Background: specific immunotherapy is the sole treatment for changing the natural course of allergic 
diseases and minimizing the risk of an exacerbation. Sublingual immunotherapy is may be preferred 
worldwide considering the favorable safety profile and absence of anxiety provoking injections. Many 
updated recommendations of its use with reports emphasize the need for a methodological control of 
research projects in order to increase their objectivity. Patients and methods: this study is designed 
to be open labeled, randomized and double armed parallel groups; 80 adult asthmatic patients were 
screened for mild to moderate persistent asthma by history, clinical examination ,chest X ray ,FEV1 , 
then screened for atopic sensitized patients with total IgE and skin prick test . Then patients were 
randomized into 2 equal groups, group 1 received ICS plus SLIT for 9 months and group 2 received 
ICS for the same period. Serum total IgE was evaluated before and after treatment, every 3 months 
FEV1 was evaluated and monthly clinical evaluation by Asthma symptom control sheet, medication 
score were done throughout the entire period. Results: 80 patients were randomized into 2 equal 
groups, group 1 received ICS plus SLIT for 9 months and group 2 received ICS for the same period. 
In group 1 serum level of total IgE after treatment show a significant decrease while FEV1 after 
treatment show significant increase. In group 2 serum level of total IgE after treatment show no 
significant difference while FEV1 show no significant difference. 
Conclusion: Serum level total IgE is a good biomarker significantly decreased with SLIT therapy.