J. Quirt,
R. Gagnon,
A. K. Ellis and
H. L. Kim
Background: Allergic rhinitis is estimated to affect 20–25% of Canadians and has a significant impact on quality of life, with many patients reporting inadequate control of their symptoms [1]. Mainstays of treatment for allergic rhinitis include avoidance, intranasal steroids, oral antihistamines and leukotriene receptor antagonists [2]. Specific immunotherapy offers disease-modifying treatment for those uncontrolled by, intolerant to, or averse to pharmacotherapy [3].
Currently two types of aeroallergen immunotherapy are used in clinical practice: subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). SLIT was first accepted as an alternative to SCIT by the WHO in 1998, and was then introduced into the ARIA guidelines [4, 5]. While SLIT has been available in Europe for some time, Canada first approved a sublingual grass immunotherapy tablet in 2012. At present, there are three sublingual tablet immunotherapy products on the market in Canada (Table 1). There will be other allergens for SLIT available soon. The sublingual route of immunotherapy offers multiple potential benefits over the subcutaneous route including the comfort of avoiding injections, convenience of home administration and a favourable safety profile. In addition, SLIT tablets appear to be economically favourable to standard drug therapy, and possibly also to SCIT [6, 7]. This position statement discusses SLIT tablets only, as SLIT drops are not approved by Health Canada.
Extract composition
|
Age indication (years)
|
Dose initiation
|
Timing of initiation before pollen season
|
Daily dose
| |
|---|---|---|---|---|---|
Oralair®
|
5 grass pollen
|
5–50
|
3 day escalation
|
8–16 weeks
|
300IR
|
Grastek®
|
Timothy grass pollen
|
≥ 5
|
Full dose
|
At least 8 weeks
|
2800 BAU
|
Ragwitek®
|
Short ragweed pollen
|
18–65
|
Full dose
|
At least 12 weeks
|
12 Amb a 1-U
|
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