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Primary Care Education Consortium

Sublingual Immunotherapy: A Guide for Primary Care

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Overview / Abstract:

Journal Article
Eligible for 1 AMA PRA Category 1 credit.
Supplement to The Journal of Family Practice | Vol 66, No 4 | APRIL 2017
For CME credit, complete the article and go to to complete the post-test survey.

Allergen immunotherapy (AIT), the only potential diseasemodifying
treatment for allergic disease, has been used
for more than a century.
Hankin et al showed significant
reduction in pharmacy, outpatient, and inpatient resources
in the 6 months following vs the 6 months preceding AIT in
Medicaid-enrolled children with allergic rhinitis (AR).
A 2013 analysis showed sustained cost reduction over
18 months in patients with AR treated with AIT compared
with matched control subjects not treated with AIT.
The overall cost savings were 38% with AIT, which was similar to
the cost savings observed in adults.
AIT is underused, partly because of the lack of familiarity
of nonallergy/immunology-trained health care providers,
and partly because of safety concerns (primarily
anaphylaxis risk) associated with its subcutaneous administration.
These safety concerns, as well as practical and
logistic considerations associated with administration of
subcutaneous immunotherapy (SCIT), spurred interest in
the use of sublingual immunotherapy (SLIT), which can be
self-administered, does not require injections, and carries a
much lower risk of anaphylaxis compared with SCIT.
While SLIT has been used outside the United States for decades,
the US Food and Drug Administration (FDA) has recently
approved 4 SLIT allergen extract products (tablets) for treatment
of the symptoms and morbidity associated with grass
pollen, ragweed, or house dust mite AR, with or without
Grass and ragweed allergens are among the most common
aeroallergens and characteristically cause seasonal
allergic rhinoconjunctivitis (ARC) and/or seasonal allergic
asthma. On the other hand, cat dander, cockroach, or dust
mite allergens cause symptoms year-round and are associated
with perennial AR and/or allergic asthma.
Medical management of seasonal and perennial nasal
allergic disease typically involves allergen avoidance and
use of pharmacotherapeutic agents such as nonsedating
oral antihistamines, intranasal antihistamines, intranasal
cromolyn and, most importantly, intranasal corticosteroids.
Required daily use for efficacy raises concerns regarding
long-term adherence, safety, and cost. Allergic asthma control
with long-term use of inhaled steroids and long-acting
bronchodilators also poses risks.
Since allergic disease is an immunologic, systemic disorder
with local manifestations, it is not surprising that treatment
with immunotherapy can modify the underlying natural
history of the disease, resulting in long-term efficacy (ie,
immune tolerance) after termination of treatment. Unlike
pharmacotherapy, AIT can also reduce the incidence of subsequent
asthma in patients with AR and reduce sensitization
to new allergens.
AIT is most beneficial for patients with moderateto-severe
intermittent or persistent symptoms of AR or ARC,
particularly those whose symptoms are not responsive to
pharmacotherapy and environmental control measures.


May 31, 2018


Nurse Practitioner , Physician CME, Physician Assistant CME


Journal, Online

Credits / Hours




Presenters / Authors / Faculty

Eli O. Meltzer, MD
Clinical Professor of Pediatrics,
Division of Allergy and Immunology, University of California, San Diego, CA

Activity Specialities / Related Topics

Allergies / Allergic Reactions, Family Medicine, Immunology / Immunosuppression, Other, Preventive Care, Primary Care, Research

Sponsors / Supporters / Grant Providers


Keywords / Search Terms

Primary Care Education Consortium Allergen immunotherapy, Allergy, Primary Care Education Consortium, Immunology, Free CE CME Free CE CME

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