yamagata University, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ohta
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Okayama University, Okayama, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Okano
authors.affiliation: Otorhinolaryngology/Allergy Center, Saitama Medical University, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kamijo
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nagoya City University, Japan.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Otorhinolaryngology, Osaka Medical University, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Terada
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Chiba University, Japan.
authors.forename: Daiju
authors.initials: D
authors.lastname: Sakurai
authors.affiliation: Departments of Otorhinolaryngology and Allergology, Iida Hospital, Japan.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Horiguchi
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Akita University, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Honda
authors.affiliation: Department of Otolaryngology Nippon Medical School, Musashikosugi Hospital, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Matsune
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Fukui, Japan.
authors.forename: Takechiyo
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Fukui, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sakashita
authors.affiliation: Yuta Clinic, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yuta
authors.affiliation: Department of Otorhinolaryngology, Shimane University, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Fuchiwaki
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Kagoshima University, Japan.
authors.forename: Ikuyo
authors.initials: I
authors.lastname: Miyanohara
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Chiba University, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Fukui, Japan. Electronic address: sfujieda@u-fukui.ac.jp.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Fujieda
mesh_terms: D000485:Allergens / Q000627:therapeutic use*; D001249:Asthma / Q000139:chemically induced; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007564:Japan; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D065631:Rhinitis, Allergic / Q000188:drug therapy*; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy; D063729:Sublingual Immunotherapy / Q000009:adverse effects / Q000379:methods*; D014581:Urticaria / Q000139:chemically induced
chemical_list: D000485:Allergens
keywords: Allergic rhinitis; Guideline; Subcutaneous immunotherapy; Sublingual immunotherapy