Portal de Periódicos da CAPES

Dose-dependence of sublingual immunotherapy shown by meta-analysis

2011; Elsevier BV; Volume: 127; Issue: 4 Linguagem: Inglês

10.1016/j.jaci.2010.12.1091

1097-6825

Franco Frati, Cristoforo Incorvaia, Silvia Scurati, Laura Sensi, Francesco Marcucci,

Dermatology and Skin Diseases

To the Editor: Sublingual immunotherapy was recognized in recent years as a viable option to reduce the sensitivity to the causative allergens in treating respiratory allergy.1Canonica G.W. Passalacqua G. Noninjection routes for immunotherapy.J Allergy Clin Immunol. 2003; 111: 437-448Abstract Full Text Full Text PDF PubMed Scopus (302) Google Scholar Concerning the possible dose-dependence of sublingual immunotherapy efficacy, the Allergic Rhinitis and its Impact on Asthma document initially suggested that doses at least 50 to 100 times higher than those administered with subcutaneous immunotherapy by extracts from the same producer were needed to ensure treatment success.2Bousquet J, van Cauwenberge P, editors. Allergic Rhinitis and its Impact on Asthma. J Allergy Clin Immunol 2001;108(suppl 5):147-334.Google Scholar In the recent position paper of the World Allergy Organization, a monthly maintenance dose of about 600 μg of the major allergens was suggested as optimal for patients with grass-induced seasonal rhinitis.3Canonica G.W. Bousquet J. Casale T. Lockey R.F. Baena-Cagnani C. Pawankar R. et al.Sublingual immunotherapy: World Allergy Organization position paper 2009.Allergy. 2009; 64: 1-59PubMed Google Scholar However, these indications come from experts' opinions and are not supported by statistical investigation. The meta-analysis by Di Bona et al4Di Bona D. Plaia A. Scafidi V. Leto-Barone M.S. Di Lorenzo G. Efficacy of sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: a systematic review and meta-analysis.J Allergy Clin Immunol. 2010; 126: 558-566Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar on 19 randomized placebo-controlled trials including 2971 patients treated with grass pollen sublingual immunotherapy provides some interesting data on dose-dependence. In fact, analysis by monthly dose of major allergens showed that the median standardized mean difference of symptom scores was –0.47 in patients receiving doses from 276 to 600 μg compared with –0.16 in patients treated with a monthly dose up to 275 μg. The meta-analysis included studies from 1995 to 2009 that used very different doses, but the observation is in line with the findings from the recent trials performed on large populations of patients for the registration of the new standardized grass pollen tablets that unequivocally showed only high doses were effective.5Durham S.R. Yang W.H. Pedersen M.R. Johansen N. Rak S. Sublingual immunotherapy with once daily grass allergen tablet: a randomized controlled trial in seasonal allergic rhinoconjunctivitis.J Allergy Clin Immunol. 2006; 117: 802-809Abstract Full Text Full Text PDF PubMed Scopus (494) Google Scholar, 6Didier A. Malling H.J. Worm M. Horak F. Jager S. Montagut A. et al.Optimal dose, efficacy, and safety of once daily sublingual immunotherapy with a 5-grass pollen tablet for seasonal allergic rhinitis.J Allergy Clin Immunol. 2007; 120: 1338-1345Abstract Full Text Full Text PDF PubMed Scopus (451) Google Scholar In any case, definitive conclusions on the magnitude of sublingual immunotherapy efficacy should be drawn by studies on well defined populations of patients according to the clinical severity of allergy and to the measured levels of pollen exposure. Efficacy of sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: A systematic review and meta-analysisJournal of Allergy and Clinical ImmunologyVol. 126Issue 3PreviewThe benefit of sublingual immunotherapy (SLIT) with grass allergens for seasonal allergic rhinitis has been extensively studied, but data on efficacy are still equivocal. Full-Text PDF ReplyJournal of Allergy and Clinical ImmunologyVol. 127Issue 4PreviewTo the Editor: Full-Text PDF