Sublingual immunotherapy dosing

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... 

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. 

For all kinds of immunotherapy the question of dose is still discussed controversially. Is a single dose more relevant or a cumulative dose The single and cumulative sublingual immunotherapy (SLIT) doses applied in published studies are from 5-fold up to several 100-fold higher than in subcutaneous immunotherapy [1], Considering the possible mechanisms of immunotherapies, especially on the dendritic cell level, a balance of both might be expected to be the most convenient. All kinds of application produce a concentration gradient... 

In a double-blind, placebo-controUed study of sublingual latex immunotherapy (SLIT), 12 health-care workers with latex allergy were randomized [38. Two had anaphylactic reactions and one had severe bronchial obstruction during the dose-incremental phase and were excluded from the study. The symptom and provocation scores between baseline and the 12th month of treatment were significantly improved in the treated group. 

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