Abstract - (2019) Volume 2, Issue 4

Allergy 2018 : Sublingual immunotherapy with house dust mites: An observational before – after study - Zareen Mohamed - National University of Singapore

Objective: To assess the efficacy of the use of sublingual immunotherapy with house dust mites in the treatment of allergic rhinoconjuctivitis and allergic asthma.


Background: Sublingual immunotherapy in patients with allergic rhinitis sensitised to house dust mites is safe, but its efficacy is controversial and sublingual immunotherapy with Blomia tropicalis has not yet been studied. This study sought to evaluate the efficacy of sublingual immunotherapy with house dust mite extract in children and adults with house dust mite allergic rhinitis over a period of two years.



This is an observational before-after monocentric study on efficacy of sublingual immunotherapy in the treatment of allergic rhinoconjunctivitis with mild asthma. A prospective observational study was conducted of children and adults diagnosed with house dust mite allergic rhinitis who were treated with sublingual immunotherapy from 2008 to 2012. Total Nasal Symptom Scores, Mini Rhinoconjunctivitis Quality of Life scores and medication usage scores were assessed prospectively.

Twenty patients with perennial allergic rhino conjunctivitis and mild asthma symptoms mono-sensitized to Dermatophagoides pteronyssinus and Dermatophagoides farinae were enrolled at varying periods from 2013 to 2017. The inclusion criteria for the study was written informed consent signed by the patient and guardian, positive clinical history of allergy to dust mites, FEV1 greater than or equal to 70% of the expected value, above 10 years of age, mono sensitization to dust mites diagnosed by positive skin tests to Dermatophagoides pteronyssinus and dermatophagoides farinae: wheal size > 3 mm diameter and / or Specific IgE(> 0.7 kU / L). (PHADIA immunocap ELISA). Total nasal rhinitis symptom scores (TNSS), visual analogue score (VAS) and total medication scores (TMS) were evaluated at: baseline, after SLIT for half a year, one year and in a few patients at two years. The adverse events (AEs) were evaluated at each visit. Patients who had completed more than 1 year of immunotherapy were evaluated for the symptom improvement and use of allergy medications.



Two patients completed three years of sublingual immunotherapy. 8 patients continued immunotherapy for more than 1 yr but did not continue beyond 2 yrs. 6 patients discontinued treatment with in1 year for varying reasons. In the patients taking treatment for more than 1 yr, SLIT provided significant symptom relief and reduced the need for medications in Perennial allergic rhinitis.



Immunotherapy is a specific treatment for allergic diseases. Unlike pharmacological treatment, immunotherapy is the only treatment that could modify the natural course of allergic disease.

The objective of this retroactive study was to estimate the efficacy and safety of sublingual immunotherapy (SLIT) for treating adult patients with allergic rhinitis (AR) induced by house dust mite (HDM) among Chinese Han population.A total of 201 adult patients with AR induced by house dust mite were included. All of them received SLIT treatment. There many  outcomes consisted of AR symptoms, and quality of life. In addition to this there are, any adverse events were also recorded in this study.Compared with the AR symptoms and quality of life before the treatment, significant differences were found after 1-year treatment , and 2-year treatment . In addition to this, only mild and which are accepted adverse events were observed in this study.This study demonstrated that SLIT may be efficacious and safety for adult patients with home dust mite effected by AR among Chinese Han population. Allergic rhinitis (AR) is one of the most common health problems that affect more than one-third population all around the world. In China, it has been reported that its prevalence varies from 9.6% to 23.9%. Previous studies also reported that the house dust mite (HDM) is the most probable inhalant allergen, and cause to the AR. Moreover, patients with such condition can also lead to chronic or more severe AR or even asthma when they are exposed to the HDM for long time. Fortunately, the symptoms of AR are often associated with poor quality of life, sleep disorder, and even emotional issues. The treatment for this condition is costly and imposes a large amount of economic burdens for individuals, families, and the society. Most treatments still focus on the symptoms relief for patients with AR, and often suffer from efficacy limitation for long time. Fortunately, more promising treatment of allergen immunotherapy is used as a guideline-recommended treatment for patients with AR.  It has been reported that this kind of therapy can not only manage the transform of AR to severer condition, but also can prevent AR to develop into asthma with the early treatment. Even though  sublingual immunotherapy is used to handle AR effectively under the recommendation of the World Allergy Organization,  limited data of SLIT for the treatment of AR among adult Chinese Han population has been reported. In this practice, we retroactive search the efficacy and safety of SLIT in patients with AR induced by HDM among Chinese Han adult population specifically.


Recent Publications (minimum 2)


1.            Analysis of allergen sensitivity in Bronchial asthma.Zareen Mohamed,Usha Shukla, Sathiya. Abstracts for poster presentation. Lung India.2013

2.            Mohamed Z, Sathiya. A case of wheat dependant exercise induced anaphylaxis. Indian J Allergy Asthma Immunol 2014;28:52-3


References (minimum 5)

3.            Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol 2011;127 1 Suppl: S1-55.  

4.            Bergmann KC, Demoly P, Worm M, Fokkens WJ, Carrillo T, Tabar AI, et al. Efficacy and safety of sublingual tablets of house dust mite allergen extracts in adults with allergic rhinitis. J Allergy Clin Immunol 2014;133:1608-14.e6. 

5.            Marogna M, Spadolini I, Massolo A, Canonica GW, Passalacqua G. Randomized controlled open study of sublingual immunotherapy for respiratory allergy in real-life: Clinical efficacy and more. Allergy 2004;59:1205-10.  

6.            Kocabas  CN, Civelek  E, Sackesen  C,  et al.  Burden of rhinitis in children with asthma.  Pediatr Pulmonol. 2005;40(3):235-240.

7.            5.Bateman  ED, Reddel  HK, Eriksson  G,  et al.  Overall asthma control: the relationship between current control and future risk.  J Allergy Clin Immunol. 2010;125(3):600-608, 608.e1-608.e6

Author(s): Zareen Mohamed

Abstract Full Text PDF