Sublingual Immunotherapy (SLIT) Lt. Col Dimitrios Vourdas M.D. Allergist Director of Allergy and Clinical Immunology Unit 251 Hellenic Air Force Hospital Athens, Hellas Everything Evolving…… Evolution in Medicine…… Evolution in Immunotherapy…… Has clarified the Mechanism of Action of Sublingual Immunotherapy or rely on Insufficient or Empirical data? Mechanism of Action (Ι) (Novak N , Allergy, 66:733-739,2011) Mechanism of Action (ΙΙ) - Langerhans like DC – The Predominant of the Immune Response in SLIT Substantial difference between the oral mucosa counterparts. Expression of FcεRI, MHC class I,II, costimulatory CD40, CD80, CD86 Activation of TLR4 leads to production of IL-10 and activation of Treg Foxp3. The result is a further production of IL-10 and TGF-β SLIT induces mucosal IgA response, which contributes significantly in immune tolerance It is important, the adjutants of the formulation of SLIT, because of them, depends largely, the induction of the immune tolerance IgG4 blocking antibodies maintained in high levels and after 2 years from initiation of treatment (Allam JP , JACI, 121:368E1-374E1,2008) Is SLIT Effective? Study data until 2003 22 randomized, controlled studies About 1000 patients Study data from 2003 to 2011 60 studies (49 for meta-analysis) About 4000 patients Improves the Quality of Life in SLIT Patients; Quality of Live (Morris MS , Journal of Allergy, 2012:ID 253879,2012) Is SLIT Safe? Safety of SLIT (Radulovic S, Allergy, 66:740-752,2011) Is it Equally Effective the SLIT Therapy in Mono-Sensitized and Poly-Sensitized Patients ? (Malling HJ , Clin Exp Allergy, 39:387-393,2009) There is Dirrect Comparison Between SLIT and SCIT ?