Sublingual immunotherapy tablets or pharmacotherapy for allergic rhinitis?

Published Online: August 16, 2016

Antihistamines, leukotriene receptor antagonists, and intranasal corticosteroids are typical pharmacotherapies used to treat allergic rhinitis (AR). The efficacy of sublingual immunotherapy (SLIT)-tablets for AR has been demonstrated in several clinical studies, but no head-to-head studies have compared the treatment effect of SLIT-tablets with pharmacotherapy.

In The Journal of Allergy and Clinical Immunology (JACI), Durham and colleagues indirectly compared the total nasal symptom scores (TNSS) from timothy grass, short-ragweed, and house dust mite SLIT-tablet clinical trials with TNSS from montelukast, desloratadine, and mometasone furoate nasal spray (MFNS) clinical trials. The SLIT-tablet trials allowed AR rescue medication use, but rescue medication was not allowed in most of the pharmacotherapy trials.

Compared with placebo, grass and ragweed SLIT-tablet improvements on TNSS were 16.3% and 17.1%, respectively, which were nearly as large as MFNS (22.2%), and numerically greater than montelukast (5.4%) or desloratadine (8.5%) for seasonal AR. House dust mite SLIT-tablet improvement on TNSS versus placebo was 16.1%, which was numerically greater than montelukast (3.7%), desloratadine (4.8%), and MFNS (11.2%) for perennial AR.

Comparisons between SLIT-tablets and pharmacotherapies were limited by their heterogenous study designs, but the treatment effect size with SLIT-tablets in addition to background AR rescue medications supports their complimentary use for AR treatment. Treatment effects with SLIT-tablets were similar for seasonal and perennial AR, whereas the effects on perennial AR with pharmacotherapies were less than for seasonal AR. SLIT-tablets also have the added advantage of long-lasting therapeutic benefits compared with pharmacotherapy.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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