According to current clinical guidelines in Germany, the accepted indications for sub-lingual immunotherapy (SLIT) are: 1) an IgE-mediated sensitization can be detected (skin prick test or IgE in vitro test); 2) there is a clear relation to clinical symptoms of allergen-induced rhinoconjunctivitis (perhaps using the provocation test); and 3) subcutaneous immunotherapy (SCIT) is not possible. Under these circumstances, SLIT may be administered provided that standardized and high-quality allergen extracts are available, there is proof of efficacy for a specific SLIT solution or tablet, and the patients are adults, Therefore, sublingual application of aqueous allergen extracts, especially short-term treatment with grass pollen extracts, is an accepted mode of allergen-specific immunotherapy in adults, the clinical efficacy of which has been demonstrated by SLIT meta-analyses. In contrast, several studies in children have shown an inconsistent response with marginal effects. Since SLIT is generally not associated with systemic side effects, it should be a useful alternative to SCIT in children.
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