SLIT vs SCIT: Which Immunotherapy Works Best for Children With Allergic Rhinitis? Review Sheds Light
Saudi Arabia: A systematic review of randomized clinical trials suggests that both sublingual and subcutaneous allergen immunotherapy are effective options for managing allergic rhinitis in children, with differences in safety profiles and practical considerations that may guide individualized treatment decisions.
The review, published in the International Journal of General Medicine, was conducted by Ashwag Asiri from the Child Health Department, King Khalid University, Abha, Saudi Arabia, and colleagues.
Allergic rhinitis is a common chronic condition in children that adversely affects quality of life, school performance, and overall health. Allergen immunotherapy (AIT), delivered either as subcutaneous injections (SCIT) or sublingual therapy (SLIT), targets the underlying immune mechanism and can alter disease progression. However, direct comparisons between these two approaches in children have been limited.
In the systematic review, the authors searched major databases, including PubMed, Embase, the Cochrane Library, and Scopus, up to July 2024. Randomized trials in children aged 18 years or younger with allergic rhinitis were included if they compared SLIT, SCIT, or either approach with controls. Key outcomes assessed were symptom control, medication use, safety, adherence, and immunological measures, with study quality evaluated using the Cochrane Risk of Bias tool in line with PRISMA guidelines.
Key Findings:
- Seven randomized controlled trials were included in the analysis, showing that both sublingual and subcutaneous immunotherapy significantly reduced allergic rhinitis symptoms and the need for rescue medications compared with control treatments.
- Direct comparisons between SLIT and SCIT generally indicated similar efficacy, with several studies reporting comparable improvements in symptom scores and medication use.
- Some trials suggested that SCIT may provide additional benefits for specific outcomes, including improved asthma-related symptoms or greater reductions in total rhinitis symptom scores from baseline.
- SLIT demonstrated a more favorable safety profile, with adverse events mainly limited to mild and local reactions such as oral itching or minor gastrointestinal symptoms.
- SCIT was associated with a higher risk of systemic adverse reactions, necessitating administration in a supervised clinical setting, a factor that may affect treatment acceptance and long-term adherence in children.
The review also highlighted potential additional benefits of SLIT, including limited evidence suggesting a role in reducing asthma development or preventing new allergen sensitizations. However, data on adherence and long-term outcomes were sparse, underscoring gaps in the current literature.
According to the authors, the findings indicate that both SLIT and SCIT are viable and effective disease-modifying treatments for pediatric allergic rhinitis. SLIT offers similar efficacy for many outcomes along with greater safety and convenience, while SCIT may provide more pronounced benefits in selected clinical scenarios but requires clinic-based delivery.
The authors emphasize that treatment choice should be individualized through shared decision-making, taking into account disease severity, patient age, comorbidities, family preferences, and healthcare resources.
They conclude that larger, high-quality comparative studies with long-term follow-up are needed to better define the optimal role of each immunotherapy approach in children with allergic rhinitis.
Reference:
Asiri, A., Alzahrani, F., Ismail, G. M., Almonawar, N., Althubaiti, S., Alkhalifah, W., … Alzhrani, L. M. (2025). Efficacy and Safety of Sublingual and Subcutaneous Immunotherapy in Children with Allergic Rhinitis: A Systematic Review of Randomized Trials Including Direct and Indirect Comparisons. International Journal of General Medicine, 18, 7037–7047. https://doi.org/10.2147/IJGM.S547338
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