Sublingual immunotherapy: World Allergy Organization position paper 2013 update

doi:10.1186/1939-4551-7-6

. 2014 Mar 28;7(1):6.

doi: 10.1186/1939-4551-7-6.

Sublingual immunotherapy: World Allergy Organization position paper 2013 update

Giorgio Walter Canonica^#¹, Linda Cox^#², Ruby Pawankar^#³, Carlos E Baena-Cagnani⁴, Michael Blaiss⁵, Sergio Bonini⁶, Jean Bousquet⁷, Moises Calderón⁸, Enrico Compalati⁹, Stephen R Durham¹⁰, Roy Gerth van Wijk¹¹, Désirée Larenas-Linnemann¹², Harold Nelson¹³, Giovanni Passalacqua¹⁴, Oliver Pfaar¹⁵, Nelson Rosário¹⁶, Dermot Ryan¹⁷, Lanny Rosenwasser¹⁸, Peter Schmid-Grendelmeier¹⁹, Gianenrico Senna²⁰, Erkka Valovirta²¹, Hugo Van Bever²², Pakit Vichyanond²³, Ulrich Wahn²⁴, Osman Yusuf²⁵

Affiliations

¹ Respiratory and Allergy Clinic, DIMI-Department of Internal Medicine, University of Genoa, IRCCS Aou San Martino, Largo Rosanna Benzi 10, Genoa 1-16132, Italy.
² Department of Medicine, Nova Southeastern University, College of Osteopathic Medicine, Davie Florida, USA.
³ Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁴ Research Center for Respiratory Medicine (CIMER), Catholic University, Fundación LIBRA, Córdoba, Argentina.
⁵ Department of Pediatrics and Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁶ Department of Medicine, Second University of Naples, Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy.
⁷ Centre Hospitalier Regional Universitaire de Montpellier, Université de Montpellier, Montpellier, France.
⁸ Section of Allergy and Clinical Immunology, Imperial College of London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
⁹ Allergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa, Genova, Italy.
¹⁰ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College of London, London, UK.
¹¹ Department of Allergology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
¹² Allergy Department, Hospital Medica Sur, Mexico City, Mexico.
¹³ National Jewish Health, University of Colorado - Denver School of Medicine, Denver, Colorado, USA.
¹⁴ Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genova, Italy.
¹⁵ Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany.
¹⁶ Pediatric Allergy and Immunology Division, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil.
¹⁷ Academic Centre of Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
¹⁸ Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri.
¹⁹ Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland.
²⁰ Allergy Unit, Verona General Hospital, Verona, Italy.
²¹ Department of Clinical Allergology and Pulmonary Diseases, University of Turku, Finland, and Allergy Clinic, Terveystalo, Turku, Finland.
²² Department of Paediatrics, University Children's Medical Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²³ Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁴ Department of Pediatric Pneumology and Immunology, Charité, Humboldt University, Berlin, Germany.
²⁵ The Allergy and Asthma Institute, Islamabad, Pakistan.

^# Contributed equally.

PMID: 24679069
PMCID: PMC3983904
DOI: 10.1186/1939-4551-7-6

Sublingual immunotherapy: World Allergy Organization position paper 2013 update

Giorgio Walter Canonica et al. World Allergy Organ J. 2014.

. 2014 Mar 28;7(1):6.

doi: 10.1186/1939-4551-7-6.

Authors

Affiliations

¹ Respiratory and Allergy Clinic, DIMI-Department of Internal Medicine, University of Genoa, IRCCS Aou San Martino, Largo Rosanna Benzi 10, Genoa 1-16132, Italy.
² Department of Medicine, Nova Southeastern University, College of Osteopathic Medicine, Davie Florida, USA.
³ Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁴ Research Center for Respiratory Medicine (CIMER), Catholic University, Fundación LIBRA, Córdoba, Argentina.
⁵ Department of Pediatrics and Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁶ Department of Medicine, Second University of Naples, Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy.
⁷ Centre Hospitalier Regional Universitaire de Montpellier, Université de Montpellier, Montpellier, France.
⁸ Section of Allergy and Clinical Immunology, Imperial College of London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
⁹ Allergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa, Genova, Italy.
¹⁰ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College of London, London, UK.
¹¹ Department of Allergology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
¹² Allergy Department, Hospital Medica Sur, Mexico City, Mexico.
¹³ National Jewish Health, University of Colorado - Denver School of Medicine, Denver, Colorado, USA.
¹⁴ Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genova, Italy.
¹⁵ Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany.
¹⁶ Pediatric Allergy and Immunology Division, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil.
¹⁷ Academic Centre of Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
¹⁸ Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri.
¹⁹ Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland.
²⁰ Allergy Unit, Verona General Hospital, Verona, Italy.
²¹ Department of Clinical Allergology and Pulmonary Diseases, University of Turku, Finland, and Allergy Clinic, Terveystalo, Turku, Finland.
²² Department of Paediatrics, University Children's Medical Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²³ Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁴ Department of Pediatric Pneumology and Immunology, Charité, Humboldt University, Berlin, Germany.
²⁵ The Allergy and Asthma Institute, Islamabad, Pakistan.

^# Contributed equally.

PMID: 24679069
PMCID: PMC3983904
DOI: 10.1186/1939-4551-7-6

Abstract

We have prepared this document, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2013 Update", according to the evidence-based criteria, revising and updating chapters of the originally published paper, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2009", available at http://www.waojournal.org. Namely, these comprise: "Mechanisms of sublingual immunotherapy;" "Clinical efficacy of sublingual immunotherapy" - reporting all the data of all controlled trials published after 2009; "Safety of sublingual immunotherapy" - with the recently published Grading System for adverse reactions; "Impact of sublingual immunotherapy on the natural history of respiratory allergy" - with the relevant evidences published since 2009; "Efficacy of SLIT in children" - with detailed analysis of all the studies; "Definition of SLIT patient selection" - reporting the criteria for eligibility to sublingual immunotherapy; "The future of immunotherapy in the community care setting"; "Methodology of clinical trials according to the current scientific and regulatory standards"; and "Guideline development: from evidence-based medicine to patients' views" - including the evolution of the methods to make clinical recommendations.Additionally, we have added new chapters to cover a few emerging crucial topics: "Practical aspects of schedules and dosages and counseling for adherence" - which is crucial in clinical practice for all treatments; "Perspectives and new approaches" - including recombinant allergens, adjuvants, modified allergens, and the concept of validity of the single products. Furthermore, "Raising public awareness about sublingual immunotherapy", as a need for our patients, and strategies to increase awareness of allergen immunotherapy (AIT) among patients, the medical community, all healthcare stakeholders, and public opinion, are also reported in detail.

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Figures

**Figure 1**
The historical process leading to the WAO SLIT Position Paper 2009.

**Figure 2**
Highlights of the evidences in SLIT, from 2009 to 2013, the scientific basis for the updating of “Sublingual Immunotherapy: World Allergy Organization Position Paper 2009”.

**Figure 3**
Number of double-blind, placebo-controlled trials investigating SLIT up to June 2013.

**Figure 4**
The GRADE system: from clinical question to recommendation.

See this image and copyright information in PMC

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References

1. Radulovic S, Wilson D, Calderon M, Durham S. Systematic reviews of sublingual immunotherapy (SLIT) Allergy. 2011;7:740–752. doi: 10.1111/j.1398-9995.2011.02583.x. - DOI - PubMed
1. Calderon MA, Penagos M, Sheikh A, Canonica GW, Durham SR. Sublingual immunotherapy for allergic conjunctivitis: cochrane systematic review and meta-analysis. Clin Exp Allergy. 2011;7:1263–1272. doi: 10.1111/j.1365-2222.2011.03835.x. - DOI - PubMed
1. Didier A, Worm M, Horak F, Sussman G, de Beaumont O, Le Gall M, Melac M, Malling HJ. Sustained 3-year efficacy of pre- and coseasonal 5-grass-pollen sublingual immunotherapy tablets in patients with grass pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol. 2011;7:559–566. doi: 10.1016/j.jaci.2011.06.022. - DOI - PubMed
1. Durham SR, Emminger W, Kapp A, de Monchy JG, Rak S, Scadding GK, Wurtzen PA, Andersen JS, Tholstrup B, Riis B, Dahl R. SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol. 2012;7:717–725. doi: 10.1016/j.jaci.2011.12.973. e715. - DOI - PubMed
1. Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol. 2011;7:18–27. doi: 10.1016/j.jaci.2010.11.030. quiz 28-19. - DOI - PubMed

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[1] Radulovic S, Wilson D, Calderon M, Durham S. Systematic reviews of sublingual immunotherapy (SLIT) Allergy. 2011;7:740–752. doi: 10.1111/j.1398-9995.2011.02583.x. - DOI - PubMed

[2] Radulovic S, Wilson D, Calderon M, Durham S. Systematic reviews of sublingual immunotherapy (SLIT) Allergy. 2011;7:740–752. doi: 10.1111/j.1398-9995.2011.02583.x. - DOI - PubMed

[3] Calderon MA, Penagos M, Sheikh A, Canonica GW, Durham SR. Sublingual immunotherapy for allergic conjunctivitis: cochrane systematic review and meta-analysis. Clin Exp Allergy. 2011;7:1263–1272. doi: 10.1111/j.1365-2222.2011.03835.x. - DOI - PubMed

[4] Calderon MA, Penagos M, Sheikh A, Canonica GW, Durham SR. Sublingual immunotherapy for allergic conjunctivitis: cochrane systematic review and meta-analysis. Clin Exp Allergy. 2011;7:1263–1272. doi: 10.1111/j.1365-2222.2011.03835.x. - DOI - PubMed

[5] Didier A, Worm M, Horak F, Sussman G, de Beaumont O, Le Gall M, Melac M, Malling HJ. Sustained 3-year efficacy of pre- and coseasonal 5-grass-pollen sublingual immunotherapy tablets in patients with grass pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol. 2011;7:559–566. doi: 10.1016/j.jaci.2011.06.022. - DOI - PubMed

[6] Didier A, Worm M, Horak F, Sussman G, de Beaumont O, Le Gall M, Melac M, Malling HJ. Sustained 3-year efficacy of pre- and coseasonal 5-grass-pollen sublingual immunotherapy tablets in patients with grass pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol. 2011;7:559–566. doi: 10.1016/j.jaci.2011.06.022. - DOI - PubMed

[7] Durham SR, Emminger W, Kapp A, de Monchy JG, Rak S, Scadding GK, Wurtzen PA, Andersen JS, Tholstrup B, Riis B, Dahl R. SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol. 2012;7:717–725. doi: 10.1016/j.jaci.2011.12.973. e715. - DOI - PubMed

[8] Durham SR, Emminger W, Kapp A, de Monchy JG, Rak S, Scadding GK, Wurtzen PA, Andersen JS, Tholstrup B, Riis B, Dahl R. SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol. 2012;7:717–725. doi: 10.1016/j.jaci.2011.12.973. e715. - DOI - PubMed

[9] Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol. 2011;7:18–27. doi: 10.1016/j.jaci.2010.11.030. quiz 28-19. - DOI - PubMed

[10] Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol. 2011;7:18–27. doi: 10.1016/j.jaci.2010.11.030. quiz 28-19. - DOI - PubMed

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Sublingual immunotherapy: World Allergy Organization position paper 2013 update

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Sublingual immunotherapy: World Allergy Organization position paper 2013 update

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