Sublingual immunotherapy for animals

Shots or Drops? Considerations When Selecting Injection Vs. Sublingual ASIT for Dogs
DVM 360, January 2014

This article compares allergy shots for dogs vs. sublingual allergy drops for dogs. A substantial number of dogs that failed to improve with allergen-specific immunotherapy using allergy shots have improved with sublingual immunotherapy. Factors to consider when deciding between dog allergy injections and sublingual immunotherapy for dogs include the client’s schedule, client’s aversion to needles, patient cooperation, the importance of mold or fungal allergens, history of anaphylactic reactions, and history of failure with dog allergy shots.

Sublingual Immunotherapy: A New Option for Allergy Patients
DVM 360 01 January 2014

Anecdotal evidence demonstrates that this needle-free method may also benefit patients with atopic dermatitis.

Sublingual Immunotherapy in Human and Canine Atopic Dermatitis: A Mini Review
Veterinary Sciences, 13 October 2014

Recently, sublingual immunotherapy has been replacing subcutaneous immunotherapy both in human and veterinary medicine due to its ease and safety, leading to increased compliance. The purpose of this mini review is to focus on the use of sublingual immunotherapy for atopic dermatitis highlighting similarities and differences between humans and dogs…..In conclusion, SLIT represents a safe and effective strategy to help with management of allergic diseases in both people and animals.

Multicenter open trial demonstrates efficacy of sublingual immunotherapy in canine atopic dermatitis.
Vet Dermatol 2012, 23 Suppl, 65.

In this open field trial, sublingual immunotherapy (SLIT) was a successful treatment in 59% of evaluable patients who had not had previous immunotherapy. This approximates the response typically reported for subcutaneous immunotherapy. In addition, SLIT was a safe and successful treatment in 49% of evaluable patients who had failed previous dog atopic dermatitis treatment using allergy shots.

Using sublingual immunotherapy to treat atopic dermatitis in canine veterinary patients
DVM 360, 01 August 2014

The option to administer allergens in a sublingual format is an exciting treatment modality. Its higher safety level, ease of administration and potentially equal or better efficacy for many patients compared with conventional immunotherapy should lead to sublingual immunotherapy being recommended early as a dog atopy treatment.

The Latest Advancements in Atopic Dermatitis Treatments in Dogs and Cats
Veterinary Practice News, May 2016

This article highlights the benefits of immunotherapy for long-term relief of atopic dermatitis. “Ideally, allergy testing followed by appropriate immunotherapy is still the hallmark treatment for atopic dermatitis. This therapy has minimal long-term side effects and is the only therapy that attempts to desensitize the animal.”  Allergen specific immunotherapy continues to be the only intervention that treats atopic dermatitis.

Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA)
BMC Veterinary Research 2015, 11:210

The value of allergen-specific immunotherapy as a canine AD-modifying treatment continues to be supported by (mostly uncontrolled) studies reporting at least a moderate efficacy (SOR B). There is some evidence that ASIT administered via the sublingual route (sublingual immunotherapy; SLIT), or in sped-up (i.e. “rush”) protocol, are safe and effective for dog atopy treatment (SOR C).

The ACVD Task Force on Canine Atopic Dermatitis (XXIV):  Allergen-Specific Immunotherapy
Veterinary Immunology and Immunopathology 81 (2001) 363-383

As ASIT (allergen-specific immunotherapy)  is believed to alter the natural course of the allergic reaction, it is the only therapy that can prevent the development of further allergy. Indeed, ASIT offers the hope of long-term remission and can result in a therapy requiring a relatively low frequency of administration, especially compared to oral drugs that require administration daily or a few times a day. In contrast, it may be difficult to achieve and maintain long-term control of the clinical signs of AD with alternative forms of therapy such as allergen avoidance and symptomatic treatment. In addition, life threatening adverse reactions are rarely reported and there are no reports of long-term side effects from ASIT in the dog, thus few contra-indications would appear to exist for the use of this therapy.


Difficulties in animal allergy testing

Agreement between allergen-specific IgE assays and ensuing immunotherapy recommendations from four commercial laboratories in the USA
Veterinary Dermatology 2014; 25: 15-e6

This article shows arbitrary results from dog allergy testing using blood tests (immunoassay tests): In summary, the chance-corrected agreement of four commercially available allergen-specific IgE assays was evaluated for 10 dogs with atopic dermatitis. The results show that the overall interassay agreement was only slightly better than expected by chance. No two laboratories displayed even moderate chance-corrected agreement (j > 0.40) with each other. The ASIT recommendations provided by the laboratories for nine dogs also displayed slight overall agreement. Eighty-five percent of the 261 ASIT antigen recommendations for these nine dogs were unique to one laboratory or another. Further studies are required to determine the degree to which the choice of allergen testing laboratory impacts on the efficacy of ASIT.


Sublingual immunotherapy (general)

Mechanisms of Allergen-Specific Immunotherapy: Multiple Suppressor Factors at Work in Immune Tolerance to Allergens
Journal of Allergy and Clinical Immunology, 2014
This paper shows the efficacy of both sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) in altering the body’s immune response.

Sublingual Immunotherapy for Allergic Rhinitis and Conjunctivitis
Immunotherapy, 2013

Sublingual immunotherapy can decrease symptoms and medication requirements in hay fever and potentially in asthma. Furthermore,  SLIT significantly alters the immune response long-term. Finally, SLIT (as well as subcutaneous immunotherapy, i.e. shots) can decrease the probability of asthma in kids with allergic rhinitis. SLIT has shown to be an effective alternative to SCIT in the treatment of allergic rhino conjunctivitis with a high safety profile.

Efficacy of Sublingual Immunotherapy Versus Subcutaneous Injection Immunotherapy in Allergic Patients
Journal of Environmental and Public Health, 2012
Subcutaneous immunotherapy and sublingual immunotherapy result in similar efficacy. SLIT decreases symptom scores for asthma and allergic rhinitis while also reducing the need for allergy drugs. SLIT can be considered as a primary treatment option for patients with asthma as well as for pediatric patients (both of whom can be difficult to treat using subcutaneous immunotherapy).

Quality of Life Improvement with Sublingual Immunotherapy: A Prospective Study of Efficacy
Journal of Allergy, 2012
The initial four months of treatment using SLIT resulted in a marked decrease in symptoms and a marked increase in quality of life. Studies beyond the four month mark showed sustained improvement.

High-Dose Sublingual Immunotherapy with Single-Dose Aqueous Grass Pollen Extract in Children is Effective and Safe: A Double-Blind, Placebo-Controlled Study
Journal of Allergy and Clinical Immunology, 2012
SLIT appreciably reduced symptoms and allergy drug requirements in children with grass allergies. The treatment was well-tolerated and should be considered as a viable treatment for pediatric grass allergies.

The Current Role of Sublingual Immunotherapy in the Treatment of Allergic Rhinitis in Adults and Children
Journal of Asthma and Allergy, 2011
SLIT is backed by a strong body of evidence supporting its effectiveness and safety profile.  In some parts of Europe, it is prescribed more often than subcutaneous immunotherapy.   In addition to its higher safety profile, SLIT appears to  be more cost-effective than shots and also to have higher compliance rates because it does not need to be given under direct medical supervision.

Safety of Sublingual Immunotherapy
Journal of Biological Regulators and Homeostatic Agents, 2011
Sublingual immunotherapy is affirmed as an alternative to allergy shots and is used commonly in European clinical practice.  SLIT’s “no-pain” administration makes it particularly appropriate for pediatric patients.  The only pejorative reactions to SLIT were classified as mild. (No deaths and two anaphylactic reactions.)

Sublingual Immunotherapy for Allergic Rhinitis
Cochrane Database of Systematic Reviews, 2010
Sublingual immunotherapy is a safe therapy that appreciably lessens symptoms as well as drug requirements in patients who suffer with allergic rhinitis.