Sublingual immunotherapy: current concepts for the U.S. practitioner

Int Forum Allergy Rhinol. 2014 Sep;4 Suppl 2:S55-9. doi: 10.1002/alr.21388.


Background: Estimates of the prevalence of allergic rhinitis in the United States range from 20% to 40%. Allergen-specific immunotherapy (SIT) is typically recommended for patients with allergic rhinitis who fail medical treatment, desire an alternative to pharmacotherapy, or would like to pursue therapy that can potentially change the natural history of the disease. Sublingual immunotherapy (SLIT) involves dosing the allergen under the tongue of the sensitized individual in controlled amounts, frequently, over a period of several years, in order to increase immunologic tolerance and diminish symptoms to that allergen. The U.S. Food and Drug Administration (FDA) approved the use of SLIT tablets in 2014, whereas the use of aqueous SLIT by U.S. practitioners is considered an "off-label" use.

Methods: This study is a review of published English language scientific literature, focusing on systematic reviews and randomized controlled trials of SLIT for inhalant allergic rhinitis.

Results: SLIT is a safe and effective immune modulating treatment that decreases symptoms and medication use for allergic rhinitis. Further study is needed to determine the relative effectiveness of SLIT compared to subcutaneous immunotherapy, the role of multiple-allergen vs single-allergen SLIT, the use of SLIT in special populations (pregnancy, patients taking beta-blockers), and optimal dosing of U.S. products.

Conclusion: SLIT is safe and effective, and offers a convenient alternative to injection immunotherapy for appropriate patients with allergic rhinitis.

Keywords: allergy desensitization; allergy immunotherapy; oral immunotherapy; specific immunotherapy; sublingual immunotherapy.

Publication types

  • Review

MeSH terms

  • Humans
  • Physicians
  • Rhinitis, Allergic / immunology
  • Rhinitis, Allergic / therapy*
  • Sublingual Immunotherapy* / adverse effects
  • Treatment Outcome
  • United States