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Sublingual grass allergen tablet immunotherapy provides sustained clinical benefit with progressive immunological changes over 2 yearsRonald Dahl, MD,a Alexander Kapp, MD,b Giselda Colombo, MD,c Jan G. R. de Monchy, MD,d Sabina Rak, MD,eWaltraud Emminger, MD,f Bente Riis, PhD,g Pernille M. Grønager, MSc,g and Stephen R. Durham, MDh Aarhus and Hørsholm, Denmark, Hannover, Germany, Milan, Italy, Groningen, The Netherland, Gothenburg, Sweden, Vienna, Austria, and London, United Kingdom Allergy sufferers in the United States have traditionally been treated with injection based immunotherapy. However, oral drop-based Sublingual immunotherapy (SLIT) has been successfully used for treating allergy in Europe, Asia, and Australia for the last 20 years. In 2006, a novel tablet-based grass allergy vaccine was approved for use in Europe. The above study, published in the February issue of the JACI examines the results achieved two years into a three year trial with the grass allergen tablets. It is the first large-scale, double-blinded, placebo-controlled trial to support a SLIT treatment regimen continuing over more than one season, as is recommended for subcutaneous immunotherapy. The safety and effectiveness of the grass allergen tablet was established after the trial's first treatment season. In this interim analysis of the study, the authors address the need for long-term proof that sublingual immunotherapy works and is safe. Now after a second consecutive pollen season, treatment with grass allergen tablets has resulted in a (mean) 36% decrease in allergy symptoms and an additional (mean) 46% reduction in the use of allergy rescue medication compared to placebo. This suggests a sustained benefit of grass tablet immunotherapy treatment over more than one season. In parallel, the use of the allergen tablets showed a long term, progressive effective on the immunological parameters IgE, IgG4 and IgE-blocking antibodies. Although the authors recommend that grass allergen tablets should be considered a baseline treatment for allergies, one barrier to endorsement of SLIT is the absence of an FDA-approved product for SLIT in the United States Nevertheless, American allergy sufferers will be hearing more about the opportunities with sublingual immunotherapy in the years to come. |
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