Guiding principles of sublingual immunotherapy for allergic rhinitis in Japanese patients

Keisuke Masuyama; Minoru Goto; Sachio Takeno; Nobuo Ohta; Mitsuhiro Okano; Atsushi Kamijo; Motohiko Suzuki; Tetsuya Terada; Daiju Sakurai; Shigetoshi Horiguchi; Kohei Honda; Shoji Matsune; Takechiyo Yamada; Masafumi Sakashita; Atsushi Yuta; Takashi Fuchiwaki; Ikuyo Miyanohara; Takeo Nakayama; Yoshitaka Okamoto; Shigeharu Fujieda

doi:10.1016/j.anl.2015.08.015

Guiding principles of sublingual immunotherapy for allergic rhinitis in Japanese patients

Auris Nasus Larynx. 2016 Feb;43(1):1-9. doi: 10.1016/j.anl.2015.08.015. Epub 2015 Nov 23.

Authors

Keisuke Masuyama¹, Minoru Goto², Sachio Takeno³, Nobuo Ohta⁴, Mitsuhiro Okano⁵, Atsushi Kamijo⁶, Motohiko Suzuki⁷, Tetsuya Terada⁸, Daiju Sakurai⁹, Shigetoshi Horiguchi¹⁰, Kohei Honda¹¹, Shoji Matsune¹², Takechiyo Yamada¹³, Masafumi Sakashita¹³, Atsushi Yuta¹⁴, Takashi Fuchiwaki¹⁵, Ikuyo Miyanohara¹⁶, Takeo Nakayama¹⁷, Yoshitaka Okamoto⁹, Shigeharu Fujieda¹⁸

Affiliations

¹ Department of Otorhinolaryngology, University of Yamanashi, Japan.
² Department of Otorhinolaryngology - Head and Neck Surgery, Nippon Medical School, Japan.
³ Department of Otolaryngology - Head and Neck Surgery, Hiroshima University, Japan.
⁴ Department of Otolaryngology - Head and Neck Surgery, Yamagata University, Japan.
⁵ Department of Otolaryngology - Head and Neck Surgery, Okayama University, Okayama, Japan.
⁶ Otorhinolaryngology/Allergy Center, Saitama Medical University, Japan.
⁷ Department of Otolaryngology - Head and Neck Surgery, Nagoya City University, Japan.
⁸ Department of Otorhinolaryngology, Osaka Medical University, Japan.
⁹ Department of Otolaryngology - Head and Neck Surgery, Chiba University, Japan.
¹⁰ Departments of Otorhinolaryngology and Allergology, Iida Hospital, Japan.
¹¹ Department of Otorhinolaryngology - Head and Neck Surgery, Akita University, Japan.
¹² Department of Otolaryngology Nippon Medical School, Musashikosugi Hospital, Japan.
¹³ Department of Otolaryngology - Head and Neck Surgery, University of Fukui, Japan.
¹⁴ Yuta Clinic, Japan.
¹⁵ Department of Otorhinolaryngology, Shimane University, Japan.
¹⁶ Department of Otolaryngology - Head and Neck Surgery, Kagoshima University, Japan.
¹⁷ Department of Health Informatics, Kyoto University School of Public Health, Japan.
¹⁸ Department of Otolaryngology - Head and Neck Surgery, University of Fukui, Japan. Electronic address: sfujieda@u-fukui.ac.jp.

PMID: 26615715
DOI: 10.1016/j.anl.2015.08.015

Abstract

Objective: Sublingual immunotherapy (SLIT) appears to offer practical advantages for the treatment of allergic rhinitis (AR). Based on a review of the scientific literature, we present recommendations as guiding principles to administer SLIT safely.

Methods: Clinical questions concerning SLIT were prepared. Literature published between January 2003 and December 2012 was searched from PubMed, the Cochrane Library, and Japana Centra Revuo Medicina. Qualified studies were analyzed and the results were evaluated, consolidated, and codified. We answered 17 clinical questions and, based on this, presented evidence-based recommendations.

Results: Sublingual immunotherapy improved symptoms (e.g., quality of life [QOL]) and reduced medication scores in seasonal AR and perennial AR. Most SLIT-induced adverse effects were local oral reactions, although systemic adverse effects such as gastrointestinal symptoms, urticaria, and asthma are occasionally reported. There have been no reports of lethal anaphylactic reactions by SLIT. When SLIT is continued for 3-4 years, its effect persists long after discontinuation.

Conclusion: A correct diagnosis of AR and sufficient informed consent from patients are required before initiating SLIT. Sublingual immunotherapy should be continued for 3 years or longer. The initial administration of SLIT during the uptitration of an allergen vaccine and the general condition of patients are critical for the safe performance of SLIT.

Keywords: Allergic rhinitis; Guideline; Subcutaneous immunotherapy; Sublingual immunotherapy.

Publication types

Review

MeSH terms

Allergens / therapeutic use*
Asthma / chemically induced
Gastrointestinal Diseases / chemically induced
Humans
Japan
Practice Guidelines as Topic*
Quality of Life
Rhinitis, Allergic / drug therapy*
Rhinitis, Allergic, Perennial / drug therapy
Rhinitis, Allergic, Seasonal / drug therapy
Sublingual Immunotherapy / adverse effects
Sublingual Immunotherapy / methods*
Urticaria / chemically induced

Substances

Allergens