➤ 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.
