Table DSublingual Immunotherapy: Summary of allergens, comparators, and main results per outcome

OutcomeNumber of StudiesNumber of ParticipantsAllergen (Number of Studies)Comparator (Number of Studies)Findings*Strength of Evidence
Symptom Scores
Asthma symptoms13625Dust mite (7)
Alternaria (2)
Grass mix (1)
Tree mix (1)
Birch (1)
Parietaria (1)
SLIT
vs. Placebo (12)
vs. Inhaled steroids (1)
vs. SLIT (1) (placebo controlled)
All placebo controlled studies demonstrated significant improvement in the SLIT group. The remaining study showed improvement in both arms.High that SLIT improves asthma symptoms more than comparators
Rhinitis or rhinoconjunctivitis symptoms352,658Grass mix (10)
Dust mite (8)
Parietaria (3)
Cedar (3)
Timothy (2)
Ragweed (2)
Birch (2)
Olive (1)
Cat (1)
Tree mix (1)
Multiple (2)
SLIT
vs. Placebo (32)
vs. Pharmacotherapy (2)
vs. SLIT (2) (placebo controlled)
All studies showed greater improvement in symptoms in the SLIT group when compared with placebo.Moderate that SLIT improves rhinitis or rhinoconjunctivitis symptoms more than comparators
Asthma plus rhinitis or rhinoconjunctivitis symptoms5308Alternaria (1)
Birch (1)
Tree mix (1)
Dust mite (1)
Multiple (1)
SLIT
vs. Placebo (4)
vs. SLIT (3) (2 placebo controlled, 1 pharmacotherapy controlled)
4 studies demonstrated significant improvement in the SLIT group. 1 study found no improvement in symptoms (placebo controlled).Moderate that SLIT improves asthma plus rhinitis or rhinoconjunctivitis symptoms more than comparators
Conjunctivitis symptoms131,074Grass mix (3)
Dust mite (2)
Timothy (1)
Ragweed (1)
Parietaria (2)
Cedar (1)
Olive (1)
Multiple (2)
SLIT
vs. Placebo (12)
vs. SLIT (1) (placebo controlled)
11 studies showed greater improvement in symptoms in the SLIT group when compared with placebo. 2 studies showed no significant results.Moderate that SLIT improves conjunctivitis symptoms more than comparators
Medication Scores
Medication use382,724Grass mix (9)
Dust mite (8)
Parietaria (4)
Cedar (3)
Timothy (2)
Ragweed(2)
Birch (2)
Alternaria (2)
Tree mix (2)
Olive (1)
Multiple (3)
SLIT
vs. Placebo (33)
vs. Pharmacotherapy (2)
vs. SLIT (5) (placebo controlled)
17 studies showed reduction in medication consumption in the SLIT group when compared with placebo (11 were statistically significant). 4 studies showed a significant reduction in medication consumption in the SLIT group when compared with pharmacotherapy. 12 studies did not show any benefit. 5 studies showed improvement in the SLIT arm only when comparing initial with final scores.**Moderate that SLIT improves medication use more than comparators
Combined Symptom and Medication Scores
Combined medication plus symptoms scores191,462Cedar (5)
Parietaria (3)
Grass mix (3)
Dust mite (1)
Alternaria (1)
Ragweed (1)
Multiple (5)
SLIT
vs. Placebo (12)
vs. Pharmacotherapy (2)
vs. Nothing (2)
vs. SLIT (3) (1 placebo controlled, 1 pharmacotherapy controlled, 1 no SLIT controlled)
10 studies showed greater improvement in the SLIT group than in the comparator group. 5 studies did not find a significant difference between comparators. 4 studies showed improvement in the SLIT arm only when comparing initial with final scores.**Moderate that SLIT improves combined medication plus symptoms scores more than comparators
Disease-specific quality of life8819Cedar (4)
Dust mite (2)
Grass mix (1)
Multiple (1)
SLIT
vs. Placebo (8)
4 studies reported significant improvement in disease-specific quality of life when compared with placebo. 2 studies showed no difference. 2 studies reported significant improvement in the SLIT group when comparing initial with final quality of life scores.**Moderate that SLIT improves disease-specific quality of life more than comparators
Other Outcomes
Pulmonary function testing141,375Dust mite (4)
Multiple (5)
SLIT
vs. Placebo (14)
SLIT consistently improves measure of pulmonary function in the allergic asthmatic population.Not graded
Allergen challenges10SLIT consistently improves response to challenges in the allergic population.Not graded

SLIT = sublingual immunotherapy

*

This column presents a summary of the relevant findings. Numbers in this column may not match the total numbers of studies included per outcome; for some outcomes, studies reported more than one comparison per outcome (e.g. different dosage groups).

**

Results from pre-post comparisons did not contribute to the evidence grades, as their design was not as strong as head-to-head comparisons. We included these results in the tables for informational purposes only.

From: Executive Summary

Cover of Allergen-Specific Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and/or Asthma: Comparative Effectiveness Review
Allergen-Specific Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and/or Asthma: Comparative Effectiveness Review [Internet].
Comparative Effectiveness Reviews, No. 111.
Lin SY, Erekosima N, Suarez-Cuervo C, et al.

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