Coadministration of Sublingual Immunotherapy Tablets and Management of Potential Adverse Effects: Austrian, German, and Swiss Expert Recommendations

Sturm, Gunter J.; Vogelberg, Christian; Marchon, Miriam; Horn, Andreas; Vitzthum, Hans-Georg; Memar-Baschi, Marco-Parwis; Kleine‐Tebbe, Jörg

doi:10.1016/j.clinthera.2019.07.005

Cited by 2 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Proactive pretreatment with rupatadine was used in some of the presented cases to prevent LAR with SLIT-T restart in subsequent seasons or with initiation of a different SLIT-T. A history of LAR to SLIT-T was already established in these patients. An expert panel has recommended that the first administration of a SLIT-T should not be pretreated with antihistamine so that the patient’s reaction to the SLIT-T can be properly assessed by the managing allergist [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Data from clinical trials indicate that the LAR associated with SLIT-T generally resolve within 30 to 60 min and cease after 2 weeks [ 6 , 8 ]. In most cases, the LAR do not require medical intervention, but for some patients the LAR may be uncomfortable and lead to SLIT-T discontinuation early in treatment [ 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…1 ). Allergy expert panels suggest that H1 antihistamines can be used to treat or prevent LAR associated with SLIT-T [ 9 , 10 ]. However, no second-generation H1 antihistamines are approved for this indication, and no clinical trials have formally evaluated the impact of antihistamines on SLIT-T LAR.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

Ellis

Connors

Francoeur

et al. 2021

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

Background Sublingual immunotherapy tablets (SLIT-T) are an effective treatment for allergic rhinitis (AR), but some patients experience local allergic reactions (LAR) in the first few weeks of treatment that can lead to treatment discontinuation. Although oral antihistamines are recommended for the treatment and pretreatment of LAR associated with SLIT-T, there are no clinical trial data to support this recommendation. Rupatadine is an H1 antihistamine that also inhibits platelet activating factor activity. The objective of this case series is to describe real-world clinical situations in which rupatadine was used to treat or mitigate SLIT-T–related LAR. Case presentations Five cases are presented by the managing allergist and off-label use of rupatadine is their expert opinion only. Patients in all 5 cases were treated with a SLIT-T (e.g. ragweed, tree, grass, or house dust mites) for the management of allergic rhinitis and experienced bothersome LAR with the first SLIT-T administration. In 3 cases, rupatadine 10 mg was administered for the immediate treatment of LAR (either in-office with the first SLIT-T dose or for subsequent LAR experienced at home) and the symptoms resolved. In 3 cases, pretreatment with other second-generation H1 antihistamines was unable to prevent LAR and the patients discontinued the SLIT-T. In these 3 cases, switching to pretreatment with rupatadine allowed the patients to restart and tolerate SLIT-T treatment with minimal or no LAR. In these patients with an established history of LAR, proactive pretreatment with rupatadine in subsequent seasons or with initiation of a different SLIT-T mitigated the previously experienced LARs. Conclusions In the cases presented, treatment with rupatadine resolved LAR associated with SLIT-T treatment and rupatadine pretreatment appeared to mitigate subsequent LAR. Rupatadine may be an option to treat or improve the tolerability of the SLIT-T, potentially improving early treatment persistence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

Ellis

Connors

Francoeur

et al. 2021

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

show abstract

“…The LAR typically do not require medical intervention, but they may be uncomfortable enough in some subjects that they choose to discontinue the SLIT-tablet. [9][10][11] The discontinuation rate due to AEs in SLIT-tablet clinical trials is ≤7%. 9 The vestibular region (groove between the lower lip and gingiva of the inferior teeth) of the oral cavity contains higher numbers of tolerogenic T cells and dendritic cells, and expresses greater levels of anti-inflammatory cytokines and dendritic cell innate immune receptors (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Occasionally, severe LAR may occur. The LAR typically do not require medical intervention, but they may be uncomfortable enough in some subjects that they choose to discontinue the SLIT‐tablet 9‐11 . The discontinuation rate due to AEs in SLIT‐tablet clinical trials is ≤7% 9 …”

Section: Introductionmentioning

confidence: 99%

Tolerability of sublingual versus vestibular allergy immunotherapy tablet administration: A randomized pilot study

Simard,

Novak,

Drolet

et al. 2023

Clin Experimental Allergy

View full text Add to dashboard Cite

BackgroundLocal application site reactions are common with sublingual allergy immunotherapy (AIT)‐tablets for the treatment of allergic rhinitis/conjunctivitis (AR/C) and occasionally lead to treatment discontinuation. Because of the lower mast cell density in the vestibular mucosa than the sublingual area, vestibular AIT‐tablet administration may result in fewer adverse events (AEs). This pilot study evaluated the tolerability of the vestibular administration route of AIT‐tablets compared with the sublingual route in adult subjects with AR/C.MethodsAdults (n = 164) aged 18–65 years with AR/C treated with daily birch pollen, grass pollen, ragweed pollen or house dust mite AIT in tablet form were randomized 1:1 to vestibular or sublingual administration for 28 days, followed by 28 days of sublingual administration only. The primary endpoint was the severity (mild, moderate, severe) of local treatment‐related adverse events (TRAEs) during the first 28 days of treatment.ResultsDuring the first 28 days, the percentage of subjects in the vestibular and sublingual groups reporting mild TRAEs were 55.6% versus 50.6%, respectively; moderate TRAEs were 27.2% versus 30.1%; and severe TRAEs were 12.3% versus 6.0% (p = .16). In the vestibular group, 95.1% of the subjects experienced at least one TRAE during the first period versus 81.9% in the sublingual group (p = .01) and discontinuation rates due to AEs were higher (12.3% vs. 3.6%).ConclusionThe frequencies of subjects experiencing severe TRAEs, at least one TRAE, and discontinuations due to AEs at the initiation of AIT‐tablets were numerically higher with vestibular administration than sublingual administration. Sublingual administration should remain the standard of care for subjects treated with AIT‐tablets for AR/C.

show abstract

Coadministration of Sublingual Immunotherapy Tablets and Management of Potential Adverse Effects: Austrian, German, and Swiss Expert Recommendations

Cited by 2 publications

References 30 publications

Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

Tolerability of sublingual versus vestibular allergy immunotherapy tablet administration: A randomized pilot study

Contact Info

Product

Resources

About