Sublingual Immunotherapy for Allergic Rhinitis and Conjunctivitis

Abstract

Sublingual immunotherapy (SLIT) for allergic respiratory diseases was first described in 1986 and immediately appeared as a viable alternative to the traditional subcutaneous route. Since then, more than 60 randomized controlled trials have been published, almost all with very favorable results. The average improvement over placebo in symptom score and medication use was always greater than 20%. The results of the clinical trials were pooled in several meta-analyses, which consistently confirmed the efficacy of the treatment. SLIT is characterized by a satisfactory safety profile, its side effects being mainly limited to oral discomfort. Only six anaphylaxes and no fatalities have been so far reported. Due to the good risk:benefit ratio, SLIT is currently being investigated in diseases other than respiratory allergy, such as food allergy and atopic dermatitis.

Potential Involvement of Type I Interferon Signaling in Immunotherapy in Seasonal Allergic Rhinitis

“…Clinically, all of the patients in our study experienced improvement of their symptoms after the first and second years of treatment, based on evaluation by the same physician, which agrees with previous studies [13, 14]. In order to more comprehensively examine gene expression changes, we performed expression profiling studies of four healthy control and four paired patient samples, taken before and after one year of SLIT.…”

Dendritic Cells in the Periphery Control Antigen-Specific Natural and Induced Regulatory T Cells

“…Antigen administration through the oral cavity, such as sublingual (s.l.) immunotherapy, is employed to treat respiratory allergy and allergic rhinitis and conjunctivitis (Moingeon and Mascarell, 2012; Passalacqua et al, 2013). However, the mechanisms by which tolerance versus immunity are regulated in the oral cavity are unclear at present.…”

“…administered antigen and ferries it into the draining lymph nodes where both migratory CD8 − DCs and resident CD8 + DCs prime the CD4 response (Song et al, 2009). S.l.-administered protein antigens are captured by DCs and are rapidly recruited to draining lymph nodes within 12–24 h, and the regulatory mechanisms established within 2–5 days in draining lymph nodes (Passalacqua et al, 2013). Both Foxp3 + T-regs and IL-10 producing Tr1 type T-regs are induced upon s.l.…”

Animal Models of Immunity to Female Genital Tract Infections and Vaccine Development

“…Our own studies show that SLI with rMOMP and CTA1-DD protects mice against hydrosalpinx and oviduct inflammation (O'Meara et al, 2014). Clinical trials of SLI with Bactek ® , a polyvalent bacterial vaccine, was well tolerated in patients and reduced the incidence of recurrent respiratory infections (Alecsandru et al, 2011), and sublingual delivery of allergens to induce tolerance and reduce allergies (sublingual immunotherapy; Passalacqua and Canonica, 2011;Passalacqua et al, 2013) is also well accepted in humans. Collectively, these data suggest that SLI is safe in humans and able to target multiple mucosal sites, including the genital tract.…”