Sublingual immunotherapy for children: Are we there yet? Defining its role in clinical practice

Immunotherapy in various forms has been used to treat allergic disorders since the early 19th century. Subcutaneous immunotherapy is now well established for the treatment of insect anaphylaxis and allergic rhinitis. The route of administration and possibility of severe adverse reactions to subcutaneous immunotherapy make sublingual immunotherapy an appealing alternative, especially for the paediatric patient. This form of immunotherapy has been increasingly used in Europe, and over the past decade several meta analyses have attempted to provide evidence for its efficacy in the treatment of seasonal and perennial allergic rhinitis and in asthma, both in the adult and paediatric population. Several trials have also shown a potential immunomodulatory effect of sublingual immunotherapy, with evidence of a reduction in the progression from allergic rhinitis to asthma and reduced new aeroallergen sensitisation. This review will give an overview of the current evidence for sublingual immunotherapy in the paediatric population.