Real-World Personalized SLIT Outcomes in Telemedicine Care

Key Takeaways

• The proportion reaching a 30-point or greater symptom improvement at least once increased from 28% at 12 months to 45% at 24 months.
• Medication use decreased over time, and more than 80% reported quality-of-life improvement across intervals, reaching 90.7% at 30 to 36 months.
• Self-reported adherence remained high, discontinuation was uncommon, and reported adverse events were mostly mild, with no anaphylaxis, eosinophilic esophagitis, or grade IV or V events.

Among 2,897 adults in a longitudinal cohort of personalized SLIT delivered through a telemedicine platform, symptom burden declined over follow-up, including a modeled 10.1-point reduction at 6 months. This retrospective routine-care analysis followed adults receiving personalized sublingual immunotherapy for environmental allergies from 2020 through 2025 within a commercially operated remote program. It assessed within-person change over time rather than treatment-group comparisons. Over longer follow-up, allergy medication use also fell, while patient-reported quality of life remained improved for most participants.

The study was a retrospective, longitudinal, single-arm observational analysis of adults receiving personalized SLIT for environmental allergies, with at least one baseline and one follow-up survey after 12 months. Participants had a mean age of 39.0 years, 52.7% were women, and 25.3% had asthma. Median follow-up from treatment initiation was 20 months, and median treatment duration was 26.0 months. Remote structured online surveys captured symptoms, medication use, quality of life, adherence, asthma outcomes, and adverse events, allowing real-world longitudinal monitoring rather than a comparative trial.

Symptom change was modeled from repeated survey measures covering nasal congestion, sneezing, watery eyes, sleep-related symptoms, activity-limiting symptoms, and overall allergy symptom control. Average symptom scores declined by 6.32 points per 12 months in unadjusted analyses and by 6.93 points after adjustment. Medication burden moved in the same direction, with an odds ratio of 2.31 per 12 months for greater reported reduction in medication use; the number of medication categories used also fell over time. Higher baseline symptom severity was linked to earlier response, and symptoms and medication use declined in parallel over follow-up.

Quality-of-life improvement remained above 80% throughout follow-up, rising from 81.4% at 12 to 18 months to 90.7% at 30 to 36 months. In the overall cohort, each additional 12 months was associated with higher odds of reported quality-of-life improvement, with an odds ratio of 4.68. Across intervals, more than 90% reported SLIT use on at least 20 days per month, and more than 80% reported at least 25 days. Only 42 patients met discontinuation criteria, and adverse events were reported in 6 of them, all grade I, consistent with persistent use during follow-up.

Adverse events were predominantly mild, with 11.7% reporting grade I events, 3.73% grade II events, and 0.83% grade III events. No grade IV or V events, anaphylaxis, or eosinophilic esophagitis were reported, although events were patient-reported and could overlap with allergic disease manifestations. In participants with asthma, longer treatment duration was associated with better control, less inhaler use, improved symptoms, and better quality of life. Asthma subgroup odds ratios per 12 months ranged from 2.16 to 4.39 across reported endpoints.

The authors described the telemedicine model as feasible and scalable in routine practice, while the single-arm retrospective design does not support causal or comparative conclusions.