AAIQ   The Association of Allergists and Immunologists of Québec

Immunotherapy by drops

The immunotherapy committee of the l’AAIQ would like to inform and caution health professionals and the population about a form of oral liquid immunotheraphy that uses for a substrate solutions of subcutaneous immunotherapy extracts destined for injection, and which are neither scientifically valid, nor approved by regulatory authorities with regards to this use.

Résumé : In Québec, for 1-2 years we have started to see the promotion of a form of oral liquid immunotherapy which uses as a substrate solutions of extracts normally destined for subcutaneous immunotherapy, in a very open and non-reserved manner. The immunotherapy committee of the AAIQ denounces this approach for several reasons: :

  1. This approach has not been accepted by the regulatory authorities in Canada.
  2. There is no solid scientific evidence to support its efficacy: a lack of rigorous protocols and the impossibility of administering precise doses.
  3. The utilisation as substrate the extracts accepted by Health-Canada for subcutaneous immunotherapy is considered 'off-label'. The promotion of this form of treatment via different media has been seen particularly in the past year in Montréal. We are not certain that this utilisation of extracts accepted by Health-Canada for subcutaneous immunotherapy truly corresponds to the definition of 'off-label' such as defined. This appears to be an indication more than simply for 'off-label' use.
  4. Finally, for the purpose of reimbursement by insurance companies, prescribers are often required to use the available registration numbers (DIN), which are those for approved extracts and are intended for subcutaneous immunotherapy, but do not correspond to the prescribed products (oral immunotherapy). It is clear that the AAIQ Immunotherapy Committee cannot subscribe to this practice.

The Committee on Immunotherapy of the AAIQ has always promoted therapeutic recommendations based on scientific evidence for the well-being of patient suffering from allergies. The Committee firmly reiterates that:

  1. Immunotherapy is an effective approach that is worth being considered as an option in the treatment of allergies.
  2. Sublingual immunotherapy offers benefits in terms of practical aspects and safety and represents an attractive future.
  3. Sublingual tablet immunotherapy, based on robust scientific evidence, is now accepted in Canada by regulatory authorities and has a place in the therapeutic choices offered to patients.
  4. Sublingual immunotherapy in liquid form is not an acceptable therapeutic solution because it is not approved, primarily for lack of scientific support: unrecognized protocols, unfamiliar doses.

For additional information, please consult the document in detail (published 11/2012, French version).

In detail