Skip to main content

Advertisement

SpringerLink
Log in

Comparative analysis of sublingual immunotherapy medicines for adherence and clinical outcomes

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

Sublingual immunotherapy (SLIT) has been considered as an effective and safe alternative to the subcutaneous route. However, different modalities and administration methods may lead to significant changes in their adherence and clinical outcomes. The purpose of this study was to compare the adherence, efficacy, and side effects of SLIT medicines: SLITone®, Lais®, and Staloral®.

Subjects and methods

Eighty-two patients suffering from AR symptoms and sensitized only to house dust mite allergens were included. The patients were treated with SLITone®, Lais®, or Staloral®. Treatment outcomes related to efficacy, dropout rate, and adverse events were evaluated. The visual analogue scale (VAS) including sneezing, rhinorrhea, nasal obstruction, and itching was scored from 0 (normal) to 10 (severe), before and after SLIT. Dropout rate was defined as the number of patients who discontinue SLIT of oneself compared to the number of patients who receive SLIT.

Results

All of the nasal symptoms and total symptom scores were significantly decreased in SLITone®, Lais®, and Staloral®. Furthermore, there were significant difference in the improvement of rhinorrhea and TNSS between SLITone® and Staloral® group (p = 0.011 and p = 0.001, respectively). Four patients out of 26 in SLITone® group, 4 patients out of 30 in Lais® group, and 11 patients out of 26 in Staloral® group have stopped SLIT of themselves. The dropout rate was significantly higher in the Staloral® group than other two groups (p = 0.024). Only one patient complained adverse reaction such as swelling of mouth floor in the Staloral® group.

Conclusion

Although all three SLIT medicines are effective in improving AR symptoms, the adherence to SLIT assessed in accordance with dropout rate was the lowest in the Staloral®.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Meltzer EO, Blaiss MS, Derebery MJ, Mahr TA, Gordon BR, Sheth KK et al (2009) Burden of allergic rhinitis: results from the pediatric allergies in American survey. J Allergy Clin Immunol 124:S43–S70

    Article  Google Scholar 

  2. Bousquet J, Van Cauwenberge P, Khaltaev N (2001) Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 108:S147–S334

    Article  CAS  Google Scholar 

  3. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al (2008) Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 63:8–160

    Article  Google Scholar 

  4. Wheatley LM, Togias A (2015) Clinical practice: allergic rhinitis. N Engl J Med 372:456–463

    Article  Google Scholar 

  5. Greiner AN, Hellings PW, Rotiroti G, Scadding GK (2011) Allergic rhinitis. Lancet 378:2112–2122

    Article  Google Scholar 

  6. Larsen JN, Broge L, Jacobi H (2016) Allergy immunotherapy: the future of allergy treatment. Drug Discov Today 21:26–37

    Article  CAS  Google Scholar 

  7. Akdis CA, Barlan IB, Bahceciler N, Akdis M (2006) Immunological mechanisms of sublingual immunotherapy. Allergy 61:11–14

    Article  Google Scholar 

  8. Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S (2007) Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev 1:CD001936

    Google Scholar 

  9. Bozek A, Kolodziejczyk K, Kozlowska R, Canonica GW (2017) Evidence of the efficacy and safety of house dust mite subcutaneous immunotherapy in elderly allergic rhinitis patients: a randomized, double-blind placebo-controlled trial. Clin Transl Allergy 7:43

    Article  Google Scholar 

  10. Masuyama K, Goto M, Takeno S, Ohta N, Okano M, Kamijo A et al (2016) Guiding principles of sublingual immunotherapy for allergic rhinitis in Japanese patients. Auris Nasus Larynx 43:1–9

    Article  Google Scholar 

  11. Passalacqua G, Guerra L, Pasquali M, Lombardi C, Canonica GW (2004) Efficacy and safety of sublingual immunotherapy. Ann Allergy Asthma Immunol 93:3–12

    Article  Google Scholar 

  12. Moral A, Moreno V, Giron F, El-Qutob D, Moure JD, Alcantara M et al (2016) Adverse reactions and tolerability of high-dose sublingual allergen immunotherapy. J Asthma Allergy 9:129–133

    Article  Google Scholar 

  13. Mosges R, Ritter B, Kayoko G, Allekotte S (2010) Carbamylated monomeric allergoids as a therapeutic option for sublingual immunotherapy of dust mite- and grass pollen-induced allergic rhinoconjunctivitis: a systematic review of published trials with a meta-analysis of treatment using Lais® tablets. Acta Dermatovenerol Alp Pannonica Adriat 19:3–10

    CAS  PubMed  Google Scholar 

  14. Frati F, Scurati S, Puccinelli P, Justicia JL, Adamec T, Sieber HJ et al (2009) Development of an allergen extract for sublingual immunotherapy-evolution of Staloral. Expert Opin Biol Ther 9:1207–1215

    Article  CAS  Google Scholar 

  15. Morjaria JB, Caruso M, Rosalia E, Russo C, Polosa R (2014) Preventing progression of allergic rhinitis to asthma. Curr Allergy Asthma Rep 14:412

    Article  Google Scholar 

  16. Durham SR, Emminger W, Kapp A, de Monchy JG, Rak S, Scadding GK et al (2012) SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol 129:717–725

    Article  Google Scholar 

  17. Durham SR, Penagos M (2016) Sublingual or subcutaneous immunotherapy for allergic rhinitis? J Allergy Clin Immunol 137:339–349

    Article  Google Scholar 

  18. Tabatabaian F, Casale TB (2015) Selection of patients for sublingual immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT). Allergy Asthma Proc 36:100–104

    Article  CAS  Google Scholar 

  19. Lee S, Nolte H, Benninger MS (2015) Clinical considerations in the use of sublingual immunotherapy for allergic rhinitis. Am J Rhinol Allergy 29:106–114

    Article  Google Scholar 

  20. Dretzke J, Meadows A, Novielli N, Huissoon A, Fry-Smith A, Meads C (2013) Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: a systematic review and indirect comparison. J Allergy Clin Immunol 131:1361–1366

    Article  Google Scholar 

  21. Di Bona D, Plaia A, Leto-Barone MS, La Piana S, Di Lorenzo G (2012) Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: a meta-analysis-based comparison. J Allergy Clin Immunol 130:1097–1107

    Article  Google Scholar 

  22. Bergmann KC, Demoly P, Worm M, Fokkens WJ, Carrillo T, Tabar AI et al (2014) Efficacy and safety of sublingual tablets of house dust mite allergen extracts in adults with allergic rhinitis. J Allergy Clin Immunol 133:1608–1614

    Article  CAS  Google Scholar 

  23. Okamoto Y, Okubo K, Yonekura S, Hashiguchi K, Goto M, Otsuka T et al (2015) Efficacy and safety of sublingual immunotherapy for two seasons in patients with Japanese cedar pollinosis. Int Arch Allergy Immunol 166:177–188

    Article  CAS  Google Scholar 

  24. Maloney J, Bernstein DI, Nelson H, Creticos P, Hebert J, Noonan M et al (2014) Efficacy and safety of grass sublingual immunology tablet, MK-7243: a large randomized controlled trial. Ann Allergy Asthma Immunol 112:146–153

    Article  CAS  Google Scholar 

  25. Allam JP, Novak N (2014) Immunological mechanisms of sublingual immunotherapy. Curr Opin Allergy Clin Immunol 14:564–569

    Article  CAS  Google Scholar 

  26. Mascarell L, Lombardi V, Louise A, Saint-Lu N, Chabre H, Moussu H et al (2008) Oral dendritic cells mediate antigen-specific tolerance by stimulating TH1 and regulatory CD4 + T cells. J Allergy Clin Immunol 122:603–609

    Article  CAS  Google Scholar 

  27. Allam JP, Novak N, Fuchs C, Asen S, Berge S, Appel T et al (2003) Characterization of dendritic cells from human oral mucosa: a new Langerhans’ cell type with high constitutive FcepsilonRI expression. J Allergy Clin Immunol 112:141–148

    Article  CAS  Google Scholar 

  28. Akdis M, Akdis CA (2014) Mechanisms of allergen-specific immunotherapy: multiple suppressor factors at work in immune tolerance to allergens. J Allergy Clin Immunol 133:621–631

    Article  CAS  Google Scholar 

  29. Makatsori M, Scadding GW, Lombardo C, Bisoffi G, Ridolo E, Durham SR et al (2014) Dropouts in sublingual allergen immunotherapy trials-a systematic review. Allergy 69:571–580

    Article  CAS  Google Scholar 

  30. Senna G, Ridolo E, Calderon M, Lombardi C, Canonica GW, Passalacqua G (2009) Evidence of adherence to allergen-specific immunotherapy. Curr Opin Allergy Clin Immunol 9:544–548

    Article  CAS  Google Scholar 

  31. Senna G, Lombardi C, Canonica GW, Passalacqua G (2010) How adherent to sublingual immunotherapy prescriptions are patients? The manufacturers’ viewpoint. J Allergy Clin Immunol 126:668–669

    Article  Google Scholar 

  32. Chester JG, Bremberg MG, Reisacher WR (2016) Patient preferences for route of allergy immunotherapy: a comparison of four delivery methods. Int Forum Allergy Rhinol 6:454–459

    Article  Google Scholar 

  33. Hsu NM, Reisacher WR (2012) A comparison of attrition rates in patients undergoing sublingual immunotherapy vs subcutaneous immunotherapy. Int Forum Allergy Rhinol 2:280–284

    Article  Google Scholar 

  34. Incorvaia C, Mauro M, Ridolo E, Puccinelli P, Liuzzo M, Scurati S et al (2008) Patient’s compliance with allergen immunotherapy. Patient Prefer Adheren 2:247–251

    Article  Google Scholar 

  35. Reisacher WR, Visaya JM (2013) Patient adherence to allergy immunotherapy. Curr Opin Otolaryngol Head Neck Surg 21:256–262

    Article  Google Scholar 

  36. Kumar MS, Oh MS, Leader B, Rotella M, Stillman L, DelGaudio JM et al (2017) Perceived compliance and barriers to care in sublingual immunotherapy. Int Forum Allergy Rhinol 7:525–529

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-gu, Busan, 602-739, South Korea

    Ji-A Kim, Yu-Mi Lee, Sung-Dong Kim & Kyu-Sup Cho

  2. Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Keun-Ik Yi & Sue-Jean Mun

Authors
  1. Ji-A Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu-Mi Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keun-Ik Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sung-Dong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sue-Jean Mun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kyu-Sup Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyu-Sup Cho.

Ethics declarations

Conflict of interest

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Ethical approval

This study protocol was approved by the Institutional Review Board of Pusan National University Hospital (PNUHIRB 1804-013-066).

Informed consent

Written informed consent was not obtained from each parent prior to the patient’s participation in the study because of retrospective chart reviews.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, JA., Lee, YM., Yi, KI. et al. Comparative analysis of sublingual immunotherapy medicines for adherence and clinical outcomes. Eur Arch Otorhinolaryngol 277, 135–140 (2020). https://doi.org/10.1007/s00405-019-05656-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05656-6

Keywords

Search

Navigation