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Sublingual Immunotherapy

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Treatment ➤ Summary Statement (SS) 1: Use only FDA-approved SLIT products for the treatment of allergic rhinitis/rhinoconjunctivitis and not for any other related or unrelated condition. (S-A/B) ➤ SS2: The physician should be aware that SLIT may not be suitable in patients with certain medical conditions, particularly those that may reduce the patient's ability to survive a systemic reaction or the resultant treatment of the systemic reaction. (S-D) ➤ SS3: Use FDA-approved SLIT products very cautiously in the pregnant or breastfeeding patient because there are insufficient data regarding the safety of initiating or continuing SLIT during either pregnancy or breastfeeding. (W-C) ➤ SS4: Do not assume dosing equivalence between SLIT tablets and extracts of the same allergen. (W-C) Notes: There are no direct comparisons between the same allergen extract administered as a SLIT tablet vs. as an aqueous SLIT extract, and it is unknown whether equal efficacy and/or safety exists when using similar doses of the 2 preparations. Each formulation has to have its own safety profile established. ➤ SS5: Administer the patient's first dose of SLIT in a medical facility under the supervision of a physician or other health care professional with experience in the diagnosis and treatment of anaphylaxis. The patient should be observed in the clinic or medical facility for 30 minutes after the administration of the SLIT dose. (S-D) ➤ SS6: Prescribe epinephrine (either an autoinjector or other form for self- injection) to patients receiving SLIT tablets. (S-D) Notes: Patients should be trained how to use the device, instructed on how to recognize and manage adverse reactions and missed doses, and advised on when to contact their physician or other health care professional. Recommendations for when to withhold the SLIT tablet dose to avoid potential situations when systemic allergic reactions may be more likely should also be provided. ➤ SS7: Reduce a patient's SLIT dose if they have missed treatment for more than 7 days. (W-D) ➤ SS8: Schedule patients receiving SLIT therapy for regular follow-up care with a specialist trained in the evaluation of patients with allergic conditions to monitor efficacy and safety and as a strategy for optimizing adherence. (M-D)

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