Intervention Review

Sublingual immunotherapy for allergic rhinitis

  1. Suzana Radulovic1,*,
  2. Moises A Calderon2,
  3. Duncan Wilson3,
  4. Stephen Durham2

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 16 FEB 2011

Assessed as up-to-date: 13 AUG 2009

DOI: 10.1002/14651858.CD002893.pub2

Database Title

Additional Information

How to Cite

Radulovic S, Calderon MA, Wilson D, Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD002893. DOI: 10.1002/14651858.CD002893.pub2.

Author Information

  1. 1

    Paediatric Allergy Research Department, King's College, LEAP Study Team, London, UK

  2. 2

    Royal Brompton Hospital, Department of Allergy and Respiratory Medicine, London, UK

  3. 3

    University Hospitals Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK

*Suzana Radulovic, LEAP Study Team, Paediatric Allergy Research Department, King's College, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK. radulovics@yahoo.com. suzana.radulovic@kcl.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 FEB 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2003.

Allergic rhinitis is a common condition which can significantly impair quality of life. Immunotherapy by injection can significantly reduce symptoms and medication use but its use is limited by the possibility of severe systemic adverse reactions. Immunotherapy by the sublingual route is therefore of considerable interest.

Objectives

To evaluate the efficacy and safety of sublingual immunotherapy for allergic rhinitis in adults and children.

Search methods

We searched the Cochrane ENT Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 14 August 2009.

Selection criteria

Randomised, double-blind, placebo-controlled trials of sublingual immunotherapy in adults or children. Primary outcome measures were symptom and medication scores. We also collected adverse event data.

Data collection and analysis

Two independent authors selected studies and assessed risk of bias. One author extracted data which was rechecked by two other authors. We used the standardised mean difference (SMD) with a random-effects model to combine data.

Main results

We included a total of 60 randomised controlled trials in the review. Forty-nine were suitable for pooling in meta-analyses (2333 SLIT, 2256 placebo participants). Overall, we found a significant reduction in symptoms (SMD -0.49; 95% confidence interval (CI) -0.64 to -0.34, P < 0.00001) and medication requirements (SMD -0.32; 95% CI -0.43 to -0.21, P < 0.00001) in participants receiving sublingual immunotherapy compared to placebo. None of the trials included in this review reported severe systemic reactions or anaphylaxis, and none of the systemic reactions reported required the use of adrenaline.

Authors' conclusions

This updated review reinforces the conclusion of the original 2003 Cochrane Review that sublingual immunotherapy is effective for allergic rhinitis and has been proven to be a safe route of administration.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Sublingual immunotherapy for allergic rhinitis (including hay fever)

Allergic rhinitis is characterised by red, itchy eyes, a blocked and runny nose, and sneezing. The most common causes of allergic rhinitis are different pollens (grass and tree), house dust mites, mould and animal dander. Allergic rhinitis can be intermittent (such as hay fever) or persistent (all year round). The treatment of allergic rhinitis depends on its severity and duration, and is usually based on the use of antihistamines and nasal corticosteroids. If these drugs cannot control symptoms immunotherapy is recommended. Immunotherapy involves the administration of gradually increasing doses of the allergen over a period of time to desensitise the patient. It is the only known treatment that modifies the immune response and treats the cause rather than the symptoms.

In reviewing 60 trials we found a significant reduction in symptom and medication scores in patients treated with sublingual immunotherapy compared to placebo. There were no serious adverse reactions reported in the included trials and no patient needed the use of adrenaline. This updated Cochrane Review therefore reinforces the conclusions of the earlier review in confirming the efficacy and safety of sublingual immunotherapy.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Inmunoterapia sublingual para la rinitis alérgica

Ésta es una actualización de una revisión Cochrane publicada por primera vez en The Cochrane Library número 2, 2003.

La rinitis alérgica es un trastorno frecuente, que puede deteriorar la calidad de vida de manera significativa. La inmunoterapia con inyección puede reducir de forma significativa los síntomas y la necesidad de fármacos, pero su uso está limitado por la posibilidad de que se presenten reacciones sistémicas graves. Por lo tanto, la inmunoterapia por vía sublingual es de considerable interés.

Objetivos

Evaluar la eficacia y la seguridad de la inmunoterapia sublingual para la rinitis alérgica en adultos y niños.

Estrategia de búsqueda

Se realizaron búsquedas en el Registro especializado de Ensayos del Grupo Cochrane ENT; CENTRAL (2010, número 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mECAs y fuentes adicionales de ensayos publicados y no publicados. La fecha de la búsqueda más reciente fue el 14 de agosto 2009.

Criterios de selección

Ensayos con asignación aleatoria, doble ciego, controlados con placebo de inmunoterapia sublingual en adultos y niños. Las medidas de resultado primarias fueron las puntuaciones de los síntomas y de los fármacos. También se obtuvieron datos de los eventos adversos.

Obtención y análisis de los datos

Dos autores independientes seleccionaron los estudios y evaluaron el riesgo de sesgo. Un autor extrajo los datos y otros dos autores los verificaron nuevamente. Se usó la diferencia de medias estandarizada (DME) con un modelo de efectos aleatorios para combinar los datos.

Resultados principales

Se incluyó un total de 60 ensayos controlados con asignación aleatoria en la revisión. Cuarenta y nueve fueron adecuados para el agrupamiento en los metanálisis (2 333 participantes recibieron inmunoterapia sublingual con alérgenos, 2 256 recibieron placebo). En general, se encontró una reducción significativa en los síntomas (DME −0,49, intervalo de confianza [IC] del 95%: −0,64 a −0,34; P. y < 0,00001) y la necesidad de medicación (DME −0,32, IC del 95%: −0,43 a −0,21; p < 0,00001) en los participantes que recibieron inmunoterapia sublingual en comparación con placebo. Ninguno de los ensayos incluidos en esta revisión informó reacciones sistémicas o anafilaxia grave, y ninguna de las reacciones sistémicas informadas requirió el uso de adrenalina.

Conclusiones de los autores

Esta revisión actualizada reafirma la conclusión de la revisión Cochrane original de 2003 acerca de que la inmunoterapia sublingual es eficaz para la rinitis alérgica y se ha mostrado que es una vía segura de administración.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

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