Sublingual immunotherapy for inhalant allergy: cautious optimism.

Abstract

Sublingual immunotherapy (SLIT) is being utilized with increasing frequency in both Europe and the United States. While the data with commercially-prepared single-antigen SLIT appear promising, there has been an extrapolation of these data beyond the scope of the well-controlled clinical trials that have been published in the literature. In this environment of enthusiasm, it is prudent to examine variables that are relevant in evaluating how SLIT can be incorporated into American allergy practice on a broader scale. This commentary will discuss five areas of potential concern in moving toward wider implementation of SLIT: (1) patient selection for treatment; (2) pattern of sensitization; (3) dosing, preparation, and delivery; (4) safety concerns; and (5) cost of therapy. Additional research is necessary to adequately address these important issues to ensure that SLIT will offer a safe, well-tolerated, and effective treatment for Americans with inhalant allergy.