The KAAACI Guidelines for Sublingual Immunotherapy

Abstract

Allergen immunotherapy is regarded as the only disease-modifying treatment option for various allergic conditions, including allergic rhinitis and asthma. Among the routes of administration of allergens, sublingual immunotherapy (SLIT) has gained clinical interest recently, and the prescription of SLIT is increasing among patients with allergies. After 30 years of SLIT use, numerous pieces of evidence supporting its efficacy, safety, and mechanism allows SLIT to be considered as an alternative option to subcutaneous immunotherapy. Based on the progressive development of SLIT, the current guideline from the Korean Academy of Asthma, Allergy, and Clinical Immunology aims to provide an expert opinion by allergy, pediatrics, and otorhinolaryngology specialists with an extensive literature review. This guideline addresses the use of SLIT, including 1) mechanisms of action, 2) appropriate patient selection for SLIT, 3) the currently available SLIT products in Korea, and 4) updated information on its efficacy and safety. This guideline will facilitate a better understanding of practical considerations for SLIT.

Keywords: Allergen immunotherapy; guideline; sublingual immunotherapy.

Figure. Mechanisms of allergen immunotherapy.

This figure is reproduced with permission: “Lee HY, Lee SM, Kang SY, Kim K, Kim JH, Ryu G, et al. KAAACI Guidelines for Allergen Immunotherapy. Allergy Asthma Immunol Res 2023;15:725-56.” Treg, regulatory T; DC, dendritic cell; IL, interleukin; Th, T helper; IFN, Interferon; CRTH2, chemoattractant receptor homologous with T-helper cell type 2 cells; Tfh, follicular helper T; CXCR5, C-X-C chemokine receptor 5; CTLA-4, cytotoxic T lymphocyte-associated antigen 4; Tfr, follicular regulatory T; iTreg, inducible regulatory T; nTreg, natural regulatory T; TGF, transforming growth factor; Foxp3, forkhead box P3; MC, mast cell; BAS, basophil; EOS, eosinophil; Breg, regulatory B; Ig, immunoglobulin.