Sublingual immunotherapy (SLIT) has been widely applied to treat patients with allergic rhinitis (AR). However, meta-analyses on the efficacy of SLIT in AR patients with asthma are still limited.
Methods
Literature without language limitation published before October 28, 2022, were retrieved from PubMed, EMBASE, and Cochrane Library. STATA 16.0 software was used for the meta-analysis of the extracted data. The results reported were symptom scores, drug scores, adverse effects rates, and cost of treatment.
Results
Ten studies involving 1722 patients met the inclusion criteria. The total rhinitis score (TRSS) (weighted mean difference [WMD] = −1.23, 95% CI: −1.39-−1.06, P < .001) and total asthma symptom score (TASS) (WMD = −1.00, 95% CI: −1.12–0.89, P < .001) were significantly lower in the SLIT group than the placebo group. The SLIT group had higher rates of treatment-related adverse events (relative risk [RR] = 2.82, 95% CI: 1.77-4.48, P < .001) and total costs of treatment (standardized mean difference [SMD] = 0.71, 95% CI: 0.45-0.97, P < .001). There was no significant difference in inhaled corticosteroids (ICS) dose (P = .195), fractional exhaled nitric oxide (FeNO) (P = .158), forced expiratory volume in 1 s (FEV1) (P = .237), and direct costs of treatment (P = .630) between the SLIT and placebo groups.
Conclusion
SLIT may be a therapeutic method for improving rhinitis symptoms and asthma symptoms in AR patients with asthma. However, as there was significant heterogeneity in results, more high-quality and well-designed studies are needed in the future to elucidate the efficacy of SLIT.
FritzschingBContoliMPorsbjergC, et al.Long-term real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma: results from the REACT study, a retrospective cohort study. Lancet Reg Health Eur. 2022;13:100275.
2.
BozekAGaluszkaBGawlikR,et al.Allergen immunotherapy against house dust mites in patients with local allergic rhinitis and asthma. J Asthma. 2022;59(9):1850–1858.
3.
PichlerCEHelblingAPichlerWJ. Three years of specific immunotherapy with house-dust-mite extracts in patients with rhinitis and asthma: significant improvement of allergen-specific parameters and of nonspecific bronchial hyperreactivity. Allergy. 2001;56(4):301–306.
4.
OkuboKKuronoYIchimuraK, et al.Japanese guidelines for allergic rhinitis 2020. Allergol Int. 2020;69(3):331–345.
5.
BrozekJLBousquetJAgacheI, et al.Allergic rhinitis and its impact on asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950–958.
6.
PawankarRBunnagCKhaltaevNBousquetJ. Allergic rhinitis and its impact on asthma in Asia Pacific and the ARIA update 2008. World Allergy Organ J. 2012;5(Suppl 3):S212–S217.
BousquetJKhaltaevNCruzAA, et al.Allergic Rhinitis and Its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.
9.
BousquetJPfaarOTogiasA, et al.2019 ARIA Care pathways for allergen immunotherapy. Allergy. 2019;74(11):2087–2102.
10.
Geller-BernsteinCPibourdinJMDornelasAFondaraiJ. Efficacy of the acaricide: Acardust for the prevention of asthma and rhinitis due to dust mite allergy, in children. Allerg Immunol (Paris). 1995;27(5):147–154.
11.
LarsenJNBrogeLJacobiH. Allergy immunotherapy: the future of allergy treatment. Drug Discov Today. 2016;21(1):26–37.
12.
KimJYJangMJKimDYParkSWHanDH. Efficacy of subcutaneous and sublingual immunotherapy for house dust mite allergy: a network meta-analysis-based comparison. J Allergy Clin Immunol Pract. 2021;9(12):4450–4458. e4456.
13.
DurhamSRCreticosPSNelsonHS,et al.Treatment effect of sublingual immunotherapy tablets and pharmacotherapies for seasonal and perennial allergic rhinitis: pooled analyses. J Allergy Clin Immunol. 2016;138(4):1081–1088. e1084.
14.
DurhamSRPenagosM. Sublingual or subcutaneous immunotherapy for allergic rhinitis?J Allergy Clin Immunol. 2016;137(2):339–349. e310.
15.
KulalertPPhinyoPLao-ArayaM. Efficacy and safety of house dust mite sublingual immunotherapy tablets in allergic rhinitis: a systematic review and meta-analysis. World Allergy Organ J. 2022;15(9):100691.
16.
LiYYuSYTangRZhaoZTSunJL. Sublingual immunotherapy tablets relieve symptoms in adults with allergic rhinitis: a meta-analysis of randomized clinical trials. Chin Med J (Engl. 2018;131(21):2583–2588.
17.
WongsaCPhinyoPSompornrattanaphanMKrikeeratiTLumkulLThongngarmT. Efficacy and safety of house dust Mite sublingual immunotherapy tablet in allergic asthma: a systematic review of randomized controlled trials. J Allergy Clin Immunol Pract. 2022;10(5):1342–1355. e1324.
18.
XuKDengZLiD,et al.Efficacy of add-on sublingual immunotherapy for adults with asthma: a meta-analysis and systematic review. Ann Allergy Asthma Immunol. 2018;121(2):186–194.
19.
MoherDLiberatiATetzlaffJAltmanDGGroupP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–1012.
20.
Estevez-LopezFMaestre-CascalesCRussellD, et al.Effectiveness of exercise on fatigue and sleep quality in fibromyalgia: a systematic review and meta-analysis of randomized trials. Arch Phys Med Rehabil. 2021;102(4):752–761.
21.
SterneJACSavovicJPageMJ, et al.Rob 2: a revised tool for assessing risk of bias in randomised trials. Br Med J. 2019;366:l4898.
22.
StangA. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–605.
23.
YangXLiangWLiJLiuP. A meta-analysis and systematic review of the therapeutic effects of arthroscopy combined with intra-articular injection of sodium hyaluronate in the treatment of knee osteoarthritis. Ann Palliat Med. 2021;10(9):9859–9869.
24.
HigginsJPThompsonSGDeeksJJAltmanDG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327(7414):557–560.
25.
HoweASLynchDA. Cytokine alterations in pediatric internalizing disorders: systematic review and exploratory multi-variate meta-analysis. Brain Behav Immun Health. 2022;24:100490.
26.
HoshinoMAkitsuKKubotaKOhtawaJ. Association between biomarkers and house dust mite sublingual immunotherapy in allergic asthma. Clin Exp Allergy. 2020;50(9):1035–1043.
27.
EmmingerWHernandezMDCardonaV,et al.The SQ house dust mite SLIT-tablet is well tolerated in patients with house dust mite respiratory allergic disease. Int Arch Allergy Immunol. 2017;174(1):35–44.
28.
MosbechHDeckelmannRde BlayF, et al.Standardized quality (SQ) house dust mite sublingual immunotherapy tablet (ALK) reduces inhaled corticosteroid use while maintaining asthma control: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2014;134(3):568–575. e567.
29.
MarognaMMassoloAColomboFIsellaPBrunoMFalagianiP. Children passive smoking jeopardises the efficacy of standard anti-allergic pharmacological therapy, while sublingual immunotherapy withstands. Allergol Immunopathol (Madr). 2011;39(2):60–67.
30.
VoltoliniSTroiseCIncorvaiaC,et al.Effectiveness of high dose sublingual immunotherapy to induce a stepdown of seasonal asthma: a pilot study. Curr Med Res Opin. 2010;26(1):37–40.
31.
CalderonMEssendropM. Specific immunotherapy with high dose SO standardized grass allergen tablets was safe and well tolerated. J Investig Allergol Clin Immunol. 2006;16(6):338–344.
32.
MoritaKMorishimaTYoshimuraC, et al.Effectiveness of add-on sublingual immunotherapy for the treatment of Japanese cedar pollinosis-associated allergic asthma is it possible to reduce the dose of inhaled corticosteroid by adding sublingual immunotherapy?Arerugi. 2021;70(8):955–964.
33.
WangMSWuHTHuangXB. Efficacy and economic evaluation of sublingual immunotherapy with dermatophagoides farinae drops in patients with allergic rhinitis and allergic asthma. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016;30(7):538–542.
34.
BertoPFratiFIncorvaiaC, et al.Comparison of costs of sublingual immunotherapy and drug treatment in grass-pollen induced allergy: results from the SIMAP database study. Curr Med Res Opin. 2008;24(1):261–266.
35.
CompalatiEPassalacquaGBoniniMCanonicaGW. The efficacy of sublingual immunotherapy for house dust mites respiratory allergy: results of a GA2LEN meta-analysis. Allergy. 2009;64(11):1570–1579.
36.
de BlayFKunaPPrietoL,et al.SQ HDM SLIT-tablet (ALK) in treatment of asthma–post hoc results from a randomised trial. Respir Med. 2014;108(10):1430–1437.
37.
VirchowJCBackerVKunaP, et al.Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. 2016;315(16):1715–1725.
38.
ParisiGFMantiSPapaleM,et al.Nasal nitric oxide and nasal cytology as predictive markers of short-term sublingual allergen-specific immunotherapy efficacy in children with allergic rhinitis. Am J Rhinol Allergy. 2022;36(3):323–329.
39.
DweikRABoggsPBErzurumSC, et al.An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602–615.
40.
A. Respiratory Allergy Group of Chinese Society of, C.M.A. Asthma Group of Chinese Thoracic Society. Chinese guidelines for the diagnosis and treatment of allergic asthma (2019, the first edition). Zhonghua Nei Ke Za Zhi. 2019;58(9):636–655.
41.
WangLAiTLuoRFanYDuanY. Benefit effect of sublingual dust mite drops on the control of asthma in children. Int J Gen Med. 2021;14:3431–3438.
42.
AiTWangLLuoR,et al.Effects of sublingual-specific immunotherapy on pulmonary function and exhaled nitric oxide levels in asthmatic children with and without allergic rhinitis. Transl Pediatr. 2020;9(5):686–694.
43.
LinSYAzarASuarez-CuervoC, et al.Role of sublingual immunotherapy in the treatment of asthma: an updated systematic review. Int Forum Allergy Rhinol. 2018;8(9):982–992.
44.
JamesCBernsteinDI. Allergen immunotherapy: an updated review of safety. Curr Opin Allergy Clin Immunol. 2017;17(1):55–59.
45.
GreenhawtMOppenheimerJNelsonM, et al.Sublingual immunotherapy: a focused allergen immunotherapy practice parameter update. Ann Allergy Asthma Immunol. 2017;118(3):276–282. e272.
46.
BertoPPassalacquaGCrimiN,et al.Economic evaluation of sublingual immunotherapy vs symptomatic treatment in adults with pollen-induced respiratory allergy: the Sublingual Immunotherapy Pollen Allergy Italy (SPAI) study. Ann Allergy Asthma Immunol. 2006;97(5):615–621.
47.
ArianoRBertoPIncorvaiaC,et al.Economic evaluation of sublingual immunotherapy vs. symptomatic treatment in allergic asthma. Ann Allergy Asthma Immunol. 2009;103(3):254–259.
48.
PassalacquaGNowak-WegrzynACanonicaGW. Local side effects of sublingual and oral immunotherapy. J Allergy Clin Immunol Pract. 2017;5(1):13–21.
