Sublingual allergen immunotherapy in children: An evidence-based overview

Although subcutaneous allergen immunotherapy (SCIT) is still considered the gold standard immunotherapy treatment for allergic diseases, due to the risk of severe adverse reactions and its limitations regarding practicality, allergen immunotherapy in the sublingual route (SLIT) has been suggested as an alternative to SCIT. In the last three decades an increasing number of studies assessing the efficacy and safety of SLIT have been published; however, not all of them bring the same degree of evidence. This paper aims to be a comprehensive review of the most outstanding and robust papers on SLIT in the paediatric population. We will discuss classical indications like rhinitis and asthma as well as novel possible indications like food allergy, conjunctivitis, latex allergy or atopic dermatitis. We used an evidence based medicine approach. We confirm that there is evidence supporting the efficacy and safety of SLIT mainly for allergic rhinitis, less for asthma and some other allergic conditions; there are still some pitfalls to go through, like immunologic mechanisms, optimal dosage, duration of treatment or long-term efficacy among others, before SLIT can be suggested as the first step in allergy treatment. (C) 2011 Elsevier Masson SAS. All rights reserved.