Sublingual immunotherapy in children

Sublingual immunotherapy (SLIT) is a safe and patient-friendly variant of allergen immunotherapy. These characteristics may provide physicians with a therapy, perfectly suited to the treatment of allergic children. To give an overview of currently published studies on SLIT in children Pubmed was searched for randomised clinical trials (RCTs). In addition available systematic reviews and long-term observational studies were analysed. Until now, 13 RCTs on allergic rhinitis, 22 studies on asthma (including eight studies involving only children) and one study on atopic dermatis have been published. In addition, five systematic reviews on allergic rhinitis have been published and one is in press. One meta-analysis of adults and children with asthma has been reported. All studies report varying results. The effects and their magnitude differ between studies. Systematic reviews give inconsistent results. For allergic rhinitis three reviews appeared to be negative, two were positive and one analysis was inconsistent regarding children. In asthma a meta-analysis involving both adults and children concluded that SLIT is moderately effective. From observational studies effects of SLIT are suggested to persist after discontinuation. Randomised trials indicate that SLIT may prevent the onset of asthma and new sensitisations. As long as evidence for effectiveness is weak, SLIT cannot be firmly recommended in clinical practice. Nevertheless, the proven effectiveness of SLIT in adults supports the proof in principle of this therapy. In the near future immunotherapy trials in children may provide the required proof of effectiveness.

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