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Sublingual immunotherapy (SLIT) represents a safer, more comfortable and more convenient allergen immunotherapy than its subcutaneous counterpart. There is an increasing body of evidence showing that SLIT for house dust mites (HDM), grass, ragweed and/or tree pollen improves allergic symptoms and asthma control.1 It is unclear whether SLIT consistently reduces the occurrence of asthma attacks.1–3
Published in 2016, the MITRA trial was arguably the most robust randomised controlled trial assessing the effect of SLIT (specifically HDM-SLIT) on the prevention of asthma attacks in mild-to-moderate allergic asthma.2 Briefly, the MITRA trial was conducted in 834 people with uncontrolled mild-to-moderate allergic asthma and positive HDM allergen-specific immunoglobulin E (IgE) (≥0.7 kU/L or >3 mm on skin prick—usual cutoffs). After randomisation to HDM-SLIT or placebo, participants were monitored on stable background inhaled corticosteroid (ICS) therapy for 7–12 months, thereafter, reducing their ICS dosing up to complete withdrawal within the next 6 months. This ALK-Abelló-sponsored investigation showed a statistically—and just about clinically significant4—decrease in the risk of moderate-to-severe exacerbation in the intervention arms, no matter the dose of HDM-SLIT.
In the original MITRA publication,2 only a few prespecified subgroup ‘responder’ analyses were reported on the trial population (age, sex, allergen sensitisation type and cosensitisation). Unfortunately, no ‘SLIT-responder group’ was identified. The absence of theragnostic markers left clinicians to randomly select who they propose SLIT to, and guidelines to softly suggest HDM-SLIT to be considered as an alternative add-on for uncontrolled mild-to-moderate allergic asthma.3
In this issue of Thorax, Hoof et al from a group of researchers from the pharmaceutical company and academic centres take a …
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Contributors All authors wrote and validated the manuscript. SC is the guarantor.
Competing interests CAC-P: reports speaker honoraria from AstraZeneca, GlaxoSmithKline, and Sanofi-Regeneron; he received consultancy fees from AstraZeneca, GlaxoSmithKline, and Sanofi-Regeneron. PL reports speaker honoraria from AstraZeneca, Sanofi-Regeneron, GlaxoSmithKline, Boehringer Ingelheim and Novartis outside of the submitted work: he received consultancy fees from AstraZeneca, GlaxoSmithKline, and Sanofi-Regeneron. SC reports non-restricted research grants from the NIHR Oxford BRC, the Quebec Respiratory Health Research Network, the Fondation Québécoise en Santé Respiratoire, AstraZeneca, bioMérieux, and Sanofi-Genyme-Regeneron; he is the holder of the Association Pulmonaire du Québec’s Research Chair in Respiratory medicine and is a Clinical research scholar of the Fonds de recherche du Québec; he received speaker honoraria from AstraZeneca, GlaxoSmithKline, Sanofi-Regeneron, and Valeo Pharma; he received consultancy fees for FirstThought, AstraZeneca, GlaxoSmithKline, and Sanofi-Regeneron; he has received sponsorship to attend/speak at international scientific meetings by/for AstraZeneca and Sanofi-Regeneron. He is an advisory board member and will have stock options for Biometry Inc—a company developing a FeNO device (myBiometry). He advised the Institut national d’excellence en santé et services sociaux (INESSS) for an update of the asthma general practice information booklet for general practitioners.
Provenance and peer review Commissioned; internally peer reviewed.