5-grass Pollen Sublingual Immunotherapy Induces Antigen-specific Tolerance

Sublingual immunotherapy (SLIT) with the pre- and coseasonal 5-grass pollen sublingual tablet has proven highly effective at ameliorating symptoms of allergic rhinitis and allergic rhinitis with conjunctivitis. An indirect comparison found that grass-pollen SLIT tablets had a greater mean relative clinical impact than second generation H₁-antihistamines and the leukotriene modifier montelukast and the same mean relative impact as nasal cortictosteroids. SLIT also has a better safety profile than subcutaneous immunotherapy.

Branded as Oralair (OA), the once-daily tablet is the first oral treatment that mimics natural exposure to the wide variety of seasonal pollen found in North America and other world regions and so also mimics sensitization. OA has been extensively studied and found to be effective from the first pollen season in a wide variety of patients including those with comorbid asthma, regardless of  mono- or polysensitizatoin status and symptom severity. Moreover, after use for three pollen seasons, patients show sustained benefit in both symptom control and quality of life for 2 years after they discontinue treatment. Such long-term disease remission and modification reflects the apparent induction of antigen-specific tolerance. Adverse events are rare. After a first dose is administered in the physician’s office, OA is routinely administered at home.

References:

Didier A, Wahn U, Horak F, Cox LS. Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience. Drug Profiles. 2014;10:1309-1324.   (doi:10.1586/1744666X.2014.957677)