Sublingual immunotherapy (SLIT) was born in the 1980s in the middle of the debate about safety issues of traditional, subcutaneous immunotherapy (SCIT). Indeed, the study by Scadding and Brostoff introducing SLIT used very low doses, and it took four years to see another controlled trial on the new treatment. Since then, a continuous production of double-blind, placebo-controlled studies demonstrating its effectiveness has driven SLIT to achieve growing consideration through the years in succeeding consensus documents on immunotherapy. A major step was the first meta-analysis, evaluating the data from the first 22 controlled studies, which clearly demonstrated the efficacy and safety of SLIT in seasonal allergic rhinitis. A number of additional controlled trials allowed further meta-analyses considering subgroups of patients such as children with rhinitis or asthma and adults with asthma. Some aspects gained progressive clarity: the dose-dependence of efficacy, envisioned in the well known ARIA document in cumulative doses higher than 50-100 times those administered with standard SCIT, was questioned until recently. Now, studies of dose-response clearly demonstrate that the clinical efficacy of SLIT depends upon the administered dosage, as already proved since a long time for SCIT. Of note, and differently from SCIT, the systematic revision of the literature showed that with SLIT there is no dose dependence of safety. This allowed the development of new formulations of SLIT, strongly reducing the updosing phase and, in the case of tablets, more friendly for the patient. Also mechanisms of action of SLIT are being little by little elucidated, along with the investigation of optimal selection of patients, administration and duration of the treatment. This book offers to the reader a comprehensive view on SLIT, providing a reference tool to the physician who already has it in his practice as well as to the physician who wants to know more on a treatment increasingly applied on the large population of allergic people.
Sublingual specific immunotherapy. From scientific background to clinical practice
DI CARA, GIUSEPPE;
2007
Abstract
Sublingual immunotherapy (SLIT) was born in the 1980s in the middle of the debate about safety issues of traditional, subcutaneous immunotherapy (SCIT). Indeed, the study by Scadding and Brostoff introducing SLIT used very low doses, and it took four years to see another controlled trial on the new treatment. Since then, a continuous production of double-blind, placebo-controlled studies demonstrating its effectiveness has driven SLIT to achieve growing consideration through the years in succeeding consensus documents on immunotherapy. A major step was the first meta-analysis, evaluating the data from the first 22 controlled studies, which clearly demonstrated the efficacy and safety of SLIT in seasonal allergic rhinitis. A number of additional controlled trials allowed further meta-analyses considering subgroups of patients such as children with rhinitis or asthma and adults with asthma. Some aspects gained progressive clarity: the dose-dependence of efficacy, envisioned in the well known ARIA document in cumulative doses higher than 50-100 times those administered with standard SCIT, was questioned until recently. Now, studies of dose-response clearly demonstrate that the clinical efficacy of SLIT depends upon the administered dosage, as already proved since a long time for SCIT. Of note, and differently from SCIT, the systematic revision of the literature showed that with SLIT there is no dose dependence of safety. This allowed the development of new formulations of SLIT, strongly reducing the updosing phase and, in the case of tablets, more friendly for the patient. Also mechanisms of action of SLIT are being little by little elucidated, along with the investigation of optimal selection of patients, administration and duration of the treatment. This book offers to the reader a comprehensive view on SLIT, providing a reference tool to the physician who already has it in his practice as well as to the physician who wants to know more on a treatment increasingly applied on the large population of allergic people.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
