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30 years of sublingual immunotherapy

机译：30年的舌下免疫疗法

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Abstract Allergen Immunotherapy (AIT) was introduced in clinical practice on an empirical basis more than 100?years ago. Since the first attempts, AIT was administered subcutaneously. Indeed, other routes of administration were proposed and studied, in particular to improve the safety, but only the sublingual route (SLIT) achieved a credibility based on evidence and was then accepted as a viable “alternative” option to the subcutaneous route. SLIT was largely used in clinical trials and clinical practice in this last 30?years. Thus, a large amount of data is available, coming from either controlled trials and postmarketing surveillance studies. It is clear that SLIT is overall effective, but it is also clear that the efficacy is not “class‐related,” as derived from meta‐analyses, but restricted to each specific product. The 30‐year lasting use of SLIT allowed to clarify many clinical aspects, such as efficacy, safety, use in asthma, regimens of administration, and optimal doses. In parallel, the mechanisms of action of AIT were elucidated, and new indications were proposed (eg food allergy, atopic dermatitis). In addition, the introduction of molecular‐based diagnosis, allowed to better refine the prescription of SLIT, based on specific sensitization profiles. The present article will describe the origin and evolution of SLIT for respiratory allergy, taking into account the clinical context that suggested this form of treatment, the recently developed aspects, the future perspectives and unmet needs, This is not, therefore, a systematic review, rather a narrative historical description of the past history, and a look forward to the future opportunities.
机译：摘要临床实践中引入了过敏原免疫疗法（AIT）的经验基础100多年前。自第一次尝试以来，AIT被皮下给药。实际上，提出并研究了其他行政途径，特别是提高安全性，但只有舌下途径（狭缝）基于证据达到了可信度，然后被接受为皮下途径的可行性“替代方案”选择。在过去30年的临床试验和临床实践中，狭缝在很大程度上用于临床实践。因此，可以获得大量数据，来自无论是对照试验和邮政监测研究。很明显，狭缝是整体有效的，但也很清楚，效果不是“类相关的”，如荟萃分析，但仅限于每个特定产品。持久使用狭缝的30年允许澄清许多临床方面，例如有效，安全，在哮喘方案，给药方案和最佳剂量方面。并行地，阐明了AIT的作用机制，提出了新的适应症（例如食物过敏，特应性皮炎）。此外，基于特定的敏化谱，引入基于分子基的诊断，使狭缝的处方更好。本文将描述呼吸道过敏的狭缝的起源和演变，考虑到这种形式的治疗，最近开发的方面，未来观点和未满足需求的临床背景，因此，这不是系统评价，相当于过去历史的叙事历史描述，而且期待未来的机会。

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