Sublingual Immunotherapy for Allergy in 2026, With Désirée Larenas-Linnemann, MD

At the 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting in Philadelphia, Désirée Larenas-Linnemann, MD, from Hospital Médica Sur, presented “What Should You Know About SLIT in 2026?”1 During her talk, she shared how sublingual immunotherapy (SLIT) fits into the evolving allergen immunotherapy landscape.

Allergen immunotherapy has long been a cornerstone of treatment for allergic diseases because it targets the underlying immune dysregulation rather than simply controlling symptoms. The therapy has been used clinically for more than a century, beginning with early allergy injections administered in 1911.2

“Allergen immunotherapy… really goes to the cause of allergic diseases…particularly [in] allergic rhinitis, allergic conjunctivitis, allergic asthma,” Larenas-Linnemann told HCPLive during the meeting. “[The therapy attacks] this altered immune system and brings it back on its track.”

Traditionally, allergen immunotherapy has been administered via subcutaneous injections given in a clinical setting, which are effective but require frequent office visits and carry a small risk of systemic allergic reactions. These logistical and safety considerations have contributed to growing interest in sublingual allergen immunotherapy. Larenas-Linnemann said strong evidence on sublingual immunotherapy was published in 2006.

Today, several sublingual immunotherapy tablets are available for specific allergens, including grass pollen, ragweed, and house dust mite. These products are approved in the United States for the treatment of allergic rhinitis and allergic conjunctivitis, providing patients with a home-based treatment option that avoids injections.

According to Larenas-Linnemann, sublingual therapy can also play an important role in managing certain cases of asthma, particularly allergic asthma, which remains common among pediatric and adult patients. Safety considerations are particularly relevant for patients with asthma undergoing injection immunotherapy, since poorly controlled disease can increase the risk of adverse reactions. For this reason, clinicians often postpone subcutaneous injections if a patient is experiencing an asthma flare or has recently required emergency care.

Allergen immunotherapy is also recognized for its disease-modifying potential. Unlike standard medications, which typically relieve symptoms only while they are being used, immunotherapy can produce durable clinical benefits after treatment is discontinued. Evidence from clinical trials suggests that ≥ 3 years of treatment with high-dose sublingual immunotherapy is necessary to achieve sustained effects.3 For example, studies of grass pollen sublingual tablets have shown that patients who complete 3 years of therapy maintain symptom improvement for ≥ 2 additional years after stopping treatment.4

Clinical guidance for allergen immunotherapy is also evolving. Updated practice parameters for allergen immunotherapy are currently in development and are expected to include expanded guidance on sublingual therapy. Larenas-Linnemann said the guideline revision process has taken > 2 years, with the first part written in July 2023. The forthcoming update is expected to provide clearer recommendations for clinicians on how to incorporate sublingual immunotherapy into routine allergy care.

“This has been a long journey,” she said. “[There have been] a lot of comments [like] ‘push it there! No, [let’s] do [a] different order! No, no, this is not true!’ and ‘where’s the evidence? Now, is there new evidence? So, we really hope to have them out for public comments… in the next 2 [to] 3 months. [It] definitely [has] to be published [in] the second half of this year, hopefully third quarter.”

Larenas-Linnemann has no relevant disclosures.

References

1. Larenas-Linnemann, D. What Should You Know About SLIT in 2026? Session presented at the American Academy of Allergy, Asthma, & Immunology (AAAAI) in Philadelphia on February 28, 2026.

2. Persaud Y, Memon RJ, Savliwala MN. Allergy Immunotherapy. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535367/

3. AllergenuityHealth. Do Sublingual Immunotherapy (SLIT allergy drops) results persist after treatment is stopped? - Allergenuity Health Associates. Allergenuity Health Associates. Published July 5, 2018. Accessed March 9, 2026. https://allergenuityhealth.com/faq-items/do-sublingual-immunotherapy-slit-allergy-drops-results-persist-after-treatment-is-stopped/

4. Scadding GW, Calderon MA, Shamji MH, et al. Effect of 2 Years of Treatment With Sublingual Grass Pollen Immunotherapy on Nasal Response to Allergen Challenge at 3 Years Among Patients With Moderate to Severe Seasonal Allergic Rhinitis: The GRASS Randomized Clinical Trial. JAMA. 2017;317(6):615-625. doi:10.1001/jama.2016.21040