BlueCross BlueShield of Tennessee Medical Policy Manual

Sublingual Liquid Immunotherapy


Sublingual liquid immunotherapy is a proposed treatment for allergies administered in liquid or drops placed under the tongue, usually given on a daily basis. Currently there is no immunotherapy antigen in liquid form cleared for sublingual use by the FDA.

Allergic rhinitis (AR) is a global health problem. Symptomatic treatment is available, but some individuals do not tolerate or respond well to these treatments. Only allergen immunotherapy offers persistent, long-term benefits. In clinical practice, subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT) tablets are the most common methods used.

For sublingual tablet immunotherapy, please refer to MCG Care Guideline - Immunotherapy, Sublingual




Many questions currently remain unanswered regarding sublingual liquid immunotherapy, such as effective dosing, optimal starting time and schedule, and duration of therapy


American Academy of Allergy, Asthma & Immunology (AAAAI) and American College of Allergy, Asthma & Immunology (ACAAI). (2017). Sublingual immunotherapy - a focused allergen immunotherapy practice parameter update. Retrieved May 4, 2017 from

Blue Cross Blue Shield Association. Evidence Positioning System. (10:2018). Sublingual immunotherapy as a technique of allergen-specific therapy (2.01.17) Retrieved March 15, 2019 from https://www.evidencepositioningsytem. (39 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. National Coverage Determination (NCD) for Antigens prepared for sublingual administration (110.9). Retrieved June 25, 2015 from

Creticos, P., Esch, R., Couroux, P., Gentile, D., D’Angelo, P., Whitlow, B, et al. (2013). Randomized, double-blind, placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis. The Journal of Allergy and Clinical Immunology, 133 (3), 751-758. (Level 2 evidence)

Elenburg, A., & Blaiss, M. (2014). Current status of sublingual immunotherapy in the United States. World Allergy Organization Journal, 7 (1), 24. (Level 5 evidence)

Pfaar, O., Bachert, C, Kuna, P., Panzner, P., Džupinová, M., Klimek, L., et al. (2019). Sublingual allergen immunotherapy with a liquid birch pollen product in patients with seasonal allergic rhinoconjunctivitis with or without asthma. Journal of Allergy and Clinical Immunology, 143 (3), 970-977. Abstract retrieved March 15, 2019 from PubMed database.




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