Ask The Expert
September 9, 2013
Role for SCIT
Because of the huge safety profile of SLIT versus SCIT, in terms of both recorded deaths and episodes of anaphylaxis, is there any role at all for SCIT in treating aeroallergen disease in countries where both are available and approved?
By Prof Hugo Van Bever
From a limited number of comparative studies between SCIT and SLIT it seems that both treatments have a similar efficacy profile, although conflicting results have been published (See Int Arch Allergy Immunol, 2012, 157, 288). Moreover, it has not been excluded whether or not specific patients will respond better to SCIT, while others to SLIT. Therefore, more studies on the clinical benefit of both treatments, including on cost-effectiveness, are still needed, especially in children. Without doubt, SLIT is more child-friendly and has a better safety profile then SCIT. However, optimal monitoring and safety precautions are still advised, as side effects of SLIT have been reported.
Taken together current evidence it seems that for the majority of patients with aeroallergen disease SLIT is the treatment of choice. Other factors that influence the choice are the vaccine availability or approval (cfr USA), the geographic location, cost, and patient compliance. The fact that a minority of patients might prefer 1 monthly injection over daily sublingual treatment, or vice versa, also influences the choice. A tailored approach in which pros and cons are discussed with each patient / parents seems the best approach, considering that both SCIT and SLIT are equally effective in patients with an aeroallergen disease.
- Kim JM, Lin SY, Suarez-Cuervo C, Chelladurai Y, Ramanathan M, Segal JB, Erekosima N. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics, 2013, 131, 1155 - 67.
- Bahceciler NN, Galip N. Comparing subcutaneous and sublingual ?mmunotherapy: what do we know? Curr Opin Allergy Clin Immunol 2012, 12, 640 - 7.
Hugo Van Bever, MD, PhD
Department of Pediatrics
NUHS - Singapore
Note: Please read disclaimer. Ask the Expert is for licensed physicians only.