Is Sublingual Immunotherapy the Best Option for Seasonal Allergies?

While sublingual grass pollen tablets offer small benefits to patients with seasonal allergic rhinoconjunctivitis (SARC), overall, the benefits may not be large enough to outweigh the risk of adverse effects while using the medication, according to a recent study.

While previous data has shown sublingual immunotherapy (SI) to be less effective than subcutaneous immunotherapy, SI remains the most commonly prescribed treatment for SARC in Europe, and was approved by the FDA in the United States in April 2014.
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In order to assess the efficacy and safety of grass pollen SI, researchers conducted a meta-analysis of randomized clinical trails comparing grass pollen ST tablets against placebo, with a primary endopoint of the difference in symptom score and medication use between ST and placebo.

Overall, researchers pooled data on symptom scores from 13 trials (4659 participants) and medication use from 12 trials (4558 participants).

While all trials showed minor benefits in symptom alleviation with ST, 6 of the 13 studies showed no greater improvement with SI over that seen with placebo, and only 7 of the 12 studies with data on medication showed that those undergoing ST decreased their use of other allergy medications.

Further, adverse events including mouth itching or burning or gastrointestinal tract symptoms were reported in 61.3% of participants taking SI, compared to 21% in the placebo group, and 7 participants in the SI group reported serious allergic reactions requiring epinephrine.

“Considering the low magnitude of the benefit, the convenience and easy administration do not seem to be sufficient reasons for the choice of SLIT,” they concluded.

—Michael Potts

Reference:

Di Bona D, Plaia A, Leto-Barone MS, et al. Efficacy of grass pollen allergen sublingual immunotherapy tablets for seasonal allergic rhinoconjunctivitis: a systematic review and meta-analysis. JAMA Intern Med. July 2015 [epub ahead of print]. doi:10.1001/jamainternmed.2015.2840.