Evidence Summary

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Sublingual immunotherapy improves symptoms in adults and children with allergic rhinitis and asthma

Lin SY, Erekosima N, Kim J, et al. Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. JAMA. 2013;309:1278-88.

Review question

How effective and safe is aqueous sublingual immunotherapy for allergic rhinitis and asthma?


Rhinitis is the irritation and inflammation of the membrane inside the nose. Symptoms include stuffy nose, runny nose, and phlegm (thick spit).

Water-dissolved (aqueous) allergens placed under the tongue (sublingual) over an extended period are used to reduce allergic symptoms.

Sublingual immunotherapy is easy to administer and does not involve injections.

How the review was done

This summary is based on a systematic review of 63 randomized controlled trials involving 5,131 people 4 to 74 years of age. 26 studies included only adults, 17 included adults and children, and 20 included only children (1,814 people). Period of publication was 1990 to 2012.

Sublingual immunotherapy was compared with placebo (46 trials), a different type of sublingual immunotherapy (9 trials), or a different drug (8 trials).

Outcomes included symptom scores for rhinitis, conjunctivitis, or asthma; medication use; symptoms and medication; quality of life; safety or harms; and adverse events.

46 studies received industry support.

What the researchers found


  • Sublingual immunotherapy improved asthma symptoms. 8 of 13 studies reported greater than 40% improvement compared with the control group.


  • Sublingual immunotherapy decreased rhinitis or rhino-conjunctivitis symptoms. 9 of 36 studies reported greater than 40% improvement compared with a control group.

Conjunctivitis and other outcomes

  • Sublingual immunotherapy improved conjunctivitis symptoms (13 studies), combined symptom and medication scores (20 studies), and disease-specific quality of life (8 studies).

Medication use for asthma and allergies

  • Sublingual immunotherapy decreased medication use for asthma and allergies by more than 40% (16 of 41 studies).

Adverse effects

  • Sublingual therapy had more frequent local reactions.
  • There were no reports of life-threatening adverse events.


Overall, evidence supports the effectiveness of sublingual immunotherapy for the treatment of allergic rhinitis and asthma.


Related Topics


Control group
A group that receives either no treatment or a standard treatment.
Treatment of disease by encouraging, enhancing, or suppressing an immune response.
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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