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SLIT: indications, follow-up, and management


I Dávila1, A Navarro2, J Domínguez-Ortega3, A Alonso4, D Antolín-Amérigo5, MC Diéguez6, E González-Mancebo7, C Martín8, C Martínez9, B Núñez10, N Prior11, M Reche12, A Rosado13, J Ruiz-Hornillos14, A Sansosti15, M Torrecillas16, MJ Jerez17; QUASAR Group (QUality in the Administration of SLIT in Allergic Rhinitis)

1Servicio de Alergia, Hospital Universitario de Salamanca, IBSAL, Salamanca
2UGC Intercentros Alergología Sevilla, Hospital El Tomillar, Sevilla
3Servicio de Alergia, IDIPAZ, Hospital Universitario La Paz, Madrid
4Alianza Médica, Valladolid
5Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid
6Servicio de Alergia, Hospital Universitario Doce de Octubre, Madrid
7Unidad de Alergia, Hospital Universitario de Fuenlabrada, Madrid
8Servicio de Alergia, Complejo Hospitalario de Zamora
9Servicio de Alergia, Complejo Hospitalario de Zamora
10Unidad de Alergia, Hospital Universitario de Getafe, Madrid
11Unidad de Alergia, Hospital Universitario Severo Ochoa, Leganés, Madrid
12Servicio de Alergia, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid
13Unidad de Alergia, Hospital Universitario Fundación Alcorcón, Madrid
14Unidad de Alergia, Hospital Universitario Infanta Elena ISS-FJD, Valdemoro, Madrid
15Servicio de Alergología, Althaia, Xarxa Assitencial Universitaria de Manresa, Barcelona
16Servicio de Alergia, Complejo Hospitalario Universitario de Albacete
17Nature Publishing Group Iberoamérica, Madrid

J Investig Allergol Clin Immunol 2013; Vol. 24, Suppl. 1: 1-35



Specific sublingual immunotherapy (SLIT) has been proved to be a safe and effective approach in respiratory allergy. However, further research is required on aspects such as patient selection, use of optimal dosing, effects on asthma, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on SLIT performed to date and the application of the criteria for subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Therefore, the QUASAR Group (QUality in the Administration of SLIT in Allergic Rhinitis), which comprises allergologists with broad clinical experience in SLIT,
investigated the latest research findings and available data on this approach. Working parties were formed in 3 different categories: selection of candidates for SLIT, treatment efficacy, and adverse reactions. We performed a PubMed search for articles that were representative of each category and found 850. From these, we finally selected 266 articles, which were reviewed to retrieve data on SLIT. Evidence for each clinical question was graded according to the Oxford classification. The resulting text was evaluated on 3 occasions by all the members of the group until the final version was agreed upon. In this version, we review available evidence on SLIT, particularly with pollens, which is the subject of most articles. In areas where evidence is insufficient, an alternative agreed upon by the members of the QUASAR group is presented. Finally, we propose algorithms for selecting candidates for SLIT and for management of adverse events.

Key words: SLIT. Adverse reactions. Evidence. Adherence. Efficacy of SLIT. Patient selection. Allergic rhinitis.