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Sublingual Immunotherapy is a form of immunotherapy that involves placing the allergen extract under the tongue. An allergist gives patient small doses of an allergen under the tongue to boost the tolerance to the substance and reduce its symptoms. At present, the only forms of SLIT approved by the FDA are tablets for ragweed, northern pasture grasses like timothy, and dust mites. The safety and efficacy of allergy drops is yet being established by the FDA, and they are only used without label in the United States. The possible advantages of sublingual treatment are those of no use of injections, comparatively few regular doctor visits, possibility of home dosing after the first treatment, also a lower risk of serious reactions. Parents of young children often prefer sublingual immunotherapy as their child does not have to have regular injections. The main disadvantage of this form of treatment is its cost as more allergen needs to be swallowed than injected, this results in the cost per allergen being more expensive than that of injected treatments. [ABSTRACT FROM AUTHOR]

Background Estimates of the prevalence of allergic rhinitis in the United States range from 20% to 40%. Allergen-specific immunotherapy (SIT) is typically recommended for patients with allergic rhinitis who fail medical treatment, desire an alternative to pharmacotherapy, or would like to pursue therapy that can potentially change the natural history of the disease. Sublingual immunotherapy (SLIT) involves dosing the allergen under the tongue of the sensitized individual in controlled amounts, frequently, over a period of several years, in order to increase immunologic tolerance and diminish symptoms to that allergen. The U.S. Food and Drug Administration (FDA) approved the use of SLIT tablets in 2014, whereas the use of aqueous SLIT by U.S. practitioners is considered an 'off-label' use. Methods This study is a review of published English language scientific literature, focusing on systematic reviews and randomized controlled trials of SLIT for inhalant allergic rhinitis. Results SLIT is a safe and effective immune modulating treatment that decreases symptoms and medication use for allergic rhinitis. Further study is needed to determine the relative effectiveness of SLIT compared to subcutaneous immunotherapy, the role of multiple-allergen vs single-allergen SLIT, the use of SLIT in special populations (pregnancy, patients taking beta-blockers), and optimal dosing of U.S. products. Conclusion SLIT is safe and effective, and offers a convenient alternative to injection immunotherapy for appropriate patients with allergic rhinitis. [ABSTRACT FROM AUTHOR]

Specific allergen immunotherapy has been practiced for allergic rhinoconjunctivitis for over 100 years and is the only treatment option that is disease modifying. In the USA, immunotherapy is usually administered via subcutaneous injection; this is the only route with a US FDA-approved formulation. There is growing interest in developing US-standardized formulations for the sublingual route, but up until recently there have been few US trials. Most of the experience with sublingual immunotherapy (SLIT) comes from Europe, where it is widely used and there is a large body of literature supporting its use. The purpose of this review is to summarize recent adult and pediatric clinical trials of SLIT in the USA. Most of the trials are for inhalant allergies, but there is some early work on SLIT as a novel therapy for food allergies. INSET: Key issues. [ABSTRACT FROM AUTHOR]

Background: Increasing interest in sublingual immunotherapy (SLIT) among practitioners and patients has resulted in numerous publications and clinical trials in recent years. With the clinical growth of SLIT, discussions of its efficacy, safety, and immunologic effects have intensified, as have comparisons to subcutaneous immunotherapy (SCIT). In the United States, SCIT has been the traditional form of immunotherapy for inhalant allergy and is the only immunotherapy method approved by the U.S. Food and Drug Administration at this time. The similarities and differences between SLIT and SCIT are often discussed, yet clinical studies directly comparing these immunotherapy methods are scarce. Methods: A literature review of specific issues and controversies between SLIT and SCIT for allergic rhinitis was conducted. Results: Safety, efficacy, and immunologic effects of these two immunotherapy techniques are reviewed. Conclusion: Unanswered questions relating to SLIT are examined. [ABSTRACT FROM AUTHOR]