Institute of Pediatrics, Department of Medical and Surgical specialty and Public Health, Ospedale Santa Maria della Misericordia, Perugia, Italy.
Int J Immunopathol Pharmacol. 2009 Oct-Dec;22(4 Suppl):31-3.
Sublingual immunotherapy (SLIT) is currently the most prescribed form of allergen immunotherapy in many European countries. Its use has been accepted in the international consensus publications, and recently also the scepticism of USA scientists is attenuated. Still, this treatment may be improved, and the possible developments consist of modification of the materials, use of adjuvants and use of recombinant allergens. Moreover, new applications of SLIT, such as food allergy, seem promising. Concerning materials, the future form of SLIT is likely to be represented by tablets, which were already tested for efficacy and safety with grass pollen extracts, and are likely to increase the convenience for the patient by the use of no-updosing schedule. Adjuvants fitting with the characteristics of SLIT seem to be CpG oligodeoxynucleotides (CpG), able to interact with the Toll-like receptor 9 (TLR9) whose activation induces a Th1-like pattern of cytokine release, combination of 1,25-dihydroxyvitamin D3 plus dexamethasone (VitD3-Dex), and Lactobacillus plantarum. The approach with recombinant allergens, named component-resolved diagnosis, offers the possibility to tailor immunotherapy, which was found to be effective in two randomized trials of subcutaneous SIT (16-17), while studies with SLIT are not yet available. Regarding food allergy, an important controlled study demonstrated that SLIT with hazelnut is able to increase patients tolerance over possible reactions from inadvertent assumption of the culprit food, and warrants for further trials with other foods.
舌下免疫疗法（SLIT）目前是许多欧洲国家最常开的变应原免疫疗法。它的使用已被国际共识出版物所接受，最近美国科学家的怀疑态度也有所减弱。不过，这种治疗方法仍有改进的空间，可能的发展方向包括改变材料、使用佐剂和使用重组变应原。此外，SLIT 在食物过敏等新领域的应用似乎也很有前景。关于材料，SLIT 的未来形式可能是片剂，已经对草花粉提取物进行了疗效和安全性测试，并且可能通过不增加剂量的方案提高患者的便利性。与 SLIT 特点相匹配的佐剂似乎是 CpG 寡脱氧核苷酸（CpG），能够与 Toll 样受体 9（TLR9）相互作用，TLR9 的激活诱导细胞因子释放的 Th1 样模式，1,25-二羟维生素 D3 加地塞米松（VitD3-Dex）和植物乳杆菌的联合使用。使用重组变应原的方法，称为成分分辨诊断，提供了定制免疫疗法的可能性，在两项皮下 SIT 的随机试验（16-17）中发现这种方法是有效的，而 SLIT 的研究尚不可用。关于食物过敏，一项重要的对照研究表明，榛子的 SLIT 能够增加患者对可能误食罪魁祸首食物的耐受性，并为其他食物的进一步试验提供了依据。
