TY - JOUR
T1 - Role of sublingual immunotherapy in the treatment of asthma
T2 - An updated systematic review
AU - Lin, Sandra Y.
AU - Azar, Antoine
AU - Suarez-Cuervo, Catalina
AU - Diette, Gregory B.
AU - Brigham, Emily
AU - Rice, Jessica
AU - Ramanathan, Murugappan
AU - Robinson, Karen A.
N1 - Publisher Copyright:
© 2018 ARS-AAOA, LLC
PY - 2018/9
Y1 - 2018/9
N2 - Background: The purpose of the systematic review is to evaluate the efficacy and safety of sublingual immunotherapy (SLIT) for the treatment of allergic asthma. Methods: PubMed, Embase, and CENTRAL databases were searched, updating an earlier review (January 1, 2005 through May 8, 2017). Randomized, controlled studies (RCTs) were included, which reported one of the prespecified outcomes: asthma symptoms measured by control composite scores; quality of life; medication use; pulmonary physiology; and health-care utilization. For safety outcomes, RCTs and observational studies were included. Two independent reviewers extracted data, assessed risk of bias, and graded strength of evidence (SOE) for each outcome. Results: Fourteen RCTs (n = 2585) assessed the efficacy of SLIT for asthma. The RCTs utilized house dust mite (HDM), birch, or grass allergen. SLIT improved asthma symptoms (high SOE), decreased use of long-term control medication, and improved forced expiratory volume in 1 second (FEV 1 ) (moderate SOE). SLIT may decrease quick-relief medication use, and improve disease-specific quality of life (low SOE). For safety, 20 RCTs and 10 observational studies (n = 3621) were identified. Local (risk differences ranged from −0.03 to +0.765) and systemic allergic reactions (risk differences ranged from −0.03 to +0.06) were a common occurrence in SLIT and control groups. Life-threatening reactions were uncommon, with 3 cases of anaphylaxis and no deaths reported. Conclusion: There is moderate-to-high strength evidence that SLIT improves allergic asthma symptoms, reduces long-term control medication use, and improves FEV 1 based on studies of HDM, birch, and grass. SLIT rarely is associated with life-threatening adverse events.
AB - Background: The purpose of the systematic review is to evaluate the efficacy and safety of sublingual immunotherapy (SLIT) for the treatment of allergic asthma. Methods: PubMed, Embase, and CENTRAL databases were searched, updating an earlier review (January 1, 2005 through May 8, 2017). Randomized, controlled studies (RCTs) were included, which reported one of the prespecified outcomes: asthma symptoms measured by control composite scores; quality of life; medication use; pulmonary physiology; and health-care utilization. For safety outcomes, RCTs and observational studies were included. Two independent reviewers extracted data, assessed risk of bias, and graded strength of evidence (SOE) for each outcome. Results: Fourteen RCTs (n = 2585) assessed the efficacy of SLIT for asthma. The RCTs utilized house dust mite (HDM), birch, or grass allergen. SLIT improved asthma symptoms (high SOE), decreased use of long-term control medication, and improved forced expiratory volume in 1 second (FEV 1 ) (moderate SOE). SLIT may decrease quick-relief medication use, and improve disease-specific quality of life (low SOE). For safety, 20 RCTs and 10 observational studies (n = 3621) were identified. Local (risk differences ranged from −0.03 to +0.765) and systemic allergic reactions (risk differences ranged from −0.03 to +0.06) were a common occurrence in SLIT and control groups. Life-threatening reactions were uncommon, with 3 cases of anaphylaxis and no deaths reported. Conclusion: There is moderate-to-high strength evidence that SLIT improves allergic asthma symptoms, reduces long-term control medication use, and improves FEV 1 based on studies of HDM, birch, and grass. SLIT rarely is associated with life-threatening adverse events.
KW - allergens
KW - allergy immunotherapy
KW - asthma
KW - sublingual immunotherapy
UR - http://www.scopus.com/inward/record.url?scp=85052504558&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052504558&partnerID=8YFLogxK
U2 - 10.1002/alr.22152
DO - 10.1002/alr.22152
M3 - Article
C2 - 29885036
AN - SCOPUS:85052504558
SN - 2042-6976
VL - 8
SP - 982
EP - 992
JO - International Forum of Allergy and Rhinology
JF - International Forum of Allergy and Rhinology
IS - 9
ER -