Sublingual immunotherapy.

Purpose Of Review: Sublingual immunotherapy is an established treatment option for allergic rhinitis in many European countries, but it is not approved in the United States and is considered investigational. Sublingual immunotherapy has received increasing attention in the United States as an alternative to subcutaneous immunotherapy for the treatment of allergic rhinitis and possibly asthma.

Recent Findings: Evidence for the safety and efficacy of sublingual immunotherapy is accumulating. The immunological effects of sublingual immunotherapy appear to be similar to those of subcutaneous immunotherapy, but their mechanisms may differ. The unique attributes of sublingual immunotherapy may offer advantages in selected patients. Controlled studies are being extended to evaluate sublingual immunotherapy for other indications, including allergic asthma, latex allergy, atopic dermatitis and food allergies.

Summary: Increasing data support the safety and efficacy of sublingual immunotherapy and its validity as a first-line treatment option for allergic rhinitis; however, acceptance in the United States is hindered by the lack of confirmatory evidence with United States-licensed products and the reluctance of allergists to accept evidence based on European studies and products. The future of sublingual immunotherapy in the United States will require addressing regulatory, economic and medical criteria.