Sublingual immunotherapy with a 300 IR tablet containing pollen from 5 grasses. A targeted systematic review and meta-analysis confirm clinical benefits for patients with allergic rhinitis and conjunctivitis, with or without concomitant asthma Review: Di Bona D, Paoletti G, Ordak M, Dragonieri S, Cognet-Sice J, Scurati S, Canonica GW. A 300 IR 5-grass pollen sublingual immunotherapy tablet-specific systematic review and meta-analysis confirms its clinical benefits for patients with allergic rhinoconjunctivitis with or without asthma
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Abstract
World Allergy Organization and European Academy of Allergy and Clinical Immunology have advocated for the conduct of product-specific meta-analyses for AIT products. This study aimed to confirm the efficacy of the 300 IR 5-grass pollen sublingual AIT (SLIT)-tablet through a meta-analysis of randomized controlled trials. Five randomized controlled trials with 1468 patients showed a significant reduction in symptom score (SMD: -0.36; 95% CI: -0.52 to -0.19; P <0.05) and medication score (SMD: -0.29; 95% CI: -0.40 to -0.19; P <0.05) compared to placebo. Subgroup analysis showed consistent efficacy regardless of age, asthma status, or geographic location. No safety concerns were reported. This meta-analysis
confirms the clinical benefits of the 300 IR 5-grass SLIT-tablet for patients with allergic rhino-conjunctivitis, with or without asthma, and supports
its favorable safety profile.
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How to Cite
Poziomkowska-Gęsicka, I. (2025). Sublingual immunotherapy with a 300 IR tablet containing pollen from 5 grasses. A targeted systematic review and meta-analysis confirm clinical benefits for patients with allergic rhinitis and conjunctivitis, with or without concomitant asthma. Alergoprofil. https://doi.org/10.24292/01.AP.204331224
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THERAPY
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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3. Di Bona D, Plaia A, Leto-Barone MS et al. Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: a meta-analysis-based comparison. J Allergy Clin Immunol. 2012; 130(5): 1097- 107.e2.
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7. Nelson H, Cartier S, Allen-Ramey F et al. Network meta-analysis shows commercialized subcutaneous and sublingual grass products have comparable efficacy. J Allergy Clin Immunol Pract. 2015; 3(2): 256-66.e3.
8. Roberts G, Pfaar O, Akdis CA et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. 2018; 73(4): 765-98.
9. Pfaar O, Ankermann T, Augustin M et al. Guideline on allergen immunotherapy in IgE-mediated allergic diseases. Allergol Select. 2022; 6: 167-232.
10. Cox L, Jacobsen L. Comparison of allergen immunotherapy practice patterns in the United States and Europe. Ann Allergy Asthma Immunol. 2009; 103(6): 451-9.
11. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.
12. Schünemann H, Brozek J, Guyatt G et al.; GRADE handbook. Grading of recommendations, assessment, development and evaluation (GRADE) Working Group; 2013.
13. The GRADE Working Group. 2004-2024, 2024.
14. Higgins JPT, Savovic J, Page MJ et al. Chapter 8: assessing risk of bias in a randomized trial. In: Cochrane Handbook for Systematic Reviews of Interventions. Version 6.4 (updated August 2023). Higgins JPT, Thomas J, Chandler J et al. (eds.). Cochrane, 2023.
15. DerSimonian R, Laird N. Meta-analysis in clinical trials. Contr Clin Trials. 1986; 7(3): 177-88.
16. Review Manager (RevMan) [Computer program]. Version 5.0. London, United Kingdom: The Cochrane Collaboration; 2012.
17. ProMeta [Computer software]. Version 3.0. Internovi, Cesena, Italy.
18. Wiechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Software. 2010; 36(3): 1-48.
19. Gradepro GDT. GRADEpro guideline development tool [software]. McMaster university and evidence prime; 2021.
20. Didier A, Malling HJ, Worm M et al. Optimal dose, efficacy, and safety of once-daily sublingual immunotherapy with a 5-grass pollen tablet for seasonal allergic rhinitis. J Allergy Clin Immunol. 2007; 120(6): 1338-45.
21. Wahn U, Tabar A, Kuna P et al.; SLIT Study Group. Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2009; 123(1): 160-6.e3.
22. Cox LS, Casale TB, Nayak AS et al. Clinical efficacy of 300IR 5- grass pollen sublingual tablet in a US study: the importance of allergen-specific serum IgE. J Allergy Clin Immunol. 2012; 130(6): 1327-34.e1.
23. Horak F, Zieglmayer P, Zieglmayer R et al. Early onset of action of a 5-grass-pollen 300-IR sublingual immunotherapy tablet evaluated in an allergen challenge chamber. J Allergy Clin Immunol. 2009; 124(3): 471-7.
24. Didier A, Worm M, Horak F et al. Sustained 3-year efficacy of pre- and coseasonal 5-grass-pollen sublingual immunotherapy tablets in patients with grass pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol. 2011; 128(3): 559-66.
25. Didier A, Malling HJ, Worm M et al. Prolonged efficacy of the 300IR 5-grass pollen tablet up to 2 years after treatment cessation, as measured by a recommended daily combined score. Clin Transl Allergy. 2015; 5: 12.
26. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11): 1539-58.
27. Devillier P, Chassany O, Vicaut E et al. The minimally important difference in the Rhinoconjunctivitis Total Symptom Score in grass-pollen-induced allergic rhinoconjunctivitis. Allergy. 2014; 69(12): 1689-95.
28. Casale TB, Cox LS, Wahn U et al. Safety review of 5-grass pollen tablet from pooled data of clinical trials. J Allergy Clin Immunol Pract. 2017; 5(6): 1717-27.
2. Di Bona D, Plaia A, Leto-Barone MS et al. Efficacy of grass pollen allergen sublingual immunotherapy tablets for seasonal allergic rhinoconjunctivitis: a systematic review and meta-analysis. JAMA Intern Med. 2015; 175(8): 1301-9.
3. Di Bona D, Plaia A, Leto-Barone MS et al. Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: a meta-analysis-based comparison. J Allergy Clin Immunol. 2012; 130(5): 1097- 107.e2.
4. Radulovic S, Calderon MA, Wilson D et al. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2010; (12): CD002893.
5. Calderon MA, Alves B, Jacobson M et al. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev. 2007; (1): CD001936.
6. Dretzke J, Meadows A, Novielli N et al. Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: a systematic review and indirect comparison. J Allergy Clin Immunol. 2013; 131(5): 1361-6.
7. Nelson H, Cartier S, Allen-Ramey F et al. Network meta-analysis shows commercialized subcutaneous and sublingual grass products have comparable efficacy. J Allergy Clin Immunol Pract. 2015; 3(2): 256-66.e3.
8. Roberts G, Pfaar O, Akdis CA et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. 2018; 73(4): 765-98.
9. Pfaar O, Ankermann T, Augustin M et al. Guideline on allergen immunotherapy in IgE-mediated allergic diseases. Allergol Select. 2022; 6: 167-232.
10. Cox L, Jacobsen L. Comparison of allergen immunotherapy practice patterns in the United States and Europe. Ann Allergy Asthma Immunol. 2009; 103(6): 451-9.
11. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.
12. Schünemann H, Brozek J, Guyatt G et al.; GRADE handbook. Grading of recommendations, assessment, development and evaluation (GRADE) Working Group; 2013.
13. The GRADE Working Group. 2004-2024, 2024.
14. Higgins JPT, Savovic J, Page MJ et al. Chapter 8: assessing risk of bias in a randomized trial. In: Cochrane Handbook for Systematic Reviews of Interventions. Version 6.4 (updated August 2023). Higgins JPT, Thomas J, Chandler J et al. (eds.). Cochrane, 2023.
15. DerSimonian R, Laird N. Meta-analysis in clinical trials. Contr Clin Trials. 1986; 7(3): 177-88.
16. Review Manager (RevMan) [Computer program]. Version 5.0. London, United Kingdom: The Cochrane Collaboration; 2012.
17. ProMeta [Computer software]. Version 3.0. Internovi, Cesena, Italy.
18. Wiechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Software. 2010; 36(3): 1-48.
19. Gradepro GDT. GRADEpro guideline development tool [software]. McMaster university and evidence prime; 2021.
20. Didier A, Malling HJ, Worm M et al. Optimal dose, efficacy, and safety of once-daily sublingual immunotherapy with a 5-grass pollen tablet for seasonal allergic rhinitis. J Allergy Clin Immunol. 2007; 120(6): 1338-45.
21. Wahn U, Tabar A, Kuna P et al.; SLIT Study Group. Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2009; 123(1): 160-6.e3.
22. Cox LS, Casale TB, Nayak AS et al. Clinical efficacy of 300IR 5- grass pollen sublingual tablet in a US study: the importance of allergen-specific serum IgE. J Allergy Clin Immunol. 2012; 130(6): 1327-34.e1.
23. Horak F, Zieglmayer P, Zieglmayer R et al. Early onset of action of a 5-grass-pollen 300-IR sublingual immunotherapy tablet evaluated in an allergen challenge chamber. J Allergy Clin Immunol. 2009; 124(3): 471-7.
24. Didier A, Worm M, Horak F et al. Sustained 3-year efficacy of pre- and coseasonal 5-grass-pollen sublingual immunotherapy tablets in patients with grass pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol. 2011; 128(3): 559-66.
25. Didier A, Malling HJ, Worm M et al. Prolonged efficacy of the 300IR 5-grass pollen tablet up to 2 years after treatment cessation, as measured by a recommended daily combined score. Clin Transl Allergy. 2015; 5: 12.
26. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11): 1539-58.
27. Devillier P, Chassany O, Vicaut E et al. The minimally important difference in the Rhinoconjunctivitis Total Symptom Score in grass-pollen-induced allergic rhinoconjunctivitis. Allergy. 2014; 69(12): 1689-95.
28. Casale TB, Cox LS, Wahn U et al. Safety review of 5-grass pollen tablet from pooled data of clinical trials. J Allergy Clin Immunol Pract. 2017; 5(6): 1717-27.