It’s something people don’t like to think about, but the fact is that there are dust mites all around us. These mites are microscopic relatives of spiders and ticks that live on skin cells that we shed. They are almost impossible to eradicate, and even the cleanest house has dust mites. Although dust mites don’t bite us or cause rashes, they’re a common cause of year-round allergy symptoms such as runny nose, itchy eyes, and sneezing. People with a dust mite allergy have persistent itchy noses even when they are away from dusty objects.
A recent study showed that a new way to treat house dust mite allergies is effective and safe. What do you need to know about this treatment called sublingual immunotherapy?
Dust mite allergy and management
The first line management of house dust mite allergies is always management of the environment. In addition to cleaning (wiping surfaces, washing bedding), wrapping non-washable upholstery reduces the effects of dust mites, which like to burrow into soft pillows and mattresses. Allergen-resistant zippered covers for pillows, mattresses and box spring beds can be purchased and are an effective measure in combating these microscopic mites. Over-the-counter allergy medications such as steroid nasal sprays and antihistamines can also help.
For decades, when these measures have failed, we have used allergy shots, also called subcutaneous immunotherapy (SCIT), to treat dust mite allergies. This is an effective but bothersome treatment that involves weekly recordings for about six to eight months and then monthly recordings for about three to five years. Because of the risk of allergic reactions, the recordings must be made in a doctor’s office where a doctor is present. This is an inconvenience during normal times, but especially during the pandemic.
SLIT: The convenient new method for treating dust mite allergies
FDA-approved sublingual immunotherapy (SLIT) is the latest treatment option for treating house dust mite allergies. It is sold under the brand name Odactra in the US. Just like SCIT, SLIT trains the immune system to no longer recognize dust mites as an allergen. The biggest advantage over SCIT is convenience: this is an oral medication that is taken at home.
The daily medication is placed under the tongue and many patients complain of a slight tingling sensation in the mouth or a strange taste. And since there is a risk of an allergic reaction, you must always have an EpiPen with you so that you can self-medicate if necessary. I teach all of my SLIT patients to identify and manage anaphylaxis. Your doctor may not prescribe SLIT if you cannot use adrenaline for some reason, such as: B. because of severe heart disease. SLIT is expensive, and despite my best efforts, getting insurance has been a major barrier for my patients.
The study shows that SLIT is safe and effective
A recent study published in the Journal of Allergy and Clinical Immunology, demonstrated the safety and effectiveness of house dust mite SLIT compared to placebo. This was an international study with approximately 800 patients in the placebo group and 800 patients in the treatment group. At the end of a year, patients who received dust mite SLIT had fewer nose and eye symptoms and fewer drugs to control allergy symptoms than those in the placebo group. The study also showed safety as no one in the SLIT group had anaphylaxis and only four applications of adrenaline. Although the study only lasted a year, SLIT would likely be used for three to five years, as long as SCIT.
SLIT for ragweed and weed is also FDA cleared, but we do not combine SLIT treatments. Therefore, the best candidate for SLIT for house dust mites is someone who is only allergic to house dust mites. A person with many allergies will be better served by SCIT, which can treat multiple allergies at the same time.
I am excited about this new method of treatment for my patients and hope that similar drugs for other allergens are in sight.