Sublingual or subcutaneous immunotherapy for allergic rhinitis?
Allergen immunotherapy is effective in patients with allergic rhinitis (AR) and, unlike antiallergic drugs, has been shown to modify the underlying cause of the disease, with proved long-term benefits. Subcutaneous immunotherapy (SCIT) has been the gold standard, whereas sublingual immunotherapy (SL...
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| Veröffentlicht in: | Journal of allergy and clinical immunology 2016-02, Vol.137 (2), p.339-349.e10 |
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| container_end_page | 349.e10 |
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| container_title | Journal of allergy and clinical immunology |
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| creator | Durham, Stephen R., MD, FRCP Penagos, Martin, MD, MSc |
| description | Allergen immunotherapy is effective in patients with allergic rhinitis (AR) and, unlike antiallergic drugs, has been shown to modify the underlying cause of the disease, with proved long-term benefits. Subcutaneous immunotherapy (SCIT) has been the gold standard, whereas sublingual immunotherapy (SLIT) has emerged as an effective and safe alternative. Previous Cochrane systematic reviews and meta-analyses have confirmed that both SLIT and SCIT are effective in patients with seasonal AR, whereas evidence for their efficacy in patients with perennial disease has been less convincing. Recent large, adequately powered trials have demonstrated reductions in both symptoms and use of rescue medication in patients with seasonal and those with perennial AR. Here we appraise evidence for SCIT versus SLIT based on indirect evidence from Cochrane reviews and recent well-powered double-blind, randomized controlled trials versus placebo and the limited direct evidence available from randomized blind head-to-head comparisons. At present, based on an overall balance of efficacy and side effects, the patient is in equipoise. Pending definitive comparative trials, choice might be determined largely by the local availability of SCIT and SLIT products of proved value and personal (patient) preference. |
| doi_str_mv | 10.1016/j.jaci.2015.12.1298 |
| format | Article |
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Subcutaneous immunotherapy (SCIT) has been the gold standard, whereas sublingual immunotherapy (SLIT) has emerged as an effective and safe alternative. Previous Cochrane systematic reviews and meta-analyses have confirmed that both SLIT and SCIT are effective in patients with seasonal AR, whereas evidence for their efficacy in patients with perennial disease has been less convincing. Recent large, adequately powered trials have demonstrated reductions in both symptoms and use of rescue medication in patients with seasonal and those with perennial AR. Here we appraise evidence for SCIT versus SLIT based on indirect evidence from Cochrane reviews and recent well-powered double-blind, randomized controlled trials versus placebo and the limited direct evidence available from randomized blind head-to-head comparisons. At present, based on an overall balance of efficacy and side effects, the patient is in equipoise. Pending definitive comparative trials, choice might be determined largely by the local availability of SCIT and SLIT products of proved value and personal (patient) preference.</description><identifier>ISSN: 0091-6749</identifier><identifier>EISSN: 1097-6825</identifier><identifier>DOI: 10.1016/j.jaci.2015.12.1298</identifier><identifier>PMID: 26853126</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Accreditation ; Administration, Sublingual ; Allergens - administration & dosage ; Allergens - immunology ; Allergic rhinitis ; Allergies ; Allergy and Immunology ; Asthma ; Copyright ; Desensitization, Immunologic - adverse effects ; Desensitization, Immunologic - methods ; Drug dosages ; Drug therapy ; Expert witness testimony ; Health education ; Humans ; Immunotherapy ; Injections, Subcutaneous ; Outdoor activities ; Quality ; Rhinitis, Allergic - immunology ; Rhinitis, Allergic - therapy ; Studies ; subcutaneous immunotherapy ; Sublingual Immunotherapy ; Treatment Outcome</subject><ispartof>Journal of allergy and clinical immunology, 2016-02, Vol.137 (2), p.339-349.e10</ispartof><rights>American Academy of Allergy, Asthma & Immunology</rights><rights>2015 American Academy of Allergy, Asthma & Immunology</rights><rights>Copyright © 2015 American Academy of Allergy, Asthma & Immunology. 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All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-473590538d02d26f927be6d3f0cbe7b33c267358e04e0e097c67dce18534b1ec3</citedby><cites>FETCH-LOGICAL-c541t-473590538d02d26f927be6d3f0cbe7b33c267358e04e0e097c67dce18534b1ec3</cites><orcidid>0000-0002-9488-194X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0091674915031127$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26853126$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Durham, Stephen R., MD, FRCP</creatorcontrib><creatorcontrib>Penagos, Martin, MD, MSc</creatorcontrib><title>Sublingual or subcutaneous immunotherapy for allergic rhinitis?</title><title>Journal of allergy and clinical immunology</title><addtitle>J Allergy Clin Immunol</addtitle><description>Allergen immunotherapy is effective in patients with allergic rhinitis (AR) and, unlike antiallergic drugs, has been shown to modify the underlying cause of the disease, with proved long-term benefits. Subcutaneous immunotherapy (SCIT) has been the gold standard, whereas sublingual immunotherapy (SLIT) has emerged as an effective and safe alternative. Previous Cochrane systematic reviews and meta-analyses have confirmed that both SLIT and SCIT are effective in patients with seasonal AR, whereas evidence for their efficacy in patients with perennial disease has been less convincing. Recent large, adequately powered trials have demonstrated reductions in both symptoms and use of rescue medication in patients with seasonal and those with perennial AR. Here we appraise evidence for SCIT versus SLIT based on indirect evidence from Cochrane reviews and recent well-powered double-blind, randomized controlled trials versus placebo and the limited direct evidence available from randomized blind head-to-head comparisons. At present, based on an overall balance of efficacy and side effects, the patient is in equipoise. Pending definitive comparative trials, choice might be determined largely by the local availability of SCIT and SLIT products of proved value and personal (patient) preference.</description><subject>Accreditation</subject><subject>Administration, Sublingual</subject><subject>Allergens - administration & dosage</subject><subject>Allergens - immunology</subject><subject>Allergic rhinitis</subject><subject>Allergies</subject><subject>Allergy and Immunology</subject><subject>Asthma</subject><subject>Copyright</subject><subject>Desensitization, Immunologic - adverse effects</subject><subject>Desensitization, Immunologic - methods</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Expert witness testimony</subject><subject>Health education</subject><subject>Humans</subject><subject>Immunotherapy</subject><subject>Injections, Subcutaneous</subject><subject>Outdoor activities</subject><subject>Quality</subject><subject>Rhinitis, Allergic - immunology</subject><subject>Rhinitis, Allergic - therapy</subject><subject>Studies</subject><subject>subcutaneous immunotherapy</subject><subject>Sublingual Immunotherapy</subject><subject>Treatment Outcome</subject><issn>0091-6749</issn><issn>1097-6825</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkl1LHTEQhkOp1KP2Fwiy0Jve7HEm2c1uLqoUqVoQvFCvw252VrPux2myKZx_3yzHVvDGhkAIeWYy77zD2DHCGgHlabfuKmPXHDBfI49blR_YCkEVqSx5_pGtABSmssjUPjvwvoN4F6X6xPa5LHOBXK7Y-V2oezs-hqpPJpf4UJswVyNNwSd2GMI4zU_kqs02aeNz1ffkHq1J3JMd7Wz9-RHba6ve0-eX85A9XP64v7hOb26vfl58v0lNnuGcZoXIFeSibIA3XLaKFzXJRrRgaipqIQyXESkJMgKKEowsGkMYy8xqJCMO2ddd3o2bfgXysx6sN9T3u1o1FjJXSkTh_4NmKMoMZES_vEG7KbgxClkoAVDGFSmxo4ybvHfU6o2zQ-W2GkEvVuhOL1boxQqNXC9WxKiTl9yhHqj5F_O39xH4tgMo9u23Jae9sTQaaqwjM-tmsu98cPYm3kQnran6Z9qSf1WiPdeg75ZpWIYBcxCIvBB_AOk_rZ4</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Durham, Stephen R., MD, FRCP</creator><creator>Penagos, Martin, MD, MSc</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7SS</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9488-194X</orcidid></search><sort><creationdate>20160201</creationdate><title>Sublingual or subcutaneous immunotherapy for allergic rhinitis?</title><author>Durham, Stephen R., MD, FRCP ; Penagos, Martin, MD, MSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-473590538d02d26f927be6d3f0cbe7b33c267358e04e0e097c67dce18534b1ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Accreditation</topic><topic>Administration, Sublingual</topic><topic>Allergens - administration & dosage</topic><topic>Allergens - immunology</topic><topic>Allergic rhinitis</topic><topic>Allergies</topic><topic>Allergy and Immunology</topic><topic>Asthma</topic><topic>Copyright</topic><topic>Desensitization, Immunologic - adverse effects</topic><topic>Desensitization, Immunologic - methods</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Expert witness testimony</topic><topic>Health education</topic><topic>Humans</topic><topic>Immunotherapy</topic><topic>Injections, Subcutaneous</topic><topic>Outdoor activities</topic><topic>Quality</topic><topic>Rhinitis, Allergic - immunology</topic><topic>Rhinitis, Allergic - therapy</topic><topic>Studies</topic><topic>subcutaneous immunotherapy</topic><topic>Sublingual Immunotherapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Durham, Stephen R., MD, FRCP</creatorcontrib><creatorcontrib>Penagos, Martin, MD, MSc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of allergy and clinical immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Durham, Stephen R., MD, FRCP</au><au>Penagos, Martin, MD, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sublingual or subcutaneous immunotherapy for allergic rhinitis?</atitle><jtitle>Journal of allergy and clinical immunology</jtitle><addtitle>J Allergy Clin Immunol</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>137</volume><issue>2</issue><spage>339</spage><epage>349.e10</epage><pages>339-349.e10</pages><issn>0091-6749</issn><eissn>1097-6825</eissn><abstract>Allergen immunotherapy is effective in patients with allergic rhinitis (AR) and, unlike antiallergic drugs, has been shown to modify the underlying cause of the disease, with proved long-term benefits. Subcutaneous immunotherapy (SCIT) has been the gold standard, whereas sublingual immunotherapy (SLIT) has emerged as an effective and safe alternative. Previous Cochrane systematic reviews and meta-analyses have confirmed that both SLIT and SCIT are effective in patients with seasonal AR, whereas evidence for their efficacy in patients with perennial disease has been less convincing. Recent large, adequately powered trials have demonstrated reductions in both symptoms and use of rescue medication in patients with seasonal and those with perennial AR. Here we appraise evidence for SCIT versus SLIT based on indirect evidence from Cochrane reviews and recent well-powered double-blind, randomized controlled trials versus placebo and the limited direct evidence available from randomized blind head-to-head comparisons. At present, based on an overall balance of efficacy and side effects, the patient is in equipoise. Pending definitive comparative trials, choice might be determined largely by the local availability of SCIT and SLIT products of proved value and personal (patient) preference.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26853126</pmid><doi>10.1016/j.jaci.2015.12.1298</doi><orcidid>https://orcid.org/0000-0002-9488-194X</orcidid></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Accreditation Administration, Sublingual Allergens - administration & dosage Allergens - immunology Allergic rhinitis Allergies Allergy and Immunology Asthma Copyright Desensitization, Immunologic - adverse effects Desensitization, Immunologic - methods Drug dosages Drug therapy Expert witness testimony Health education Humans Immunotherapy Injections, Subcutaneous Outdoor activities Quality Rhinitis, Allergic - immunology Rhinitis, Allergic - therapy Studies subcutaneous immunotherapy Sublingual Immunotherapy Treatment Outcome |
| title | Sublingual or subcutaneous immunotherapy for allergic rhinitis? |
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