Current Evidence on Safety and Practical Considerations for Administration of Sublingual Allergen Immunotherapy (SLIT) in the United States.
Liquid sublingual allergen immunotherapy (SLIT) has been used off-label for decades, and Food and Drug Administration (FDA)-approved grass and ragweed SLIT tablets have been available in the United States since 2014. Potentially life-threatening events from SLIT do occur, although they appear to be very rare, especially for FDA-approved products. Practice guidelines that incorporate safety precautions regarding the use of SLIT in the United States are needed. This clinical commentary attempts to address unresolved issues including controversy regarding the FDA mandate for the prescription of epinephrine autoinjectors for patients on SLIT; how to approach polysensitized patients; optimal timing and duration of SLIT administration; how to address gaps in therapy; whether antihistamines can prevent local reactions, if certain patient populations (such as persistent asthmatics) should not receive SLIT; and when to instruct patients to self-administer epinephrine. Key points are that physicians should focus on educating patients regarding: (1) when not to administer SLIT; (2) how to recognize a potentially serious allergic reaction to SLIT; and (3) when to administer epinephrine and seek emergency care.
Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: epsteite@uc.edu.
Tolly G
TG
Epstein
Dilley Allergy and Asthma Specialists, San Antonio, Tx.
Christopher
C
Calabria
University of Miami Miller School of Medicine at Holy Cross Hospital, Ft. Lauderdale, Fla.
Linda S
LS
Cox
Department of Pediatric Allergy, Women's and Children's Health, University of Uppsala, Uppsala, Sweden.
Sten
S
Dreborg
D000485:Allergens / Q000276:immunology / Q000627:therapeutic use*; D000818:Animals; D002985:Clinical Protocols; D064420:Drug-Related Side Effects and Adverse Reactions / Q000276:immunology / Q000517:prevention & control*; D004837:Epinephrine / Q000008:administration & dosage*; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000628:therapy*; D006109:Poaceae / Q000276:immunology; D011058:Pollen / Q000276:immunology; D017410:Practice Guidelines as Topic; D012646:Self Administration; D063729:Sublingual Immunotherapy / Q000009:adverse effects / Q000379:methods*; D014481:United States; D014486:United States Food and Drug Administration
D000485:Allergens; D006633:Histamine Antagonists; D004837:Epinephrine
Patient guidelines; SLIT; Safety of; Sublingual allergen immunotherapy; Systemic allergic reactions