Can dust mite allergy be treated with a pill? – Harvard Health Blog

It’s something people don’t like to think about, but it’s a fact that dust mites are all around us. These mites are microscopic relatives of spiders and ticks that live on the skin cells we shed. It is almost impossible to eradicate them, and even the cleanest house has dust mites. Although dust mites don’t bite us or cause rashes, they are a common cause of allergy symptoms throughout the year such as a runny nose, itchy eyes, and sneezing. People who are allergic to dust mites have a constantly itchy nose, even when they are not physically near dusty objects.

A recent study has shown that a new way to treat dust mite allergy is effective and safe. What should you know about this treatment, called sublingual immunotherapy?

House dust mite allergy and management

The first line management of dust mite allergy is always to manage the environment. Beyond cleaning (wiping surfaces, washing clothes), covering upholstery that cannot be washed will reduce the impact of dust mites, which like to burrow into soft cushions and mattresses. Allergen resistant zippered covers for pillows, mattresses and box springs can be purchased and are an effective measure in the control of these microscopic mites. Over-the-counter allergy medications such as steroidal nasal sprays and antihistamines can also help.

For decades, when these measures failed, we have used allergy shots, also known as subcutaneous immunotherapy (SCIT), to treat dust mite allergy. It is an effective but restrictive treatment, which involves weekly injections for about six to eight months, then monthly injections for about three to five years. Injections should be done in a doctor’s office, where a doctor is present, because of the risk of allergic reactions. This is a disadvantage in normal times, but even more so during the pandemic.

SLIT: The new, practical way to treat dust mite allergy

Sublingual immunotherapy (SLIT), which was approved by the FDA in 2017, is the latest treatment option for the treatment of house dust mite allergy. It is sold under the Odactra brand in the United States. Like SCIT, SLIT trains the immune system to no longer recognize dust mites as an allergen. The biggest advantage over SCIT is its convenience: it is an oral medication that is taken at home.

The daily medicine is placed under the tongue and many patients complain of a little tingling in the mouth or of a strange taste. And since there is a risk of an allergic reaction, you should always have an EpiPen with you so that you can treat yourself if necessary. I teach all my patients on SLIT to recognize and treat anaphylaxis. Your doctor may not prescribe SLIT for you if you cannot use epinephrine for some reason, such as severe heart disease. SLIT is expensive and approval of insurance has been a major barrier for my patients, despite my best efforts.

Study Finds SLIT Safe and Effective

A recent study, published in the Journal of Allergy and Clinical Immunology, have shown the safety and efficacy of mite SLIT compared to placebo. This was an international study, with around 800 patients in the placebo group and 800 patients in the treatment group. After one year, patients who received SLIT mites had fewer nasal and eye symptoms and used fewer drugs to control allergy symptoms, compared to those in the placebo group. The study also demonstrated safety, no one suffering from anaphylaxis and only four uses of epinephrine in the SLIT group. Although the study only lasted one year, SLIT would likely be used for three to five years, the same length of time as SCIT.

SLIT for ragweed and herb is also FDA approved, but we do not combine SLIT treatments, so the best candidate for SLIT mites is someone who is allergic to dust mites only. A person with many allergies is best served by SCIT, which can treat multiple allergies at once.

I am excited about this new method of treating my patients and hope similar drugs for other allergens will be on the horizon.

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Jothi Venkat

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