Sublingual immunotherapy

Some patients experience discomfort and frequent swelling at the site of injection. As a consequence, sublingual immunotherapy has been explored in Europe. An extract of allergens is placed under the tongue for a couple of minutes and is then swallowed. The dose for sublingual immunotherapy is 3-300 times greater than that for subcutaneous immunotherapy. This form of therapy is more effective for 

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Pajno GB, Caminiti L, Vita D, Barberio G, Salzano G, Lombardo F, Canonica GW, Passalacqua G Sublingual immunotherapy in mite-sensitized children with atopic dermatitis a randomized, double-blind, placebo-con-trolled study. J Allergy Clin Immunol 2007 120 164-170. 

Bohle B, Kinaciyan T, Gerstmayr M, Radakovics A, Jahn-Schmid B, Ebner C Sublingual immunotherapy induces IL-lO-producing T regulatory ceUs, allergen-specific T-ceU tolerance, and immune deviation. J Allergy Clin Immunol 2007 120 707-713. ... 

Roder E, Berger MY, Hop WC, Bernsen RM, de Groot H, Gerth van Wijk R. Sublingual immunotherapy with grass pollen is not effective in symptomatic youngsters in primary care. J Allergy Clin Immunol 2007 119(4) 892-8. [Epub 2007 Feb 23]. 

Wilson DR, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis systematic review and meta-analysis. Allergy 2005 60(1) 4-12. Review. 

Specific immunotherapy is a very powerful tool which is currently underutilized in the treatment of allergies. Sublingual immunotherapy (SLIT) has many advantages over subcutaneous immunotherapy (SCIT), and has been well proven to work for many pollens and dust mites. Multiple studies have shown SLIT improves symptoms and reduces the reliance on medications. Sublingual treatment has been studied in Europe and is endorsed by the World Health Organization Committee on Immunotherapy as a viable alternative to SCIT. 

Conclusion SLIT offers another option for patients who are not currently candidates for subcutaneous immunotherapy. Because of improved safety, convenience and compliance, sublingual immunotherapy should be used as a first-line treatment option. 

European baseline SCIT dosage is lower than the US (this may account for some of the variability and higher ratios). SLIT/SCIT ratio = Sublingual immunotherapy monthly maintenance dose/subcutaneous monthly maintenance dose IR = index of reactivity N/A = not available ssx = symptom scores NC = no change meds = medication use ID = intradermal NS = not significant. 

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The advent of oral/sublingual immunotherapy has redirected interest towards resorption of allergens from the oral mucosa. The resorption of small nonprotein molecules such as ethanol and nitro preparations from the oral mucosa is well known and the latter is arguably one of the most frequently used pharmacological interventions in clinical medicine. However, Passalacqua (fig. 6) was the first to demonstrate resorption of allergens from the oral and nasal mucosa. Parietaria antigen marked with radioactive iodine... 

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Frew AJ, Smith HE Sublingual immunotherapy. J Allergy Clin Immunol 2001 107 441-444. 

Therapeutic Procedures of Sublingual Immunotherapy in Clinical Practice... 

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