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Objective: Sublingual immunotherapy (SLIT) appears to offer practical advantages for the treatment of allergic rhinitis (AR). Based on a review of the scientific literature, we present recommendations as guiding principles to administer SLIT safely.Methods: Clinical questions concerning SLIT were prepared. Literature published between January 2003 and December 2012 was searched from PubMed, the Cochrane Library, and Japana Centra Revuo Medicina. Qualified studies were analyzed and the results were evaluated, consolidated, and codified. We answered 17 clinical questions and, based on this, presented evidence-based recommendations.Results: Sublingual immunotherapy improved symptoms (e.g., quality of life [QOL]) and reduced medication scores in seasonal AR and perennial AR. Most SLIT-induced adverse effects were local oral reactions, although systemic adverse effects such as gastrointestinal symptoms, urticaria, and asthma are occasionally reported. There have been no reports of lethal anaphylactic reactions by SLIT. When SLIT is continued for 3-4 years, its effect persists long after discontinuation.Conclusion: A correct diagnosis of AR and sufficient informed consent from patients are required before initiating SLIT. Sublingual immunotherapy should be continued for 3 years or longer. The initial administration of SLIT during the uptitration of an allergen vaccine and the general condition of patients are critical for the safe performance of SLIT. [ABSTRACT FROM AUTHOR]

Abstract: Objective: In anticipation of the development of guidelines for antigen-specific subcutaneous immunotherapy (SCIT), we present recommendations that can serve as guiding principles based on a review of the scientific literature. Methods: Clinical questions (CQs) concerning SCIT were prepared. Literature searches for publications between January 1990 and February 2011 were performed in PubMed, the Cochrane Library, and Japana Centra Revuo Medicina Web version 4. Qualified studies were analyzed and the results were evaluated, consolidated, and codified. Results: We present answers for 13 CQs on the indications, methods, effectiveness and mechanisms of SCIT, with evidence-based recommendations. Conclusion: The guiding principles are intended to be applied to children (≤15 years old) and adults (≥16 years old) with allergic rhinitis (AR). These principles can be used by otorhinolaryngologists for diagnosis of AR, evaluation of severity and rhinoscopic findings, performance of antigen challenge tests, and management of systemic anaphylactic reactions associated with SCIT. [Copyright &y& Elsevier]

Immunotherapy is not generally used in Japan and very few medical institutions perform it. For radical treatment, immunotherapy should be selected. However, subcutaneous immunotherapy has not yet gained acceptance. Japanese cedar pollinosis is a seasonal allergic rhinitis that is indigenous to Japan and occurs with a nationwide mean prevalence of 25%. Clinical research on sublingual immunotherapy for Japanese cedar pollinosis has made progress and it should come into practical use within 2-3 years. If sublingual immunotherapy becomes practical, it should provide a new treatment option for Japanese cedar pollinosis. [ABSTRACT FROM AUTHOR]

Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are the 2 forms of desensitization for allergic diseases which are used internationally. Despite the lack of sufficient evidence of the mechanism, SCIT has been used in Japan. When SCIT is performed appropriately, it is effective for allergic rhinitis, as supported by high-level evidence, including the results of meta-analysis. However, its use in Japan has not become widespread due to various problems, including the risk of anaphylaxis. Therefore, attention is being focused on SLIT because it is easier to perform but may be similarly effective and has been extensively discussed and evaluated internationally. Comparison of SCIT and SLIT can only be done with some allergen, which has also been discussed extenesively. Many patients and physicians would welcome the use of SLIT in Japan, and its first use against pollinosis due to Japanese cedar pollen is planned for 2014. [ABSTRACT FROM AUTHOR]

Allergen immunotherapy (AIT) is a specific treatment involving the administration of relevant allergens to allergic patients, with subtypes including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). In asthma, AIT using the house dust mite (HDM) alleviates clinical symptoms and decreases airway hyper responsiveness and medication dose. In addition, AIT can improve the natural course of asthma. For example, the effects of AIT can be preserved for at least a few years, even after ending treatment. AIT may increase the remission rate of asthma in children and suppress sensitization to new allergens. If AIT is introduced in pollinosis, AIT may prevent the development of asthma. Moreover, AIT can control other allergic diseases complicated by asthma, such as allergic rhinitis, which also improves the control of asthma. The indication of HDM-SCIT for asthma is mild-to-moderate HDM-sensitized allergic asthma in a patient with normal respiratory function. To date, HDM-SLIT is applicable in Japan for allergic rhinitis, not for asthma. However, the effect of SLIT on asthma has been confirmed internationally, and SLIT is available for asthma in Japan if allergic rhinitis is present as a complication. [ABSTRACT FROM AUTHOR]

Background: Recently, subcutaneous immunotherapy (SCIT) has not been performed very much in our country. We investigated SCIT for allergic rhinitis in our hospital for the past 17 years., Methods: Subjects were 188 cases who started SCIT by rush method under hospitalization. We investigated the patient background, laboratory findings, side reactions from their medical records and carried out questionnaire survey about effects and satisfaction to patients and their guardians., Results: The median age at start was 10 years 4 months. Cedar pollen was the most common allergen used in treatment followed by mite, and two or more allergens were used in 85% patients. Five percent of patients dropped out. Medication score decreased significantly after SCIT, and 45% had become free from medication. Systemic adverse reaction was observed in 117 of the 5,954 injections (2%) during the rapid phase and in 10 of the 5,567 injections (0.2%) during the maintenance phase, and all episodes disappeared immediately. Symptom score significantly decreased after SCIT, the effects being similar even after 3 years of cessation of SCIT., Conclusion: SCIT was effective for allergic rhinitis in childhood. The effect lasted after treatment cessation for a long term and the patient satisfaction was very high. There are some advantages of SCIT that sublingual immunotherapy does not have. SCIT should be considered as a choice for the treatment of allergic rhinitis in childhood.