SLIT: indications, follow-up, and management.

Area of Science:

• Allergy and Immunology
• Respiratory Medicine

Background:

• Sublingual immunotherapy (SLIT) is recognized as a safe and effective treatment for respiratory allergies.
• Existing research on SLIT presents heterogeneity, complicating clinical application and decision-making regarding patient selection, dosing, and adverse event management.

Purpose of the Study:

• To review current evidence on SLIT, focusing on pollen allergies.
• To address knowledge gaps in patient selection, optimal dosing, asthma effects, long-term outcomes, and adverse reaction management.
• To provide practical algorithms for SLIT candidate selection and adverse event management.

Main Methods:

• A systematic PubMed search identified 850 articles, from which 266 were selected for review.
• Evidence was graded using the Oxford classification system.
• The QUASAR Group, comprising experienced allergologists, reviewed and evaluated findings to reach consensus.

Main Results:

• The review synthesizes evidence on SLIT efficacy, particularly for pollen allergies.
• Identified areas with insufficient evidence, proposing expert-agreed alternatives.
• Developed algorithms for SLIT candidate selection and management of adverse events.

Conclusions:

• SLIT is a valuable therapeutic option for allergic rhinitis.
• Standardized guidelines are needed for optimal SLIT implementation, including patient selection and adverse event handling.
• The proposed algorithms aim to support clinicians in the effective and safe administration of SLIT.