Future developments in sublingual immunotherapy

The increasing prevalence of allergic rhinitis and its progression to asthma has severe implications for patients and health care systems in many countries. An ideal therapy is one that is effective not only against symptoms but also towards the natural progression of the allergic disease. Immunotherapy is recognized to achieve both these aims. Administration of allergens by the sublingual route, a modality with a very low rate of systemic reactions, is widely considered a treatment of choice. However, if it is to be universally accepted, more developments are required. Although, it is effective against grass and other seasonal pollens, further controlled trials are needed to confirm its efficacy against perennial allergens. Additional studies, particularly in paediatric populations, are needed to confirm its long-term effects on disease progression. New vaccine developments, which take into account the increasing understanding of the underlying immune mechanisms and that exploit molecular engineering techniques will create allergens that are effective, stable, risk free and easy to administer.