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Updated: Sep 6, 2025
Sublingual Immunotherapy as an Alternative to Induce Protection Against Acute Respiratory Infections
Published on: August 30, 2014
Morning Versus Evening Dosing of Sublingual Immunotherapy in Allergic Asthma: A Prospective Study
Feng Liao1, Shi Chen1, Ling Wang1
1Center for Prevention and Treatment of Pediatric Asthma, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Hainan, China.
Insights
Evening sublingual immunotherapy (SLIT) for allergic asthma (AS) in children is effective and well-tolerated. Evening dosing may improve asthma control and reduce nitric oxide levels compared to morning dosing.
Area of Science:
- Allergy and Immunology
- Pediatric Pulmonology
- Immunotherapy
Background:
- Sublingual immunotherapy (SLIT) is an established treatment for pediatric allergic asthma (AS).
- Optimal timing for SLIT administration remains an area requiring further investigation.
- House dust mite (HDM) allergy is a common trigger for AS in children.
Purpose of the Study:
- To compare the efficacy and safety of morning versus evening sublingual immunotherapy (SLIT) dosing in children with allergic asthma (AS).
- To evaluate the impact of administration timing on asthma control, pulmonary function, and fractional exhaled nitric oxide (FeNO).
Main Methods:
- A 1-year randomized controlled trial involving 163 children (aged 4-13 years) with AS.
- Participants were assigned to either morning dosing (MD) or evening dosing (ED) of Dermatophagoides farinae SLIT.
- Outcomes included Asthma Control Questionnaire (ACQ), FeNO, pulmonary function tests, and adverse events (AEs).
Main Results:
- Both MD and ED groups showed significant improvements in clinical efficacy, pulmonary function, and FeNO after 1 year.
- The ED group demonstrated significantly lower ACQ scores at 0.5 years and lower FeNO levels at 1 year compared to the MD group.
- No significant difference in AE rates was observed between the groups, with all AEs occurring early and being mild.
Conclusions:
- One-year house dust mite (HDM) SLIT is effective and safe for pediatric allergic asthma (AS) irrespective of administration time.
- Evening SLIT dosing may offer enhanced asthma control and a greater reduction in FeNO levels compared to morning dosing.
- Further research into chronotherapy for SLIT in pediatric allergic diseases is warranted.
Background:
Sublingual immunotherapy (SLIT) has been proved to be an effective and safe treatment for allergic asthma (AS) in children. Nonetheless, several issues regarding SLIT remain to be resolved, including the information about optimal administration timing.
Methods:
A total of 163 AS children aged 4-13 years were enrolled and randomized into the morning dosing (MD) group and the evening dosing (ED) group. Participants received SLIT with Dermatophagoides farinae drops between 7:00 a. m. and 9:00 a.m. (for the MD group) or between 8:00 p. m. and 10:00 p.m. (for the ED group). The total asthma symptom score (TASS), total asthma medicine score (TAMS), Asthma Control Questionnaire (ACQ), forced expiratory volume in one second (FEV1), FEV1/forced volume vital capacity (FVC), fractional exhaled nitric oxide (FeNO) and adverse events (AEs) were assessed at baseline, 0.5 and 1 year during the 1-year SLIT.
Results:
After 1 year, 62 patients in the MD group and 63 patients in the ED group completed the entire study. The clinical efficacy, pulmonary function and FeNO in both groups improved significantly at 0.5 and 1 year (p < 0.001). Compared to the MD group, the ED group showed significant lower ACQ score at 0.5 year (p < 0.001) and lower FeNO at 1 year (p < 0.05). No significant difference between two groups was observed in AE rate (p > 0.05). All AEs occurred in the first month, with no systemic AEs reported.
Conclusion:
1-year house dust mite (HDM) SLIT is effective and well-tolerated in AS children regardless of administration time. SLIT dosing in the evening might enhance the asthma control level and reduce FeNO level compared with SLIT dosing in the morning.
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