Practice parameters for sublingual immunotherapy


  • C. Ortolani | Casa di Cura Ambrosiana, Cesano Boscone, Milan, Italy.
  • F. Agostinis Allergy Consultant, Pediatrics Macedonio Melloni Hospital, Milan, Italy.
  • S. Amoroso Unità di Allergologia, Ospedale Civico, Palermo, Italy.
  • R. Ariano ASL 1 Imperiese, Allergology Department, Bordighera, Imperia, Italy.
  • A. Barbato University Department of Pediatrics, Padova, Italy.
  • M. Bassi Rho Hospital, Pediatrics, Rho, Italy.
  • G. Cadario Le Molinette Hospital, Torino, Italy.
  • P. Campi Allergology Department, ASL n. 10 FI, S. Giovanni di Dio Hospital, Firenze, Italy.
  • F. Cardinale III Clinica Pediatrica, Policlinico di Bari, Bari, Italy.
  • G. Ciprandi U.O. di Otorinolaringoiatria, S. Martino Hospital, Genova, Italy.
  • R. D’Anneo Pneumology Department, Regina Margherita Hospital, Messina, Italy.
  • M. Di Gioacchino Dipartimento di Medicina e Scienza dell’Invecchiamento, Immunologia e medicina del lavoro, G. D’Annunzio University, Chieti, Italy.
  • V. Di Rienzo Allergology Department, Poliambulatorio ASL FR, Frosinone, Italy.
  • A. Fiocchi Pediatric Department, Macedonio Melloni Hospital, Milan, Italy.
  • M. Galimberti Allergology Department, Novara Hospital, Novara, Italy.
  • E. Galli Pediatric Allergology, F.B.F. S. Pietro Hospital, Roma, Italy.
  • M. Giovannini Pneumology Department, Lugo Hospital, Ravenna, Italy.
  • C. Incorvaia Allergology/Pulmonary rehabilitation. Istituti Clinici di Perfezionamento, Milano, Italy.
  • S. La Grutta III Divisione di Pediatria, Sezione di Allergologia e Pneumologia, P.O.G. Di Cristina ARNAS Civico, Palermo, Italy.
  • C. Lombardi Divisione di Medicina, S. Orsola F.B.F., Brescia, Italy.
  • F. Marcucci Sezione di Terapia e Immuno-Allergologia Pediatrica, Dipartimento di Scienze Ginecologiche, Ostetriche e Pediatriche, Policlinico Monteluce, Perugia, Italy.
  • G. Marseglia Pediatric Allergology, S. Matteo Policlinico, Pavia, Italy.
  • M. Minelli Ambulatorio di Allergologia, U.O. Medicina Generale, Ospedale Campi Salentina, Lecce, Italy.
  • A. Musarra Ambulatorio di Allergologia, ASL Reggio Calabria, Italy.
  • E. Nettis Cattedra Allergologia e Immunologia Clinica, Policlinico di Bari, Italy.
  • E. Novembre Ambulatorio di Allergologia e Broncopneumologia, Dipartimento di Pediatria, Ospedale A. Meyer, Firenze, Italy.
  • G. Pajno Clinica Pediatrica, Policlinico di Messina, Italy.
  • G. Patriarca Allergology Department, Policlinico Gemelli, Università Cattolica, Roma, Italy.
  • F. Pezzuto Reparto di Allergologia e Immunologia, Ospedale Curteri, Mercato S. Severino, Salerno, Italy.
  • P. Piras Reparto di Otorinolaringoiatra - U.O. di Allergologia, Santissima Trinità Hospital, Cagliari, Italy.
  • S. Pucci U.O. di Allergologia, Ospedale Civile Civitanova Marche, ASL 8, Macerata, Italy.
  • A. Romano Allergology, Complesso Integrato Clinica Columbus, Roma, Italy.
  • C. Romano U.O.S. Pediatric Allergology, ASL NA n. 5, De Luca & Rossano Hospital, Napoli, Italy.
  • O. Quercia Allergology Department, Ospedale per gli Infermi, Faenza, Italy.
  • G. Scala Ambulatorio di Allergologia, Loreto Crispi Hospital, Napoli, Italy.
  • D. Schiavino Allergology Department, Policlinico Gemelli, Università Cattolica, Roma, Italy.
  • G. Sforza Allergology Department, ASL BA/1, Andria, Bari, Italy.
  • M. Tosca Pediatria Allergologica, Gaslini Hospital, Genova, Italy.
  • S. Tripodi Allergologia Pediatrica, Sandro Pertini Hospital, Roma, Italy.
  • F. Frati Scientific Department, Stallergénes, Milan, Italy.


The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, metaanalysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre coseasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient’s tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).



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Sublingual immunotherapy, rhinitis, asthma, conjunctivitis
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How to Cite
Ortolani, C., F. Agostinis, S. Amoroso, R. Ariano, A. Barbato, M. Bassi, G. Cadario, P. Campi, F. Cardinale, G. Ciprandi, R. D’Anneo, M. Di Gioacchino, V. Di Rienzo, A. Fiocchi, M. Galimberti, E. Galli, M. Giovannini, C. Incorvaia, S. La Grutta, C. Lombardi, F. Marcucci, G. Marseglia, M. Minelli, A. Musarra, E. Nettis, E. Novembre, G. Pajno, G. Patriarca, F. Pezzuto, P. Piras, S. Pucci, A. Romano, C. Romano, O. Quercia, G. Scala, D. Schiavino, G. Sforza, M. Tosca, S. Tripodi, and F. Frati. 2016. “Practice Parameters for Sublingual Immunotherapy”. Monaldi Archives for Chest Disease 65 (1).

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