SLIT now is FDA approved.

In 2014, the US Food & Drug Administration (FDA) has approved three different sublingual dissolvable tablets for the administration of allergy extracts.

Effectiveness of Subcutaneous Versus Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma: A Systematic Review

Background

Allergen-specific immunotherapy is widely used in the management of patients with allergic rhinoconjunctivitis and asthma, but the best route of delivery is unclear.

Objective

We performed a systematic review of studies with head-to-head comparison of effectiveness and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in the treatment of allergic rhinoconjunctivitis and asthma.

Methods

MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched through December 21, 2012. We included English language randomized controlled trials that enrolled patients with allergic rhinoconjunctivitis and/or asthma with head-to-head comparisons of SCIT with SLIT. Paired reviewers extracted detailed information from included articles on standardized forms and assessed the risk of bias in each article.

Results

Eight trials compared the effectiveness and safety of SCIT and SLIT. The effectiveness of the 2 forms of immunotherapy in managing allergic asthma and rhinoconjunctivitis were reported in 4 and 6 clinical trials, respectively. Low-grade evidence supports greater effectiveness of SCIT than SLIT for asthma symptom reduction and also at reducing a combined measure of rhinitis symptoms and medication use. Moderate-grade evidence supports greater effectiveness of SCIT than SLIT for nasal and/or eye symptom reduction. All 8 trials reported on adverse events with an episode of anaphylaxis reported in a child treated with SCIT.

Conclusion

Our review provides low-grade evidence to support that SCIT is superior to SLIT for reduction in asthma symptoms and moderate-grade evidence for reduction of allergic rhinoconjunctivitis. Additional studies are required to strengthen this evidence base for clinical decision making.
 

Chelladurai Y, Suarez-Cuervo C, Erekosima N, Kim JM, Ramanathan M, Segal JB, et al. Effectiveness of subcutaneous versus sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: A systematic review. J Allergy Clin Immunol: In Practice. http://dx.doi.org/10.1016/j.jaip.2013.04.005.

http://www.jaci-inpractice.org/article/PIIS2213219813002018/abstract

US FDA accepts Merck's BLA for ragweed pollen sublingual allergy immunotherapy tablet

The US Food and Drug Administration (FDA) has accepted Merck's biologics license application (BLA) for its investigational ragweed pollen (Ambrosia artemisiifolia) sublingual allergy immunotherapy tablet. The immunotherapy tablet is an investigational sublingual dissolvable tablet designed to help treat the underlying cause of allergic rhinitis by generating an immune response to help protect against the targeted allergen. Merck has partnered with ALK-Abello to develop its sublingual allergy immunotherapy tablets for ragweed pollen, timothy grass pollen and house dust mite in North America.
http://www.pharmabiz.com/NewsDetails.aspx?aid=75270&sid=2

More Evidence for Allergy Relief Without Shots

Wall Street Journal coverage of the new JAMA article on sublingual immunotherapy (SLIT or allergy drops) can be found at http://stream.wsj.com/story/latest-headlines/SS-2-63399/SS-2-201838/. 

Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma: A Systematic Review

Importance Allergic rhinitis affects up to 40% of the US population. To desensitize allergic individuals, subcutaneous injection immunotherapy or sublingual immunotherapy may be administered. In the United States, sublingual immunotherapy is not approved by the Food and Drug Administration. However, some US physicians use aqueous allergens, off-label, for sublingual desensitization.
Objective To systematically review the effectiveness and safety of aqueous sublingual immunotherapy for allergic rhinoconjunctivitis and asthma.
Evidence Acquisition The databases of MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials were searched through December 22, 2012. English-language randomized controlled trials were included if they compared sublingual immunotherapy with placebo, pharmacotherapy, or other sublingual immunotherapy regimens and reported clinical outcomes. Studies of sublingual immunotherapy that are unavailable in the United States and for which a related immunotherapy is unavailable in the United States were excluded. Paired reviewers selected articles and extracted the data. The strength of the evidence for each comparison and outcome was graded based on the risk of bias (scored on allocation, concealment of intervention, incomplete data, sponsor company involvement, and other bias), consistency, magnitude of effect, and the directness of the evidence.
Results Sixty-three studies with 5131 participants met the inclusion criteria. Participants' ages ranged from 4 to 74 years. Twenty studies (n = 1814 patients) enrolled only children. The risk of bias was medium in 43 studies (68%). Strong evidence supports that sublingual immunotherapy improves asthma symptoms, with 8 of 13 studies reporting greater than 40% improvement vs the comparator. Moderate evidence supports that sublingual immunotherapy use decreases rhinitis or rhinoconjunctivitis symptoms, with 9 of 36 studies demonstrating greater than 40% improvement vs the comparator. Medication use for asthma and allergies decreased by more than 40% in 16 of 41 studies of sublingual immunotherapy with moderate grade evidence. Moderate evidence supports that sublingual immunotherapy improves conjunctivitis symptoms (13 studies), combined symptom and medication scores (20 studies), and disease-specific quality of life (8 studies). Local reactions were frequent, but anaphylaxis was not reported.
Conclusions and Relevance The overall evidence provides a moderate grade level of evidence to support the effectiveness of sublingual immunotherapy for the treatment of allergic rhinitis and asthma, but high-quality studies are still needed to answer questions regarding optimal dosing strategies. There were limitations in the standardization of adverse events reporting, but no life-threatening adverse events were noted in this review.

Lin SY, Erekosima N, Kim JM et al. JAMA. 2013;309(12):1278-1288

Promising results with SLIT for childhood grass pollen allergy

High-dose sublingual immunotherapy (SLIT) effectively reduces allergic symptoms and medication use in children with grass pollen-allergic rhinoconjunctivitis, show study results.  To test its viability in children, Ulrich Wahn (Charité Medical University, Berlin, Germany) and colleagues carried out a randomized, placebo-controlled trial of high-dose SLIT for grass pollen allergy in 179 children (132 SLIT; 47 placebo) aged 4‑12 years.  The children who received SLIT were given up to 4 drops per day (3600‑4800 µg) of a aqueous grass solution containing equal extracts from six species of grass (Dactylis glomerata, Festuca pratensis, Holcus lanatus, Lolium perenne, Phleum pratense, and Poa pratensis). Treatment took place between January and August.

"This study confirmed that this SLIT preparation significantly reduced symptoms and medication use in children with grass pollen-allergic rhinoconjunctivitis," write Wahn et al in the Journal of Allergy and Clinical Immunology.  "Such standardized studies in the pediatric population are considered necessary and will allow researchers to compare different results and to build more appropriate meta-analyses with more reliable conclusions about SLIT efficacy and safety in allergic children."

http://www.news-medical.net/news/20120831/Promising-results-with-SLIT-for-childhood-grass-pollen-allergy.aspx
http://www.jacionline.org/article/S0091-6749(12)01118-9/abstract

Beat Allergies Drop by Drop

July 30, 2012, Wall Street Journal.

An increasingly popular alternative to allergy shots is a sweet-tasting liquid taken under the tongue at home. The treatment, called "sublingual immunotherapy," has been proven effective in several recent large studies. It is available in Europe in tablet form, and in the U.S., doctors repurpose the liquid extracts of allergens used in shots for delivery under the tongue with an eyedropper, syringe or hand pump.

http://online.wsj.com/article/SB10000872396390444226904577559120291051452.html?mod=googlenews_wsj