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Sublingual immunotherapy (SLIT) was developed to avoid the risk of severe systemic side effects which occur in subcutaneous immunotherapy. Data from more than 20 controlled studies clearly show the efficacy and safety of this type of immunotherapy in patients with allergic rhino-conjunctivitis due to pollen and mites. The data for allergic asthma still need confirmation. Sublingual immunotherapy is no substitute for subcutaneous immunotherapy but an additional option for defined groups of patients. The application of a sufficient amount of allergen is important for the efficacy of SLIT. According to the recommendation of the ARIA working group, a 50- to 100-fold cumulative dose should be applied as compared to subcutaneous immunotherapy. SLIT can be used preseasonally, during the saison or perennially. Therapy starts with a daily increase of the dose. In some cases, e. g., in adult patients with pollen allergy, doses can be increased within hours. The well-tolerated maintenance dose should be taken three times a week or daily. The sublingual seasonal short-time immunotherapy may become an additional option for subgroups of patients, e. g., for adolescents.

Asthma is a chronic inflammatory disease of the airways considered as the result of a deregulated immune response, with a pivotal role played the TH2 cytokine phenotype. The treatment of allergic asthma is based on allergen avoidance, pharmacotherapy, allergen-specific immunotherapy, and patient education. Specific immunotherapy is able to normalize the upraised TH2 cytokine phenotype and indicated for patients who have demonstrable evidence of IgE-mediated clinically relevant sensitisation to pollens, house-dust mites and cat or dog allergens. The exposure to the allergens must be related to the appearance of symptoms. Randomised controlled trials in asthma have found that immunotherapy was effective (evidence 1a, strength of recommendation A) in reducing specific and non-specific bronchial hyperreactivity, asthmatic symptoms, and medication requirements. Patient selection is important and efficacy must be balanced against the risk of side effects. Immunotherapy should be used by pneumologists with a training in allergology in patients with mild asthma.