Efficacy and safety of Sublingual immunotherapy for allergic rhinitis: an overview of systematic reviews and meta analyses

Wang, Z., Wang, N., Liang, X. et al.  Eur Arch Otorhinolaryngol (2025). https://doi.org/10.1007/s00405-025-09664-7

Abstract

Introduction

Reappraisal of Systematic reviews/Meta analyses on Sublingual Immunotherapy for Allergic Rhinitis: Evidence for Clinical Practice and Decision-Making.

Methods

A comprehensive computerized search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, WANFANG, and CBM databases from their inception to June 8, 2025, to systematically identify Systematic reviews and Meta analyses on Sublingual Immunotherapy for allergic rhinitis. A citation overlap matrix was constructed to calculate the corrected covered area, assessing the degree of primary study overlap. The risk of bias, methodological quality, reporting quality, and certainty of evidence in the included Systematic reviews/Meta analyses were evaluated using ROBIS, AMSTAR-2, PRISMA 2020, and GRADE tools, respectively. Both quantitative and qualitative analyses were performed on the primary outcomes to derive a more comprehensive and in-depth understanding.

Results

Cartesian heatmap of the scores of each item in PRISMA 2020.
Note: Green indicates compliance; Gray indicates partial compliance;
Red indicates non-compliance

A total of 20 Systematic reviews/Meta analyses were included in this umbrella review. The corrected covered area of 6.391% derived from the citation matrix analysis indicated a modest degree of primary study overlap among the included literature.

Risk of bias assessment demonstrated that all incorporated studies exhibited low bias risk. Methodological quality evaluation revealed 2 high-quality, 3 moderate-quality, 14 low-quality, and 1 extremely low-quality study. Reporting quality assessment yielded scores ranging from 22 to 41.5, with 7 studies classified as high-quality, 11 as moderate-quality, and 2 as low-quality reports. The evidence quality assessment revealed that among all evaluated outcomes, 7 were rated as high quality, 19 as moderate quality, 31 as low quality, and 14 as extremely low quality according to the GRADE framework.

Discussion

Current evidence demonstrates that Sublingual Immunotherapy exhibits favorable efficacy in improving symptom scores and medication use for allergic rhinitis, with generally acceptable safety profiles despite mild adverse reactions in some cases. Future research should focus on large-scale, real-world studies with diverse outcome measures, investigating variations in regional populations, allergen types, dosage regimens, and treatment durations to further optimize clinical application protocols for Sublingual Immunotherapy.

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