Sublingual Immunotherapy for Allergic Rhinitis and Conjunctivitis

Giovanni Passalacqua; Valentina Garelli; Francesca Sclifò; Giorgio Walter Canonica

Disclosures

Immunotherapy. 2013;5(3):257-264. 

In This Article

Future Perspective

The very favorable safety profile of SLIT suggested new possible applications of the treatment, especially in conditions other than respiratory allergy. At least three exploratory studies used SLIT in food allergy, one with Pru p 3 (lipid transfer protein of peach), one with hazelnut extract and one with peanut.[72–74] All these trials reported positive results in terms of clinical efficacy and immunological effects. In addition, there is abundant literature regarding the efficacy of oral desensitization for cow milk allergy in children.[75] Latex allergy seems to be a promising field of application for SLIT since several trials with positive results have been published involving adults and children,[76] with only one completely negative study.[77] Due to the partial discrepancy of the results, latex allergy has not yet been accepted as an indication to SLIT, although standardized extracts are commercially available and used. The use of SLIT has also been proposed in the treatment of extrinsic atopic dermatitis. A double-blind study conducted in 30 children with mite allergy[78] reported a significant effect of SLIT in reducing the SCORAD in mild-to-moderate atopic eczema and a concomitant reduction in the need for rescue medications. Another pilot study showed that SLIT with honeybee venom reduces the diameter of large local reactions upon sting challenge.[79]

Other possible developments include the use of mucoadhesive substances that could improve the contact of allergenic extracts with the oral mucosa, resulting in an enhanced immunological effect, as shown in animal models.[80] The use of adjuvants (either bacterial or DNA-based) in association with SLIT seems to be a feasible and promising approach, as previously demonstrated with SCIT,[81] whereas, due to regulatory and marketing problems, the use of recombinant allergens seems likely in the more distant future.[82] Finally, since the oral mucosa (specifically the dendritic cells) is responsible for the presentation of the allergen to the immune system, there is currently a promising research field dedicated to the development of SLIT extracts in terms of molecular structure to optimize the interactions with APCs.[83]

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....