TABLE IX.D.4-2.
Aggregate grades of evidence for specific SLIT issues
| Issue | Aggregate grade of evidence |
Direction of impact |
Magnitude of impacta | Recommendation, considering: harm and cost |
| SLIT is effective for AR symptom reduction in adults | A | Yes | Low impact | Strong recommendation |
| LOE: Lin 1a; Radulovic 1a; Di Bona (2 studies) 1a; Nelson 1b; Calderon 2a. | ||||
| SLIT is effective for AR symptom reduction in children | B | Yes | Low impact | Recommendation |
| LOE: Kim 2a; Larenas-Linnemann 2a. Not enough evidence: Roder 2a. | ||||
| SLIT is safe for the treatment of AR in adults | A | Yes | —— | Safety profile is very good |
| Many of the systematic reviews (1a and 2a) included safety evaluation. Makatsori 1a: same dropout rates SLIT vs placebo. | ||||
| SLIT is safe for the treatment of AR in children | B | Yes | —— | Safety profile is very good |
| The systematic reviews (Kim, Larenas-Linnemann, Roder: all 2a) included safety evaluation. Makatsori 1a: same dropout rates SLIT vs placebo. | ||||
| SCIT is more effective than SLIT | A | Yes | Weak evidence | Recommendation |
| LOE: Chelladurai 1a; Dretzke 2a; Calderon 2a; Kim 2a. Grass pollen tablets/drops vs SCIT: Di Bona 2012 1a; SCIT = grass pollen tablets only, drops slightly less effective Nelson 1b. | ||||
| SLIT is safer than SCIT | B | Yes | Weak evidence | Recommendation |
| LOE: Aasbjerg 2a | ||||
| The total cost of SLIT is less than SCIT | A | Yes | Moderate evidence | Recommendation |
| LOE: Meadows 1a (UK setting); Dranitsaris 2a (Canadian setting) | ||||
| It is safe to continue SLIT during pregnancy | B | No added risk. | Moderate evidence | Recommendation |
| LOE: Oykman 3a | ||||
| It is safe to start SLIT during the season | B | Slightly added risk. | Moderate evidence | Option |
| LOE: Creticos 2a | ||||
| Tablet SLIT is more effective than pharmacotherapy. Exception in SAR: INCS are as efficacious as tablet SLIT. | A | Yes | Moderate: antihistamine, montelukast. Weak: INCS | Recommendation |
| LOE: Devillier 1a (pollen tablet SLIT); Durham 1b (grass pollen or ragweed tablet SLIT). | ||||
| SLIT is cost-effective in the 1st year | B | No | Moderate evidence | Option (considering its long-term benefit) |
| LOE: Meadows 1a; Dranitsaris 2a | ||||
| SLIT is cost-effective after several years of treatment | B | Yes | Weak-moderate | Recommendation |
| LOE: Meadows 1a; Dranitsaris 2a | ||||
| SLIT has a long-term effect beyond 3-years’ application | B | Yes | Moderate evidence | Recommendation |
| LOE: Durham 20121705 2b, Didier 20151706 2b | ||||
| SLIT with grass-pollen is effective for SAR | A | Yes | Low impact | Strong recommendationb |
| LOE: Di Bona (2 studies) 1a; Nelson 1b; Durham 1b. | ||||
| SLIT with tree-pollen is effective for SAR | A | Yes | Moderate effect | Strong recommendationb |
| LEO: Valovirta 20061683 1b | ||||
| SLIT with ragweed-pollen is effective for SAR | A | Yes | Moderate effect | Strong recommendationb |
| LOE: Durham 2016, Nolte 2013, Creticos 2013, 1b (tablet ragweed); Creticos 2014 (drop ragweed); Skoner 2010 (drop ragweed) 1b | ||||
| SLIT with HDM is effective for AR | A | Yes | Low impact | Strong recommendationb |
| LOE: Nolte 2015, Bergmann 2014, Mosbech 2015 all 1b; Calderon 2a | ||||
| SLIT with epithelia is effective for AR | — | No data | No data | Option |
| No separate data in the systematic reviews/meta-analyses; no recent trials | ||||
| SLIT with fungi is effective for AR | B | Yes | Weak evidence | Option |
| No separate data in the systematic reviews/meta-analyses. Cortellini 20101688 1b | ||||
a
For those variables with meta-analysis: according to Cohen’s classification: low impact SMD 0.2-0.5, moderate 0.5-0.8, high above 0.8. For those with only systematic review: strength of evidence.
b
Considering the added long-term posttreatment effect and the possible preventive effects on the development of asthma and new sensitizations.
AR = allergic rhinitis; INCS = intranasal corticosteroids; LOE = level of evidence; SAR = seasonal allergic rhinitis; SCIT = subcutaneous immunotherapy; SLIT = sublingual immunotherapy.