Sublingual Immunotherapy (allergy drops)

SLIT now is FDA approved.

2014-05-30T21:25:00.000-04:00

In 2014, the US Food & Drug Administration (FDA) has approved three different sublingual dissolvable tablets for the administration of allergy extracts.

Effectiveness of Subcutaneous Versus Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma: A Systematic Review

2013-06-08T21:45:00.001-04:00

Background

Allergen-specific immunotherapy is widely used in the management of patients with allergic rhinoconjunctivitis and asthma, but the best route of delivery is unclear.

Objective

We performed a systematic review of studies with head-to-head comparison of effectiveness and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in the treatment of allergic rhinoconjunctivitis and asthma.

Methods

MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched through December 21, 2012. We included English language randomized controlled trials that enrolled patients with allergic rhinoconjunctivitis and/or asthma with head-to-head comparisons of SCIT with SLIT. Paired reviewers extracted detailed information from included articles on standardized forms and assessed the risk of bias in each article.

Results

Eight trials compared the effectiveness and safety of SCIT and SLIT. The effectiveness of the 2 forms of immunotherapy in managing allergic asthma and rhinoconjunctivitis were reported in 4 and 6 clinical trials, respectively. Low-grade evidence supports greater effectiveness of SCIT than SLIT for asthma symptom reduction and also at reducing a combined measure of rhinitis symptoms and medication use. Moderate-grade evidence supports greater effectiveness of SCIT than SLIT for nasal and/or eye symptom reduction. All 8 trials reported on adverse events with an episode of anaphylaxis reported in a child treated with SCIT.

Conclusion

Our review provides low-grade evidence to support that SCIT is superior to SLIT for reduction in asthma symptoms and moderate-grade evidence for reduction of allergic rhinoconjunctivitis. Additional studies are required to strengthen this evidence base for clinical decision making.

Chelladurai Y, Suarez-Cuervo C, Erekosima N, Kim JM, Ramanathan M, Segal JB, et al. Effectiveness of subcutaneous versus sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: A systematic review. J Allergy Clin Immunol: In Practice. http://dx.doi.org/10.1016/j.jaip.2013.04.005.

http://www.jaci-inpractice.org/article/PIIS2213219813002018/abstract

US FDA accepts Merck's BLA for ragweed pollen sublingual allergy immunotherapy tablet

2013-05-10T18:23:00.003-04:00

The US Food and Drug Administration (FDA) has accepted Merck's biologics license application (BLA) for its investigational ragweed pollen (Ambrosia artemisiifolia) sublingual allergy immunotherapy tablet. The immunotherapy tablet is an investigational sublingual dissolvable tablet designed to help treat the underlying cause of allergic rhinitis by generating an immune response to help protect against the targeted allergen. Merck has partnered with ALK-Abello to develop its sublingual allergy immunotherapy tablets for ragweed pollen, timothy grass pollen and house dust mite in North America.
http://www.pharmabiz.com/NewsDetails.aspx?aid=75270&sid=2

More Evidence for Allergy Relief Without Shots

2013-04-02T15:07:00.003-04:00

Wall Street Journal coverage of the new JAMA article on sublingual immunotherapy (SLIT or allergy drops) can be found at http://stream.wsj.com/story/latest-headlines/SS-2-63399/SS-2-201838/.

Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma: A Systematic Review

2013-04-01T14:47:00.001-04:00

Importance Allergic rhinitis affects up to 40% of the US population. To desensitize allergic individuals, subcutaneous injection immunotherapy or sublingual immunotherapy may be administered. In the United States, sublingual immunotherapy is not approved by the Food and Drug Administration. However, some US physicians use aqueous allergens, off-label, for sublingual desensitization.
Objective To systematically review the effectiveness and safety of aqueous sublingual immunotherapy for allergic rhinoconjunctivitis and asthma.
Evidence Acquisition The databases of MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials were searched through December 22, 2012. English-language randomized controlled trials were included if they compared sublingual immunotherapy with placebo, pharmacotherapy, or other sublingual immunotherapy regimens and reported clinical outcomes. Studies of sublingual immunotherapy that are unavailable in the United States and for which a related immunotherapy is unavailable in the United States were excluded. Paired reviewers selected articles and extracted the data. The strength of the evidence for each comparison and outcome was graded based on the risk of bias (scored on allocation, concealment of intervention, incomplete data, sponsor company involvement, and other bias), consistency, magnitude of effect, and the directness of the evidence.
Results Sixty-three studies with 5131 participants met the inclusion criteria. Participants' ages ranged from 4 to 74 years. Twenty studies (n = 1814 patients) enrolled only children. The risk of bias was medium in 43 studies (68%). Strong evidence supports that sublingual immunotherapy improves asthma symptoms, with 8 of 13 studies reporting greater than 40% improvement vs the comparator. Moderate evidence supports that sublingual immunotherapy use decreases rhinitis or rhinoconjunctivitis symptoms, with 9 of 36 studies demonstrating greater than 40% improvement vs the comparator. Medication use for asthma and allergies decreased by more than 40% in 16 of 41 studies of sublingual immunotherapy with moderate grade evidence. Moderate evidence supports that sublingual immunotherapy improves conjunctivitis symptoms (13 studies), combined symptom and medication scores (20 studies), and disease-specific quality of life (8 studies). Local reactions were frequent, but anaphylaxis was not reported.
Conclusions and Relevance The overall evidence provides a moderate grade level of evidence to support the effectiveness of sublingual immunotherapy for the treatment of allergic rhinitis and asthma, but high-quality studies are still needed to answer questions regarding optimal dosing strategies. There were limitations in the standardization of adverse events reporting, but no life-threatening adverse events were noted in this review.

Lin SY, Erekosima N, Kim JM et al. JAMA. 2013;309(12):1278-1288

Promising results with SLIT for childhood grass pollen allergy

2012-09-04T08:55:00.000-04:00

High-dose sublingual immunotherapy (SLIT) effectively reduces allergic symptoms and medication use in children with grass pollen-allergic rhinoconjunctivitis, show study results. To test its viability in children, Ulrich Wahn (Charité Medical University, Berlin, Germany) and colleagues carried out a randomized, placebo-controlled trial of high-dose SLIT for grass pollen allergy in 179 children (132 SLIT; 47 placebo) aged 4‑12 years. The children who received SLIT were given up to 4 drops per day (3600‑4800 µg) of a aqueous grass solution containing equal extracts from six species of grass (Dactylis glomerata, Festuca pratensis, Holcus lanatus, Lolium perenne, Phleum pratense, and Poa pratensis). Treatment took place between January and August.

"This study confirmed that this SLIT preparation significantly reduced symptoms and medication use in children with grass pollen-allergic rhinoconjunctivitis," write Wahn et al in the Journal of Allergy and Clinical Immunology. "Such standardized studies in the pediatric population are considered necessary and will allow researchers to compare different results and to build more appropriate meta-analyses with more reliable conclusions about SLIT efficacy and safety in allergic children."

http://www.news-medical.net/news/20120831/Promising-results-with-SLIT-for-childhood-grass-pollen-allergy.aspx
http://www.jacionline.org/article/S0091-6749(12)01118-9/abstract

Beat Allergies Drop by Drop

2012-07-31T07:12:00.000-04:00

July 30, 2012, Wall Street Journal.

An increasingly popular alternative to allergy shots is a sweet-tasting liquid taken under the tongue at home. The treatment, called "sublingual immunotherapy," has been proven effective in several recent large studies. It is available in Europe in tablet form, and in the U.S., doctors repurpose the liquid extracts of allergens used in shots for delivery under the tongue with an eyedropper, syringe or hand pump.

http://online.wsj.com/article/SB10000872396390444226904577559120291051452.html?mod=googlenews_wsj

GREER(R) Reports Positive Findings from Large Phase III Clinical Trial Evaluating Sublingual Immunotherapy for Ragweed Allergies

2012-06-14T08:52:00.000-04:00

Trial reaches objectives of significantly reducing allergy symptom scores and anti-allergy medication use during ragweed pollen season.
http://www.marketwatch.com/story/greerr-reports-positive-findings-from-large-phase-iii-clinical-trial-evaluating-sublingual-immunotherapy-for-ragweed-allergies-2012-06-12

Sublingual immunotherapy (SLIT) vs subcutaneous immunotherapy (SCIT)

2012-06-11T10:27:00.000-04:00

Sublingual immunotherapy (SLIT) is gaining acceptance in otolaryngology circles, but is it really any better than subcutaneous injections? Which patients can benefit from it? How can it affect practice?

These are questions ENT Today set out to answer by asking three physicians who use SLIT in practice: Bradley F. Marple, MD, Professor of Otolaryngology at University of Texas Southwestern Medical School; Mary Morris, MD, an allergist and partner at Allergy Associates of La Crosse, and Medical Director for Allergy Choices in Wisconsin; and Steven B. Levine, MD, Assistant Clinical Professor of Otolaryngology at Yale University.
http://www.entoday.com/pt/re/entoday/fulltext.01265117-200902000-00008.htm;jsessionid=JhTWS5gTNn4PdG2TZ49QNB84FkkxXlGJkHYxrdqmMHW7LLHvlVC9!-858031623!181195628!8091!-1

Novel Routes for Allergen Immunotherapy

2012-04-12T22:31:00.000-04:00

Allergen immunotherapy is the only curative treatment of IgE-mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) is used as a reference therapy and has transformed allergic treatments; it improves symptoms (asthma and rhinitis) as well as the quality of life of patients. SCIT requires repetitive administration and carries the risk of severe systemic adverse effects, including anaphylaxis. Sublingual immunotherapy (SLIT) is now a valid noninvasive alternative to SCIT, as a safe and efficacious treatment for respiratory allergies. In this article, we compare various routes of allergen immunotherapy, including SCIT and SLIT, as well as more exploratory routes currently under investigation (i.e., intralymphatic, epicutaneous, intranasal and oral). We discuss their respective advantages, as well as their foreseen modes of action.

Posted: 04/10/2012; Immunotherapy. 2012;4(2):201-212.
http://www.medscape.com/viewarticle/761450

From Medscape Medical News: Sublingual Immunotherapy Improves Ragweed Allergy

2012-03-29T11:06:00.000-04:00

March 28, 2012 (Orlando, Florida) — Children who undergo a prolonged trial of sublingual immunotherapy (SLIT) before undertaking oral immunotherapy (OIT) for milk allergy have fewer treatment-related symptoms, particularly severe ones, than those on OIT alone, according to a study reported here at the American Academy of Allergy, Asthma and Immunology (AAAAI) 2012 Annual Meeting.
"We found that prolonged SLIT before OIT improved safety and reduced severe symptoms but did not eliminate all symptoms." There was also no difference in food-challenge thresholds, reported Shannon Seopaul, a research assistant at Johns Hopkins University in Baltimore, Maryland. "At this time, we can't say that prolonged SLIT before OIT is any more effective than OIT itself."

The study was part of a larger study that compared SLIT alone with SLIT followed by OIT (J Allergy Clin Immunol. 2012;129:448-455).

http://www.medscape.com/viewarticle/761136

Treating food allergy with sublingual immunotherapy (SLIT) news made CNN

2012-03-06T09:11:00.000-05:00

http://thechart.blogs.cnn.com/2012/03/05/experimental-treatment-may-help-food-allergies/

Treatment for food allergies showing progress

2012-03-05T14:37:00.002-05:00

ORLANDO, Fla. – Combined treatment of food allergies that includes both sublingual immunotherapy (SLIT) and oral immunotherapy appears to be effective in children who are severely allergic to milk, according to findings presented here during the 2012 Annual Meeting of the American Academy of Allergy, Asthma and Immunology.

Robert A. Wood, MD, director of Allergy & Immunology at Johns Hopkins Children’s Center, presented new study results that indicated children with severe milk allergy who received a longer schedule of sublingual immunotherapy and then moved to oral immunotherapy had less respiratory reactions, along with less frequent use of certain medications.

“While the overall result of the study, which was recently published in The Journal of Allergy and Clinical Immunology, found that oral was far more effective than sublingual immunotherapy, it was also clear that oral was associated with more significant allergic reactions to the treatment,” Wood, who is the senior study author, said in a press release.

The difference between sublingual and oral immunotherapy is that the allergen is held under the tongue with sublingual, where the allergen is simply swallowed with oral immunotherapy.

Previous research by Wood and colleagues compared sublingual therapy (allergen is held under the tongue) with oral immunotherapy (allergen is swallowed) after a short period of increasing sublingual doses. In the current study, the same researchers from Johns Hopkins and Duke University tested patients to determine if a longer period on sublingual and then oral immunotherapy would improve the safety of the treatment.

Thirty children with cow’s milk allergy were randomly placed into two groups that received either a short or longer sublingual schedule followed by oral immunotherapy. Eight patients who received sublingual therapy were moved to oral immunotherapy. After comparing reactions across the doses, the study authors concluded that the longer sublingual schedule before switching to oral immunotherapy appeared to improve safety, although it did not eliminate all symptoms. Symptoms occurred with approximately 25% of 2,251 doses.
While the overall rates of reaction between the two groups were similar, the longer sublingual immunotherapy group followed by oral immunotherapy had fewer lower and upper respiratory reactions and used antihistamines and inhaled beta-agonists less frequently, according to the study findings.

“We continue to search for the best approach for the treatment of food allergy. This study shows that for at least some children, especially those with more frequent or severe reactions to oral immunotherapy, beginning treatment with sublingual might be beneficial,” Wood said.

http://www.pediatricsupersite.com/view.aspx?rid=95272

Patients exhibited comparable treatment with SLIT as with SCIT

2012-03-02T22:22:00.001-05:00

March 2, 2012 ORLANDO, Fla. — Sublingual immunotherapy compared with traditional subcutaneous immunotherapy resulted in comparable results, according to data presented at the 2012 Annual Meeting of the American Academy of Allergy, Asthma and Immunology.

Subcutaneous immunotherapy (SCIT) has been effective in stimulating prolonged remission of allergic rhinitis, but has been implicated in association with allergic side effects. In previous studies, an alternative strategy using sublingual immunotherapy (SLIT) has demonstrated an approximate 30% reduction in symptom scores and a 40% reduction in medication use during the summer months.

To investigate the long-term effects of SLIT as a beneficial alternative to SCIT — whether SLIT induces tolerance and by what mechanism — Stephen R. Durham, MA, MD, and colleagues compared approaches in patients with severe hay fever using SCIT as a positive control. In a double-blind, placebo-controlled, double-dummy study, lasting 1 year, the investigators enrolled 50 patients to compare SLIT with placebo and SCIT with placebo, with a special focus on the comparison between SLIT and placebo. In this small study, researchers found that similar effects were produced from both approaches.

Durham SR. Course 1204. Subcutaneous vs. sublingual immunotherapy for aeroallergens. Presented at: the 2012 AAAAI Annual Meeting; March 2-6, 2012; Orlando. http://www.pediatricsupersite.com/view.aspx?rid=95262

Disease-modification of allergic rhinoconjunctivitis by sublingual grass immunotherapy

2012-02-07T09:41:00.001-05:00

Specific immunotherapy is highly effective for treatment of seasonal allergic rhinitis, particularly where symptomatic medications have proved ineffective or their use is limited by side effects. A major advantage of subcutaneous immunotherapy is the induction of long-term clinical and immunologic tolerance for years after discontinuation. Now it has been demonstrated, using the sublingual route that long-term tolerance similarly can be achieved.

http://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/disease-modification-allergic-rhinoconjunctivit.aspx

Quality of Life Improvement with Sublingual Immunotherapy: A Prospective Study of Efficacy

2012-02-05T15:31:00.001-05:00

Due to its excellent safety profile, ease of administration, and economic considerations, sublingual immunotherapy (SLIT) is becoming a preferred form of allergen specific immunotherapy. The efficacy of SLIT is still debated. The purpose of this act of practice trial is to evaluate quality of life outcomes in patients treated with SLIT. Fifty one patients with allergic rhinoconjunctivitis demonstrated by skin testing completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) at initiation, at four months and at 10–12 months of SLIT. Significant improvement (p<0.05) on six of seven domain categories of the RQLQ questionnaire was noted. Total RQLQ scores also showed significant improvement. This study supports SLIT as a modality effective in controlling allergic symptoms.

Morris MS, Lowery A, Theodoropoulos DS et al. Journal of Allergy. Volume 2012 (2012).
http://www.hindawi.com/journals/ja/2012/253879/abs/

Powder Tops Drops for Treating Milk Allergies

2011-12-13T07:07:00.001-05:00

A larger percentage of children with cow's milk allergies achieved desensitization with high doses of powdered milk protein than with low-dose liquid drops, according to a small, randomized study. After therapy, one of 10 patients in the liquid drops group passed a milk challenge, compared with six of 10 patients in a low-dose milk powder group and eight of 10 patients in a high-dose milk powder group, reported Corinne Keet, MD, from Johns Hopkins Hospital, and colleagues.

Oral and sublingual immunotherapies are viable therapies for food allergies, but the optimal mode of administration, mechanism of action, and duration of response are unknown, the authors explained. Previous research by these investigators demonstrated that both approaches can mitigate allergic symptoms, but this is the first head-to-head comparison of the two therapies with regard to efficacy and side effects.

Limitations to this study included the lack of a placebo group and variations in the day-to-day food challenge threshold. Also, the study did not assess whether starting liquid drops first eased the transition to milk powder.

The findings highlight the value of routine milk consumption to preserve desensitization and to avoid relapse, the authors said. The investigators called for more research and warned that because of the risk for serious allergic reactions, neither therapy should be undertaken without medical supervision.

http://www.medpagetoday.com/AllergyImmunology/Allergy/30180

From Medscape Medical News: Sublingual Immunotherapy Improves Ragweed Allergy

2011-11-10T07:07:00.001-05:00

November 9, 2011 (Boston, Massachusetts) — Sublingual immunotherapy for ragweed allergy with ragweed allergy immunotherapy tablets (AIT) is safe and effective, according to a first of its kind study of more than 500 multisensitized North American adults, presented in a poster session here at the American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting.
http://www.medscape.com/viewarticle/753209

Allergen-specific sublingual immunotherapy in the treatment of migraines: a prospective study

2011-10-11T14:43:00.000-04:00

In patients with allergic rhinitis, migraine development and course may have a significant allergic component. Assessment of migraineurs for the possibility of co-existing allergic rhinitis is justified. Treatment of allergic rhinitis by immune response modifiers, such as immunotherapy, may have a place in the management of migraines for these patients.

The allergic patients in this study with migrane were successfully treated with sublingual immunotherapy.

D.S. Theodoropoulos, D.R. Katzenberger, W.M. Jones et al. Eur Rev Med Pharmacol Sci 2011; 15 (10): 1117-1121. http://www.europeanreview.org/article/1044

Stamford University has now joined the list of studies looking at sublingual immunotherapy.

2011-10-09T11:55:00.000-04:00

Go to http://med.stanford.edu/clinicaltrials/detail.do?studyId=8549.

Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis

2011-08-25T21:05:00.000-04:00

Background. Allergic conjunctivitis (AC) is a common manifestation and represents an important co-morbidity of allergic rhinitis (AR). Sublingual immunotherapy (SLIT) is an effective and safe treatment for nasal symptoms of AR; its effectiveness is however less well established for ocular symptoms.

Objectives. To evaluate the effectiveness of SLIT in reducing ocular symptoms, the need for ocular treatments and the threshold exposure for conjunctival immediate allergen sensitivity (CIAS).

Methods. We searched eight databases up to January 2010. We included only randomized controlled trials (RCT), double-blind and placebo-controlled evaluating the efficacy of SLIT in patients with symptoms of allergic rhinoconjunctivitis (ARC) or AC. Primary outcome measures were total ocular symptom scores, individual ocular symptoms scores (itchy eyes, eye redness, watery eyes, swelling eyes), eye drops use and CIAS. Meta-analysis was undertaken using RevMan 5 software.

Results. From 811 abstracts that were screened, 109 studies were reviewed in their full text version. Forty two trials including 3958 participants (n=2011 SLIT and n=1947 placebo) had data suitable for inclusion in the meta-analysis. SLIT induced a significant reduction on both total ocular symptom scores (SMD: −0.41; 95%CI: −0.53 to −0.28; I²: 59%) and individual ocular symptoms scores [red (−0.33; −0.45 to −0.22), itchy (−0.31; −0.42 to −0.20) and watery eyes (−0.23; −0.34 to −0.11)] compared with placebo. Participants in the SLIT group showed an increase in the threshold dose for the CIAS (SMD: 0.35; 0.00–0.69). No significant reduction was observed on eye drops use (SMD: −0.10; −0.22 to 0.03).

Conclusions and Clinical Relevance. SLIT is effective in reducing total and individual ocular symptom scores in subjects with ARC or conjunctivitis. No significant reduction was observed in ocular eye drops use.

Cite this as: M. A. Calderon, M. Penagos, A. Sheikh, G. W. Canonica and S. R. Durham, Clinical & Experimental Allergy, 2011 (41) 1263–1272. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2011.03835.x/abstract

Efficacy of sublingual immunotherapy for grass pollen allergy sustained over time

2011-08-12T11:53:00.000-04:00

The link below is a video clip from www.thedoctorschannnel.com reporting that sublingual immunotherapy (SLIT) is effective.
http://www.thedoctorschannel.com/video/4602.html

ALK: Phase III studies with ragweed allergy immunotherapy tablet (AIT) meet primary endpoints

2011-08-04T07:25:00.000-04:00

ALK announces successful outcome of two Phase III clinical studies of the new innovative ragweed tablet. Both studies met the primary efficacy endpoints and the efficacy results were consistent between the two studies. Copenhagen, 2011-08-03 12:53 CEST (GLOBE NEWSWIRE) --

http://www.cisionwire.com/alk-abello-g/r/alk--phase-iii-studies-with-ragweed-allergy-immunotherapy-tablet--ait--meet-primary-endpoints,e249906

This study among others will lead the Food and Drug Administration (FDA) to ultimately approve sublingual immunotherapy (SLIT) for commerial use.

Sublingual immunotherapy (SLIT) review: effective, with no reported anaphylaxis or epinephrine use

2011-08-01T07:39:00.000-04:00

Allergic rhinitis is common worldwide, with significant morbidity and impact on quality of life. In patients who don’t respond adequately to anti-allergic drugs, subcutaneous allergen immunotherapy (SCIT) is effective but requires specialist administration. Sublingual immunotherapy (SLIT) may represent an effective and safer alternative, according to the review authors. I would add that SLIT requires specialist prescription and monitoring as well.

This Cochrane systematic review is an update of one published in 2003, and included 49 randomised, double-blind, placebo- controlled trials of sublingual immunotherapy in adults and children. There were significant reductions in symptoms (standardised mean difference (SMD), −0.49; P less than 0.00001) and medication requirements (SMD −0.32) compared with placebo. None of the trials reported severe systemic reactions, anaphylaxis or use of adrenaline (epinephrine). The authors concluded that sublingual immunotherapy (SLIT) is effective for allergic rhinitis and appears a safe route of administration.

References: Radulovic S, Wilson D, Calderon M, Durham S. Systematic reviews of sublingual immunotherapy (SLIT). Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02583.x.

Allergy Notes: Allergy and Asthma News Updated Daily by Allergist and Assistant Professor at University of Chicago. http://allergynotes.blogspot.com/2011/07/sublingual-immunotherapy-slit-review.html.

Sublingual immunotherapy for allergic respiratory diseases: efficacy and safety.

2011-05-07T10:09:00.000-04:00

Subcutaneous immunotherapy (SCIT) is effective and safe when properly prescribed and administered. However, a certain risk of severe side effects exists, even when the reaction is managed correctly. These potential adverse effects stimulated the search for new administration routes (nasal, bronchial, oral, sublingual), which were expected to be safer. Not all of these alternative routes provided an improved benefit-safety profile compared with SCIT. The sublingual route (SLIT) seemed to be a good candidate for the clinical practice because of its satisfactory safety profile and is now considered an acceptable alternative to SCIT in adults and children.

Passalacqua G, Canonica GW. Immunol Allergy Clin North Am. 2011 May;31(2):265-77.
http://www.ncbi.nlm.nih.gov/pubmed/21530819