Work

Efficacy and Safety of Sublingual and Subcutaneous Immunotherapy in Children with Allergic Rhinitis: A Systematic Review of Randomized Trials Including Direct and Indirect Comparisons

Year: 2025

Type: review

Abstract: Background: Allergic rhinitis (AR) is a prevalent condition significantly impacting children's health globally. Allergen immunotherapy (AIT), via sublingual (SLIT) or subcutaneous (SCIT) routes, offers disease modification, but direct pediatric comparisons are limited. This systematic review evaluates the relative efficacy and safety of SLIT versus SCIT in children with AR based on randomized clinical trial (RCT) evidence. Methods: A systematic literature search (PubMed, Embase, Cochrane Library, Scopus; July 2024) identified RCTs comparing SLIT vs SCIT, or either vs control, in children (≤18 years) with AR. Data on study design, participants, interventions, outcomes (symptom/medication scores, safety, adherence, immunological markers), were extracted. Methodological quality was assessed using the Cochrane Risk of Bias tool version 2 (RoB-2). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: Seven RCTs met inclusion criteria. Both SLIT and SCIT effectively reduced AR symptoms and medication use versus controls. Comparative efficacy was nuanced: several studies found comparable reductions in symptom/medication scores, while others suggested potential SCIT advantages for specific outcomes (asthma symptoms, Total Rhinitis Symptom Score from baseline). SLIT consistently showed a more favorable safety profile (mainly local reactions), whereas SCIT carried a higher risk of systemic reactions. Limited data suggested potential SLIT benefits in asthma prevention. Adherence data from included RCTs were sparse. Conclusion: Both SLIT and SCIT are effective for pediatric AR. SLIT offers comparable efficacy for many outcomes with better safety/convenience, while SCIT may have advantages for certain outcomes but requires clinic administration. Treatment choice requires individualization based on efficacy, safety, adherence potential, and patient/family factors. Further high-quality, long-term comparative trials are needed.

Source: International Journal of General Medicine

DOI: 10.2147/ijgm.s547338