Sublingual Immunotherapy May Be Useful for Asthma, Allergies

Troy Brown

March 26, 2013

A systematic review of 63 studies with 5131 participants found moderate support for sublingual immunotherapy for the treatment of allergic rhinitis and asthma.

Sandra Y. Lin, MD, an associate professor of otolaryngology–head and neck surgery at Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues published their findings March 27 in JAMA.

"We found that the evidence is of moderate strength overall and it supports the position that aqueous sublingual immunotherapy is associated with improvement in allergic rhinitis and asthma outcomes," the authors write.

The researchers searched the databases of MEDLINE, Embase, LILACS, and the Cochrane Central Register of Controlled Trials through December 22, 2012. They identified 63 randomized, controlled trials with 5131 participants aged 4 to 74 years. Of those trials, 26 (41%) studied adults only, 17 (27%) enrolled both adults and children, and 20 (32%) studied children only.

The comparator groups studied were placebo (46 studies; 73%), a different sublingual intervention without a placebo group (9 studies; 14%), and conventional pharmacotherapy treatment without placebo (8 studies; 13%).

The risk for bias was low in 13 studies (21%), medium in 43 studies (68%), and high in 7 studies (11%).

The investigators found that the evidence was strong in support of the use of sublingual immunotherapy for the control of asthma symptoms; 8 of 13 studies reported greater than 40% improvement vs the comparator.

The evidence was moderate in support of the use of sublingual immunotherapy for the control of rhinitis or rhinoconjunctivitis symptoms; 9 of 36 studies reported greater than 40% improvement vs the comparator.

The evidence was moderate in support of the use of sublingual immunotherapy for decreasing medication use, with a greater than 40% decrease in medication use in 16 of 41 studies.

The evidence was moderate in support of the use of sublingual immunotherapy to improve conjunctivitis symptoms (13 studies), combined symptom and medication scores (20 studies), and disease-specific quality of life (8 studies).

The evidence strength was similar in studies of children (younger than 18 years).

Local reactions were more common in patients receiving sublingual immunotherapy (range, 0.2% - 97%) than in those in the comparator groups (range, 3% - 38.5%), but there were no reports of anaphylaxis, life-threatening reactions, or death in any treated patients across studies.

Robert Bush, MD, professor emeritus of medicine in the Section of Allergy and Immunology at the University of Wisconsin in Madison, commented on the study in an email interview with Medscape Medical News.

"This paper updates the previous Cochrane meta-analysis and appears to strengthen the data regarding the efficacy and safety of [sublingual immunotherapy] by adding recent studies," Dr. Bush said. Dr. Bush was not involved with the study.

"While the article is generally supportive of the potential use of [sublingual immunotherapy] as being efficacious and relatively safe, it is important to remember that [sublingual immunotherapy] has yet to gain FDA approval for the vaccines. Further research is needed to establish standardized dosing, and FDA approval will be necessary before [sublingual immunotherapy] is considered as a part of clinical practice," Dr. Bush explained.

Dr. Lin has served as a consultant to Wellpoint. The other study authors have disclosed no relevant financial relationships. Dr. Bush has disclosed no relevant financial relationships.

JAMA. 2013;309:1278-1288.

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