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Table 9 Evidence models used to establish guidelines for sublingual immunotherapy

From: Sublingual immunotherapy: World Allergy Organization position paper 2013 update

  Year Evidence model No. of RCTs* Recommendation
Specific guidelines on immunotherapy**
WHO consensus [278] 1989 None 0 None
EAACI 1988 guidelines [279] 1988 None 0 None
EAACI 1992 [280] 1992 None 0 None
WHO Position Paper [281] 1998 None 2 None
EAACI Local 1998 None 4 Suggested in adults
Immunotherapy [282]
AAAAI/ACAAI Practice parameters [283] 2007 Shekelle [284] 14 SLIT as investigational in US (no FDA approval yet)
Canadian guidelines[285] 2006 None 10 SLIT evaluated positively as ‘novel form’, but no recommendation given
Argentinean guidelines[286] 2010 None No review Indications on IT in general (AR, AC, Asthma) as co-treatment with medication. Extra indication for SLIT if SCIT is not tolerated/acceptable
AAAAI/ACAAI Practice parameters[102] 2011 Shekelle[284] 9 SLIT as investigational in US (No FDA approval yet)
British guidelines[287] 2011 SIGN 25 SLIT for adults and children with AR, after treatment failure with medication and avoidance.
Mexican guidelines[288] 2011 GRADE 18 Recommend SLIT for adults and children with AR and asthma; suggest for some cases of atopic dermatitis, latex allergy, and large local reactions to hymenoptera venom.
Chinese expert consensus on AIT for AR[289] 2011 Consensus ? ?
Finnish update on current care guidelines: AIT[290] 2012 ? ? Indicated for AR caused by grass pollen. Oral tolerance induction in children older than 5 y with severe food allergy.
Other guidelines in which immunotherapy is mentioned
ARIA 2001 [291] 2001 Shekelle [284] 12 Recommended in adults, suggested in children
ARIA Update 2008 [159] 2008 Shekelle [284] 36 Indicated in the same conditions as SCIT: patients with rhinitis/conjunctivitis/asthma caused by pollen or HDM; patients who have presented systemic reactions during SCIT.
ARIA Update 2010[292] 2010 GRADE 63 Suggests the use of pollen and HDM SLIT for allergic rhinitis in adults and of pollen SLIT in children. Does not suggest HDM SLIT in children for treatment of AR. Suggests SLIT in patients with AR+Asthma for asthma treatment (low quality evidence).
GA2LEN/EAACI pocket guide for AIT[293] 2010 Based on WAO IT papers and ARIA 2001, 2008, and 2010 No new review  
BSACI guidelines on Hymenoptera venom allergy[294] 2011 NICE accredited 0 SLIT for venom immunotherapy is mentioned as a future research area.
Guidelines for treatment of atopic eczema of the European Academy of Dermatology and Venereology[295] 2012 Appraisal of Guidelines Research and Evaluation and DELPHI procedure. 0 (this is a Review of Guidelines not RCTs) Allergen IT (not stating SLIT or SCIT) to aeroallergens may be useful in selected cases of atopic eczema.
  1. *number of randomized controlled trials on SLIT the guidelines are based on.
  2. **normal font: published in the original WAO SLIT position paper; bold font: new guidelines published since 2009.
  3. Table of evidence and recommendation taken from other guidelines based on Shekelle [284].
  4. AC = allergic conjunctivitis; AIT, allergen specific immunotherapy; AR, allergic rhinitis; FDA, US Food and Drug Administration; HDM, house dust mite; IT, immunotherapy; NICE = National institute for Health and Care excellence, RCT, randomized controlled trial; SIGN = Scottish Intercollegiate Guidelines Network (SIGN) (http://www.sign.ac.uk/); SLIT, sublingual immunotherapy.