House Dust Mite Sublingual Immunotherapy for Pediatric Patients With Allergic Asthma

Abstract

Objective: To review the published literature evaluating administration of house dust mite (HDM) sublingual immunotherapy (SLIT) in pediatric patients with allergic asthma.

Data sources: PubMed database search (1966 to November 2017) using the search terms allergy, allergic rhinitis, asthma, allergic asthma, house dust mite, allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, MK-8237, children, and pediatric. Package labeling and references from identified articles were also reviewed.

Study selection and data extraction: Studies published in English evaluating the efficacy of HDM SLIT in children <18 years of age were included.

Data synthesis: Patients with allergic asthma who fail to improve with pharmacotherapy may require disease-modifying, HDM-specific immunotherapy. Acceptance of subcutaneous immunotherapy (SCIT) in the pediatric population is limited by the need for weekly injections and the risk of systemic adverse effects. Trials in pediatric patients with allergic rhinitis and asthma monosensitized to HDM demonstrated mixed results, likely because of variability in methodologies. SLIT reduced asthma symptoms in 8 placebo-controlled studies; however, asthma medication use was reduced in just 4 trials. Compared with pharmacotherapy alone, SLIT and SCIT decreased asthma symptom scores similarly for up to 3 years. Sequential SCIT/SLIT decreased both asthma symptoms and medication scores and was more effective than SLIT alone.

Conclusions: Sublingual HDM immunotherapy reduces symptom scores in pediatric patients with allergic asthma but may be slower in onset and less effective than SCIT in reducing asthma medication use.

Keywords: allergic rhinitis; allergy; asthma; immunology; pediatric.