[Comparison of injection-related and local immunotherapy]

Allergen-specific immunotherapy is a well-accepted method in the management of respiratory allergic diseases, applied since over 90 years. Traditional immunotherapy is the practice of subcutaneous administering to subjects with allergy, increasing amounts of modified allergen to achieve hyposensitisation. Recently other routes of allergen administration were proposed including bronchial, nasal, oral and sublingual routes. Controlled trials failed to demonstrate the clinical efficacy and the safety of oral and bronchial administration. Nasal immunotherapy is also declining due to limited efficacy and special administration technique. The sublingual route is safe and efficacious. Unfortunately, up to date no well-designed controlled study comparing subcutaneous with sublingual methods of immunotherapy is available. Still several points need to be elucidated, including long lasting efficacy, mechanism of action, optimal dose, adherence to this therapy and cost-effectiveness. However, sublingual immunotherapy is now accepted by WHO as a valid alternative to the subcutaneous route and should be used in all patients who require immunotherapy and do not accept subcutaneous route of allergen administration. One question is presently beyond discussion: it is better to administer sublingual immunotherapy in patients with allergic diseases than not to give immunotherapy at all.