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Sublingual and Injectable Customized Allergy Immunotherapy: Clinical and Cost-Effectiveness and Guidelines

Last updated: May 31, 2016
Project Number: RC0784-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of sublingual versus injectable forms of customized allergy immunotherapy in patients with allergies?
  2. What is the comparative clinical effectiveness of either the sublingual or injectable forms of customized allergy immunotherapy versus oral antihistamines in patients with allergies?
  3. What is the comparative cost-effectiveness of either the sublingual or injectable forms of customized allergy immunotherapy versus oral antihistamines in patients with allergies?
  4. What are the evidence-based guidelines associated with the use of either the sublingual or injectable forms of customized allergy immunotherapy in patients with allergies?

Key Message

Four systematic reviews, six RCTs, one cost-effectivess analysis (CEA) , and one evidence-based guideline were identified that provided evidence comparing SLIT to SCIT or oral antihistamines. Overall, the majority of evidence (of low to moderate quality) favoured SCIT over SLIT in reducing asthma or rhinitis symptoms or medication use. In one RCT involving oral antihistamine, the results favoured SLIT. While local and systemic adverse effects were reported, no deaths occurred during the included studies. A CEA done in Germany found the SLIT tablet Oralair® to be more cost-effective than antihistamine (loratadine) and steroid (budesonide) treatment. An evidence-based guideline recommended the use of immunotherapy after a patient has not responded to pharmacotherapy, and the patient has received counseling about avoiding allergens and about the adverse effects of immunotherapy.