Under the Tongue Allergy Management

Sublingual immunotherapy, or what I've entitled 'under the tongue allergy management' appears to be coming of age after having been used for many years in Europe, Rick and I agree on this week's PodMed.  That's based on a review of the literature done by our colleague Sandra Lin here at Hopkins and published in the Journal of the American Medical Association.  What exactly did they review?

Lin and colleagues searched the literature and found 63 studies, representing over 5000 subjects, that met their inclusion criteria for analysis.  About 1800 subjects were children, in whom this type of allergy therapy is particularly attractive.  The analysis determined the weight of evidence regarding sublingual immunotherapy for improving various aspects of allergic response, grading it as strong or moderate in several circumstances.  Specifically, strong evidence in favor of the technique was found for reducing symptoms of asthma. Moderate evidence was found for reducing rhinitis or rhinoconjunctivitis symptoms, and moderate evidence exists for improvement of rhinitis symptoms, a combined medication and symptom score, and disease-specific quality of life.

What's with the 'moderate' and 'strong' evidence conclusion?  As Rick explains in the podcast, since there was no standardization possible regarding dosages and other interventions across the breadth of studies included in this analysis, no statistical conclusions were possible for these outcomes.  There was, however, a 40% reduction in the use of medications to control asthma and allergies in 16 of 41 studies included.   Overall, the authors conclude that a moderate level of evidence exists in favor of sublingual immunotherapy but recommend that standardized studies conducted in a rigorous fashion be undertaken, something we certainly agree with and hope to see.  That's because the scope of the problem is huge, and likely growing. 

Right now, somewhere between 20 and 40% of the US population complains of allergic rhinitis, and it's a billion dollar industry.  So-called 'allergy shots' or subcutaneous immunotherapy, are tried by many to relieve the symptoms and avoid medication  use but themselves entail a host of problems, necessitating a visit to the physician's office, a mildly painful injection, and a 30 minute or so wait post-injection to make sure no systemic reactions occur. Injections are particularly disliked by children, of course.

In contrast, sublingual immunotherapy uses the self-same allergen preparations currently used for injection but simply places them under the tongue, so we have abundant clinical experience in their preparation already.  The patient or parent can administer the therapy at home, conveniently.  Without an office visit therapy is also less expensive. As someone who attempted subcutaneous injections for years to alleviate allergic rhinitis, I would definitely sign up for a study using the sublingual approach, and look forward to more on the subject.

Other topics this week include, in the same journal, a study panning use of chelation therapy after heart attack, 2 studies related to off-pump coronary artery bypass surgery in NEJM, and the impact of vitamin D levels during pregnancy in the BMJ.  Until next week,y'all live well.




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Under the Tongue Allergy Management | jhublogs
March 29, 2013 at 12:04 pm

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