World Allergy Organization Sublingual Immunotherapy Position Paper: 2026 update: Global expert consensus on efficacy, safety, disease modification, and implementation.
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Canonica Giorgio Walter, Morais-Almeida Mário, Di Bona Danilo, Ansotegui Ignacio J, Oppenheimer John J, Al-Nesf Maryam, Bernstein Jonathan A, Caimmi Davide, Chang Yoon-Seok, Davis Carla M, Ebisawa Motohiro, Fiocchi Alessandro, Gómez R Maximiliano, González-Díaz Sandra N, Hong Soon Jong, Papadopoulos Nikolaos G, Pawankar Ruby, Peter Jonny G, Rojo Gutiérrez María Isabel, Tantilipikorn Pongsakorn, Virchow Johann Christian, Wong Gary Wk, Zachary Cherie Y, Fernandez-Caldas Enrique, Durham Stephen R, Alangari Abdullah A, Ishchanka Aksana, Latiff Amir Hamzah Abdul, Jang An Soo, Morete Ana, Bożek Andrzej, Nowak-Wegrzyn Anna H, Ellis Anne K, Irani Carla, Panaitescu Carmen Bunu, Rondón Carmen, Zubrinich Celia, Betancourt Sánchez Diego, González-Mancebo Eloína, Hidalgo Castro Emilia Maria, Ng'ang'a Evelyn, Zaitoun Fares H, Rodrigues Fernandes Fátima, Andoh Hilary Dzigbodi, Chantaphakul Hiroshi, Kaidashev Igor, Nasr Iman, Chong-Neto Herberto, Pereira Celso, Dorsainvil Jean-Claude, Tracy James M, Li Jing, Trujillo Juan, Jamalyan Kristina R, Gáspár Krisztian, Ahmetaj Luljeta, Worm Margitta, Staevska Maria, Atanasković-Marković Marina, Bukovskis Maris, Valentin Rostan Marylin, Gharnaout Merzak, Gotoh Minoru, Al-Ahmad Mona, Sonomjamts Munkhbayarlakh, Prasad Komarla Nagendra, Odusote Olatunde, Monge Ortega Olga Patricia, Tsilochristou Olympia, Demoly Pascal, Stepaniuk Peter, Panzner Petr, Li Philip Hei, Aguilera-Insunza Raquel, Sepiashvili Revaz, Asero Riccardo, Tarazona Martinez Robin Ali, Altrichter Sabine, Husain Salina, Karabus Sarah Jane, Uriarte Silvia A, de Barayazarra Susana, Huq Syed Rezaul, Abbas Syed Shahid, Zuberbier Torsten, Sahiner Umit Murat, Pereira Veridiana Aun Rufino, Patella Vincenzo, Kvedarienė Violeta, Tal Yuval, Ispayev Zhanat, Martin Bryan L
Аннотация
METHODS: An international panel of experts developed an updated Position Paper on SLIT using a structured Delphi consensus methodology. Statements were formulated based on a targeted review of the scientific literature and expert clinical experience, addressing indications, patient selection, safety, treatment duration, adherence, biomarkers, disease modification, and implementation domains. Two rounds of anonymous electronic voting were conducted. Consensus was predefined as ≥70% agreement (scores 4-5 on a 5-point Likert scale).
RESULTS: Eighty-three experts representing all WAO regions were invited, and seventy-eight of them participated in the Delphi process. High levels of consensus were achieved for core principles, including SLIT effectiveness, safety, the importance of appropriate patient selection, a minimum treatment duration of 3 years, supervised administration of the first dose followed by home-based treatment, and the central role of adherence and regular follow-up. Consensus regarding disease-modifying effects was stronger for children and adolescents than for adults. Lower consensus was observed on topics related to regional allergens, likely influenced by differences in allergen exposure, product availability, clinical experience, and regulatory contexts; however, formal region-stratified analyses were not performed.
CONCLUSIONS: This WAO Position Paper establishes a globally applicable, evidence-informed consensus framework for the positioning and implementation of SLIT. By clearly delineating areas of strong agreement and domains of conditional or context-dependent evidence, it provides both a clinical reference and a strategic roadmap for equitable and sustainable SLIT integration worldwide.