Update of Sublingual Immunotherapy for Allergic Rhinitis

Lee, Ji Eun; Kim, Dong Young

Abstract

Current treatment strategies for allergic rhinitis include avoidance of the offending allergens, pharmacotherapy, immunotherapy and surgery. Among them, immunotherapy is the only therapeutic option that modifies the basic allergic mechanism by inducing desensitization and producing a state of anergy in the presence of offending allergens. Immunotherapy by subcutaneous allergen injection (subcutaneous immunotherapy, SCIT) has been used since 1911 and has been demonstrated to be a clinically effective treatment for allergic disorders such as rhinoconjunctivitis and asthma. However, the inconvenience, invasiveness and potentially lethal adverse systemic events associated with SCIT have motivated physicians to develop other routes for the administration of allergens such as orally, sublingually or intranasally. Sublingual immunotherapy (SLIT) has recently received considerable attention around the world as a treatment for allergic rhinitis and is now widely used as an alternative to the subcutaneous route. The Allergic Rhinitis and Its Impact on Asthma (ARIA) group of the WHO has acknowledged the potential effectiveness of SLIT for pollen or mite-sensitized allergic rhinitis. Clinical trials evaluating the efficacy and safety of SLIT have been ongoing worldwide since 1980, and newer studies are evaluating practical applications for improving patient care. SLIT has recently been introduced and become widely available for allergic rhinitis treatment in Korea. We previously published our experiences with SLIT and its use in allergic rhinitis patients sensitized to house dust mites. As evidence continues to accumulate, the validity of SLIT as one of the initial treatment options for allergic rhinitis is now becoming more widely accepted.