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Sublingual Immunotherapy

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➤ It is crucial that the practicing allergist separate the data on FDA reviewed products that have led to approval of these products (ie, dust mites, grass and ragweed tablets) from the data in the literature with other allergens and other formulations (eg, liquid formulations) that have not undergone the rigor of FDA review. Key Points Table 1. World Allergy Organization Grading System for Sublingual Immunotherapy (SLIT) Local Reactions a Symptom/ sign Grade 1: mild Grade 2: moderate Grade 3: severe Unknown severity Pruritus/ swelling of mouth, tongue, or lip; throat irritation, nausea, abdominal pain, vomiting, diarrhea, heartburn, or uvular edema • Not troublesome AND • No symptomatic treatment required AND • No discontinuation of SLIT because of local side effects • Troublesome OR • Requires symptomatic treatment AND • No discontinuation of SLIT because of local side effects • Grade 2 AND • SLIT discontinued because of local side effects Treatment is discontinued, but there is neither subjective nor objective description of severity from the patient/ physician. Each local adverse event (AE) can be early (<30 minutes) or delayed. a Reprinted with permission from: Passalacqua G et al. J Allerg y Clin Immunol. 2013;132:93e98. IV.

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