Sublingual or subcutaneous immunotherapy for allergic rhinitis?
Abstract
Allergen immunotherapy is effective in patients with allergic rhinitis (AR) and, unlike antiallergic drugs, has been shown to modify the underlying cause of the disease, with proved long-term benefits. Subcutaneous immunotherapy (SCIT) has been the gold standard, whereas sublingual immunotherapy (SLIT) has emerged as an effective and safe alternative. Previous Cochrane systematic reviews and meta-analyses have confirmed that both SLIT and SCIT are effective in patients with seasonal AR, whereas evidence for their efficacy in patients with perennial disease has been less convincing. Recent large, adequately powered trials have demonstrated reductions in both symptoms and use of rescue medication in patients with seasonal and those with perennial AR. Here we appraise evidence for SCIT versus SLIT based on indirect evidence from Cochrane reviews and recent well-powered double-blind, randomized controlled trials versus placebo and the limited direct evidence available from randomized blind head-to-head comparisons. At present, based on an overall balance of efficacy and side effects, the patient is in equipoise. Pending definitive comparative trials, choice might be determined largely by the local availability of SCIT and SLIT products of proved value and personal (patient) preference.
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Specific data on nasal obstruction are not usually published in systematic reviews and meta-analyses of subcutaneous and sublingual immunotherapy.
“Total symptom score is the main variable in systematic reviews and meta-analyses, both in SCIT [172] and in SLIT in drops [173] or in tablets [174]; therefore, specific data on NO are not usually published [171].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [171]
Subcutaneous immunotherapy and sublingual immunotherapy are effective in reducing symptoms, including nasal obstruction, of seasonal and perennial allergic rhinitis.
“Both subcutaneous immunotherapy (SCIT) [168] and sublingual immunotherapy (SLIT) [169,170] have proven effective in reducing the symptoms (including NO) of seasonal and perennial AR [171].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [171]
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Scadding, G. W., Calderon, M. A., Shamji, M. H., Eifan, A. O., Penagos, M., Dumitru, F., Sever, M. L., Bahnson, H. T., Lawson, K., Harris, K. M., et al. (2017) · JAMA · doi:10.1001/jama.2016.21040 · Cited by 229 · see citing works
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- Authors
- Durham, S. R., & Penagos, M.
- Affiliations
- Imperial College London (GB)
- Corresponding author
- Durham, Stephen R.
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 137
- Issue
- 2
- Pages
- 339-349.e10
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2271602246
- Cited by
- 200
- References
- 6
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 19 · 2023: 20 · 2022: 27 · 2021: 21 · 2020: 24 · 2019: 18 · 2018: 19 · 2017: 26 · 2016: 11
- FWCI
- 3.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- allergic rhinitis, sublingual immunotherapy, subcutaneous immunotherapy, allergen immunotherapy, perennial allergic rhinitis, rescue medication use, treatment efficacy, adverse effects, head-to-head comparison
- MeSH terms
- Administration, Sublingual, Allergens, Desensitization, Immunologic, Humans, Injections, Subcutaneous, Treatment Outcome, Sublingual Immunotherapy, Rhinitis, Allergic
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