Sublingual Immunotherapy
(SLIT)
Lt. Col Dimitrios Vourdas M.D.
Allergist
Director of Allergy and Clinical Immunology Unit
251 Hellenic Air Force Hospital
Athens, Hellas
Everything Evolving……
Evolution in Medicine……
Evolution in Immunotherapy……
Has clarified the Mechanism of Action
of Sublingual Immunotherapy or rely
on Insufficient or Empirical data?
Mechanism of Action (Ι)
(Novak N , Allergy, 66:733-739,2011)
Mechanism of Action (ΙΙ) - Langerhans like DC –
The Predominant of the Immune Response in SLIT
Substantial difference between the oral mucosa
counterparts. Expression of FcεRI, MHC class I,II,
costimulatory CD40, CD80, CD86
Activation of TLR4 leads to production of IL-10 and
activation of Treg Foxp3. The result is a further
production of IL-10 and TGF-β
SLIT induces mucosal IgA response, which
contributes significantly in immune tolerance
It is important, the adjutants of the formulation
of SLIT, because of them, depends largely, the
induction of the immune tolerance
IgG4 blocking antibodies maintained in high levels
and after 2 years from initiation of treatment
(Allam JP , JACI, 121:368E1-374E1,2008)
Is SLIT Effective?
Study data until 2003
22 randomized, controlled studies
About 1000 patients
Study data from 2003 to 2011
60 studies (49 for meta-analysis)
About 4000 patients
Improves the Quality of Life
in SLIT Patients;
Quality of Live
(Morris MS , Journal of Allergy, 2012:ID 253879,2012)
Is SLIT Safe?
Safety of SLIT
(Radulovic S, Allergy, 66:740-752,2011)
Is it Equally Effective the SLIT Therapy in
Mono-Sensitized and Poly-Sensitized
Patients ?
(Malling HJ , Clin Exp Allergy, 39:387-393,2009)
There is Dirrect Comparison Between
SLIT and SCIT ?