Sublingual immunotherapy for allergic rhinitis and conjunctivitis

Allergy & Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Padiglione Maragliano, L.go R. Benzi 10, 16132 Genoa, Italy.
Immunotherapy (Impact Factor: 2.07). 03/2013; 5(3):257-64. DOI: 10.2217/imt.12.157
Source: PubMed


Sublingual immunotherapy (SLIT) for allergic respiratory diseases was first described in 1986 and immediately appeared as a viable alternative to the traditional subcutaneous route. Since then, more than 60 randomized controlled trials have been published, almost all with very favorable results. The average improvement over placebo in symptom score and medication use was always greater than 20%. The results of the clinical trials were pooled in several meta-analyses, which consistently confirmed the efficacy of the treatment. SLIT is characterized by a satisfactory safety profile, its side effects being mainly limited to oral discomfort. Only six anaphylaxes and no fatalities have been so far reported. Due to the good risk:benefit ratio, SLIT is currently being investigated in diseases other than respiratory allergy, such as food allergy and atopic dermatitis.

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    • "Traditionally, AIT has been administered via the subcutaneous route; this involves the inconvenience of frequent injections and is associated with a low but nonnegligible risk of potentially severe, systemic anaphylactic reactions [3]. Over the last few decades, alternative administration routes (such as the sublingual route) have been developed with a view to limiting discomfort and mitigating risk [4]. There is now substantial and growing use of sublingual immunotherapy (SLIT) in Europe and the USA [1] [2] [5]. "
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    ABSTRACT: . Although the safety and efficacy of sublingual immunotherapy (SLIT) with a five-grass pollen tablet have been demonstrated in randomized clinical trials (RCTs), these outcomes must always be evaluated in real-life medical practice. Methods . In a prospective, open-label, noninterventional, “real-life” study in Germany, we evaluated the safety, tolerability, and effectiveness of SLIT with a five-grass pollen tablet in adults with grass-pollen-induced allergic rhinoconjunctivitis. Results . 808 adults were enrolled between September 2008 and December 2009. 35.3% of the participants experienced at least one adverse drug reaction (ADR), the most common of which were mild-to-moderate gastrointestinal and respiratory disorders. Serious ADRs considered causally related to SLIT treatment occurred in four patients. Overall, the five-grass pollen tablet was considered to have good or very good tolerability by most investigators and patients. Treatment was associated with the relief of nasal, ocular, and bronchial symptoms and decreased symptomatic medication use. However, interpretation of clinical improvements was limited by lower atmospheric grass pollen levels during the study season (relative to the preceding season). Conclusions . In a large population of patients treated in real-life medical practice, SLIT with a five-grass pollen tablet was safe and well tolerated. The patient-reported symptom relief suggests that SLIT was associated with clinical benefits.
    Full-text · Article · Sep 2015
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    • "administered antigen and ferries it into the draining lymph nodes where both migratory CD8− DCs and resident CD8+DCs prime the CD4 response (Song et al., 2009). S.l.-administered protein antigens are captured by DCs and are rapidly recruited to draining lymph nodes within 12–24 h, and the regulatory mechanisms established within 2–5 days in draining lymph nodes (Passalacqua et al., 2013). Both Foxp3+ T-regs and IL-10 producing Tr1 type T-regs are induced upon s.l. "
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    ABSTRACT: Dendritic cells (DCs) are specialized antigen-presenting cells that regulate both immunity and tolerance. DCs in the periphery play a key role in expanding naturally occurring Foxp3(+) CD25(+) CD4(+) regulatory T cells (Natural T-regs) and inducing Foxp3 expression (Induced T-regs) in Foxp3(-) CD4(+) T cells. DCs are phenotypically and functionally heterogeneous, and further classified into several subsets depending on distinct marker expression and their location. Recent findings indicate the presence of specialized DC subsets that act to expand Natural T-regs or induce Foxp3(+) T-regs from Foxp3(-) CD4(+) T cells. For example, two major subsets of DCs in lymphoid organs act differentially in inducing Foxp3(+) T-regs from Foxp3(-) cells or expanding Natural T-regs with model-antigen delivery by anti-DC subset monoclonal antibodies in vivo. Furthermore, DCs expressing CD103 in the intestine induce Foxp3(+) T-regs from Foxp3(-) CD4(+) T cells with endogenous TGF-β and retinoic acid. In addition, antigen-presenting DCs have a capacity to generate Foxp3(+) T-regs in the oral cavity where many antigens and commensals exist, similar to intestine and skin. In skin and skin-draining lymph nodes, at least six DC subsets have been identified, suggesting a complex DC-T-reg network. Here, we will review the specific activity of DCs in expanding Natural T-regs and inducing Foxp3(+) T-regs from Foxp3(-) precursors, and further discuss the critical function of DCs in maintaining tolerance at various locations including skin and oral cavity.
    Full-text · Article · Jun 2013 · Frontiers in Immunology

  • No preview · Article · Dec 2013 · DMW - Deutsche Medizinische Wochenschrift
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