Current status of sublingual immunotherapy in the United States

Sublingual immunotherapy (SLIT) use in the United States to date has been limited, despite common use and demonstrated efficacy elsewhere in the world. This is largely in part due to lack of FDA-approved SLIT products, lack of established dosing and administration guidelines, and cost concerns. Several recent studies have demonstrated efficacy and safety of two sublingual grass tablets and one ragweed tablet approved by the FDA, and one sublingual ragweed liquid currently pending FDA approval. With FDA approved SLIT products, there will be numerous challenges to the allergist and patient in deciding whether to pursue SLIT or SCIT (subcutaneous immunotherapy) for allergic rhinitis. This review highlights the current state of SLIT in the United States, and expected future directions.