Synonym(s)
Immunotherapy sublingual; sublingual hyposensitization; Sublingual immunotherapy
DefinitionThis section has been translated automatically.
Firmly established (not uncontroversial) procedure of specific immunotherapy (see guidelines for the practical implementation of specific immunotherapy of the German Society for Allergology and Immunology [DGAK]), in which allergens are applied in drop or tablet form exclusively sublingually. The desired effect is achieved by absorption of the allergens through the oral mucosa.
General definitionThis section has been translated automatically.
The results of SLIT do not match the results of subcutaneous immunotherapy. Long-term studies in 60 children showed a significant reduction in asthma and drug use even 5 years after SLIT was discontinued. There are no comparative studies between sublingual immunotherapy and subcutaneous immunotherapy. Questions about the optimal allergen dose (effective allergen concentration between 3-5 times (!) to 375 times (!) the allergen concentration in SCIT), the mechanism of action and the suitable clientele remain open.
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EffectsThis section has been translated automatically.
The exact immunological mechanism of action is currently not known. A decrease of IgE as well as an increase of IgG1 and IgG4 as in SCIT does not seem to occur. Decisive for the effectiveness is probably the contact of the allergen with the oral mucosa.
IndicationThis section has been translated automatically.
According to the indications for specific immunotherapy (hyposensitization):
- Patients suffering from pollen (see below pollinosis) - or house dust mite allergy.
- Patients who do not respond sufficiently to symptomatic drugs.
- Patients with systemic reactions to subcutaneous specific immunotherapy.
- Patients who strictly refuse subcutaneous specific immunotherapy.
ImplementationThis section has been translated automatically.
- The allergen extract in drop form is administered in increasing doses. It is kept in the mouth for a defined time and then ejected ex ore. In the case of the grass allergen tablet (e.g. GRAZAX), the lyophilisate disintegrates under the tongue within a few minutes without leaving any residue. This allows very high local allergen concentrations to be achieved - possibly an important prerequisite for achieving a good effect.
- A well-tolerated ultra-rush procedure is described in which the allergen is increased over 2 hours in 30-minute intervals until the maintenance dose is reached. This dose is then continued as a maintenance dose (e.g. during the entire pollen season).
- In a double-blind dose-finding study with a monomeric grass pollen allergoid at doses of 300,600,1000 and 2000 UA once/day for 12 weeks, 76.7% of the 1000 UA group showed a relevant decrease in clinical symptoms. >50% of the patients showed no more conjunctival provocation after the end of therapy (84 days) (Mösges R et al. 2017)
Undesirable effectsThis section has been translated automatically.
Severe ADRs are not known. Slight to moderate local reactions. Other adverse events such as headache or rhinorrhoea are not more frequent than with placebo.
ContraindicationThis section has been translated automatically.
S.u. immunotherapy, specific.
Complication(s)This section has been translated automatically.
S.u. immunotherapy, specific.
PreparationsThis section has been translated automatically.
Pangramine SLIT, TOL SL, Sublivac B.E.S.T., Staloral 300, Oralvac plus, GRAZAX (lattice tablet from a lyophilized pollen extract of timothy grass; approved throughout Europe), Oralair (solid tablet with 5 grass allergens)
Note(s)This section has been translated automatically.
Naturopathic: Plant extracts from Astragalus membranaceus (Allavent) seem to reduce the hypersensitivity of the immune system to pollen.
LiteratureThis section has been translated automatically.
- Bousquet J et al (1999) Sublingual-swallow immunotherapy (SLIT) in patients with asthma due to house-dust mites: a double-blind, placebo-controlled study. Allergy 54: 249-260
- Canonica GW et al (2003) Noninjection routes for immunotherapy. J Allergy Clin Immunol 111: 437-448
- Dahl R et al (2006) Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 118: 434-440
- Marogna M et al (2007) Long-lasting effects of sublingual immunotherapy for house dust mites in allergic rhinitis with bronchial hyperreactivity: A long-term (13-year) retrospective study in real life. Int Arch Allergy Immunol 142: 70-78
- Mösges R et al (2017) Dose-finding study of carbamylated monomeric allergoid tablets in grass-allergicrhinoconjunctivitis
patients. Immunotherapy 9:1225-1238. - Mortemousque B et al (2003) House-dust mite sublingual-swallow immunotherapy in perennial conjunctivitis: a double-blind, placebo-controlled study. Clin Exp Allergy 33: 464-469
- Nelson HS et al (2003) Advances in upper airway diseases and allergen immunotherapy. J Allergy Clin Immunol 111 (3 Suppl): S793-798
- Silvestri M et al (2002) Changes in inflammatory and clinical parameters and in bronchial hyperreactivity asthmatic children sensitized to house dust mites following sublingual immunotherapy. J Investig Allergol Clin Immunol 12: 52-59
Prof. Dr. med. Peter Altmeyer