Evidence and Practicalities of Aqueous Sublingual Immunotherapy, Tablet Sublingual Immunotherapy, and Oral Mucosal Immunotherapy for Allergic Rhinitis and Allergic Asthma

Abstract

Allergen immunotherapy (AIT) is the only disease-modifying treatment for allergic rhinitis (AR). Multiple modalities of AIT dosed via sublingual or oral routes are becoming available. This review discusses current evidence and practicalities of aqueous and tablet sublingual immunotherapy (SLIT) and oral mucosal immunotherapy (OMIT) in the treatment of AR and allergic asthma. Several large-scale studies demonstrate the efficacy and safety of SLIT. These studies have led to the United States Food and Drug Administration (USFDA) approval of tablet SLIT against grass, ragweed, and house dust mites (HDM). However, off-label use of aqueous SLIT is still practiced as a safe and effective alternative in polysensitized patients. Growing evidence suggests a role for SLIT in patients with allergic asthma. The literature supports the efficacy and safety of aqueous and tablet SLIT for AR, while some controversy remains over the utility of SLIT for allergic asthma. OMIT is currently in the early stages of development.