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Wise et al.

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Author Manuscript Author Manuscript Author Manuscript Author Manuscript RCTs

Study Year LOE Study design Study groups Clinical endpoint Conclusion a SLIT or SCIT: children only Larenas-Linnemann et al. 1671 Symptom and medication scores RCTs

Strong evidence that grass pollen SLIT in children reduces symptoms of AR. Moderate-low evidence for HDM SLIT.

Insufficient evidence that AIT in any form has a positive effect on AR in children.

Low grade evidence favors SCIT over SLIT for AR symptom and medication reduction. Moderate evidence for nasal and eye symptom reduction.

SCIT more effective than SLIT (drops) and SLIT (tablet) for symptom and medication score reduction.

Symptom and medication scores with SCIT, SLIT tablets and drops all reduced vs. placebo, except for symptom score with SLIT drops.

Safety data Many products without structured collection of safety data. General safety assessment: SLIT safer than SCIT. Efficacy, safety, cost for Canadian setting Symptom score, IT schedule, dosing Symptom and medication scores

Symptoms: all IT treatments better than placebo. Costs for 5-grass tablet greater than costs for Timothy grass tablet and SCIT.

Improved symptom score vs placebo was observed more frequently for SCIT. Data is weak as the basic treatment parameters vary widely. Trend favoring SCIT over SLIT for AR symptom and medication score reduction. No conclusive results.

In children, moderate evidence that SLIT improves AR symptoms and medication use, low evidence that SCIT is superior to SLIT for both outcomes. Not enough evidence because of poor quality of the studies.

Symptom and medication scores scores

SMD of symptom and medication scores

Symptom and medication scores

Symptom and medication scores

Symptom and medication scores

Children with AR and/or asthma treated with SLIT vs placebo/open controls

Children 0–18 years with AR: any form of AIT vs placebo

SCIT vs SLIT (and vs placebo) in AR Symptom and medication Grass pollen SCIT; placebo vs grass pollen SLIT; placebo in SAR Grass pollen SLIT tablets vs placebo. Grass pollen SLIT drops vs placebo. Grass pollen SCIT vs placebo. AR patients receiving Phleum pratense SCIT, SLIT drops, or SLIT tablets vs placebo. (including 314 children.)

Timothy grass tablet, 5-grass tablet, grass pollen SCIT vs placebo in SAR

Patients allergic to HDM, with AR and asthma, treated with HDM SCIT vs SLIT vs placebo

SCIT and aqueous SLIT vs placebo, SCIT vs SLIT in AR

Children with SAR (asthma): Aqueous SLIT vs SCIT vs placebo for SAR (and asthma) SLIT vs placebo in children with asthma/ARC

RCT

comparison

analysis of RCTs

RCTs, product

information, registry

RCTs and indirect comparison RCTs

RCT and indirect comparison

RCTs and indirect comparison RCTs

2013 2a Systematic review of

Roder et al. 1670 2008 2a Systematic review of SLIT vs SCIT

Chelladurai et al. 1697 2013 1a Systematic review of

Di Bona et al. 1698 2012 1a Meta-analysis based Nelson et al. 1699 2015 1b Network meta

Aasbjerg et al. 1700 2015 2a Systematic review of Dranitsaris and Ellis 1701

2014 2a Systematic review of

Calderon et al. 1702 2013 2a Systematic review of

Dretzke et al. 1703 2013 2a Systematic review of SLIT vs SCIT: children only

Kim et al. 1672 2013 2a Systematic review of

Hoeks et al. 1704 2008 2a Systematic review of

a Only outcomes with statistically significance are mentioned here. b Clinical impact score = season-long nasal or total symptom scores: 100 × (scorePlacebo – scoreActive)/scorePlacebo. AE = adverse event; AIT = allergen immunotherapy; AR = allergic rhinitis; ARC = allergic rhinoconjunctivitis; CI = confidence interval; HDM = house dust mite; INCS = intranasal corticosteroid; LOE = level of evidence; PAR = perennial allergic rhinitis; RCT = randomized controlled trial; RDBPCT = randomized double-blind placebo-controlled trial; SAR = seasonal allergic rhinitis; SCIT = subcutaneous immunotherapy; SLIT = sublingual immunotherapy; SMD = standardized mean difference.

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.