Sublingual Immunotherapy for Allergic Rhinitis and Asthma
Summary
Sublingual immunotherapy (SLIT) represents a disease-modifying approach to the management of allergic rhinitis and asthma by administering precise doses of allergen extracts beneath the tongue. This route exploits the oral mucosal network of antigen-presenting cells to induce long-term immune tolerance, shifting the inflammatory profile from IgE-mediated Th2 dominance towards regulatory T cell activity and allergen-blocking IgG4 antibodies. Clinical trials and real-world cohorts have demonstrated sustained reductions in symptom severity and medication requirements when SLIT is continued for three to five years. Compared with subcutaneous immunotherapy, SLIT displays a superior safety profile, with most adverse events confined to mild local reactions such as oral pruritus or throat irritation. Home administration of tablet or liquid formulations enhances patient adherence and broadens access, supporting its integration into diverse healthcare settings globally. Emerging evidence suggests that early intervention with SLIT may not only alleviate current symptoms but also prevent the progression from rhinitis to asthma, underscoring its role in long-term airway health.
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Sublingual Immunotherapy for Allergic Rhinitis and Asthma publication trend
The graph below shows the total number of articles in sublingual immunotherapy for allergic rhinitis and asthma across all publications each year (not limited to Nature Index journals).
Technical terms
Sublingual immunotherapy (SLIT): A modality of allergen-specific immunotherapy in which allergen extracts are placed under the tongue to promote immune tolerance through local mucosal mechanisms.
Subcutaneous immunotherapy (SCIT): Allergen-specific immunotherapy administered by injections, typically in a clinical setting, to induce long-term desensitisation.
Allergic rhinitis: An IgE-mediated inflammatory condition of the nasal mucosa triggered by environmental allergens, characterised by sneezing, nasal congestion, itching and rhinorrhoea.
Regulatory T cells (Tregs): A specialised subset of T lymphocytes that suppress immune over-reaction and facilitate the development of peripheral tolerance to allergens.
Anaphylaxis: A rapid-onset, potentially life-threatening systemic allergic reaction that can occur following allergen exposure or immunotherapy administration.
References
- Real-world, long-term effectiveness of allergy immunotherapy in allergic rhinitis: Subgroup analyses of the REACT study. Journal of Allergy and Clinical Immunology (2023).
- Efficacy and safety of sublingual versus subcutaneous immunotherapy in children with allergic rhinitis: a systematic review and meta-analysis. Frontiers in Immunology (2023).
- Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organization Journal (2014).
- Induction of Tolerance via the Sublingual Route: Mechanisms and Applications. Journal of Immunology Research (2011).
- Quality of life improvement after a three-year course of sublingual immunotherapy in patients with house dust mite and grass pollen induced allergic rhinitis: results from real-life. Health and Quality of Life Outcomes (2017).
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