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 that we shed. It is almost impossible to eliminate them, and even the cleanest house has dust mites. Although dust mites do not sting us or cause rashes, they are a common cause of year-round allergy symptoms such as a runny nose, itchy eyes, and sneezing. People with dust mite allergy experience constant itching on the nose even when they are not near dusty objects.
A recent study showed that the new method for treating dust mite allergy is effective and safe. What do you want to know about this treatment called sublingual immunotherapy?
Dust mite allergy and its management
The first to manage dust mite allergy is always environmental management. In addition to cleaning (wiping down surfaces and laundry linens), wrapping any upholstery that cannot be washed will reduce the impact of dust mites, which like to burrow into soft pillows and mattresses. Zip-locked hypoallergenic covers for pillows, mattresses, and square springs can be purchased and are effective in controlling microscopic mites. Over-the-counter allergy medications can also be helpful, such as steroid nasal sprays and antihistamines.
For decades, when these procedures failed, we’ve used allergy shots, also called subcutaneous immunotherapy (SCIT), to treat dust mite allergies. This is an effective but cumbersome treatment, which includes weekly doses for about six to eight months, then monthly shots for about three to five years. Injections should be given in a doctor’s office, where a doctor is present, due to the risk of allergic reactions. This is a nuisance during normal times, but is more difficult during a pandemic.
SLIT: the convenient new way to treat dust mite allergy
Sublingual Immunotherapy (SLIT), which was approved by the Food and Drug Administration in 2017, is the newest treatment option for treating dust mite allergy. It is sold under the brand name Odactra in the United States. Just like SCIT, SLIT technology trains the immune system not to recognize dust mites as allergens. The biggest benefit compared to SCIT is convenience: It’s a medication to be taken orally at home.
The daily medication is placed under the tongue, and many patients complain of some tingling or strange taste in the mouth. Because there is a risk of an allergic reaction, you should carry an adrenaline injection pen at all times so that you can treat yourself if necessary. I teach all of my patients on SLIT to learn about and treat them Squeamishness. Your doctor may not prescribe SLIT if you cannot use epinephrine for any reason, such as severe heart disease. SLIT is expensive, and insurance approval has been a major hindrance for my patients, despite my efforts.
The study found SLIT to be safe and effective
a A recent study, Published in Journal of Allergy and Clinical Immunology, Demonstrated safety and efficacy of SLIT dust mites compared to placebo. This was an international study, with about 800 patients in the placebo group and 800 patients in the treatment group. At the end of one year, patients treated with SLIT had fewer nasal and eye symptoms and used fewer medications to control allergy symptoms, compared to those in the placebo group. The study also showed safety, with no one ever developing anaphylaxis and only four uses of epinephrine on SLIT Group. Although the study spanned only one year, SLIT would likely be used for three to five years, the same duration as SCIT.
SLIT technology for ragweed and grass is also approved by the FDA, but we don’t combine SLIT treatments, so the best SLIT filter for dust mites is someone who is only allergic to dust mites. SCIT is best served to a person with multiple allergies, which can treat several allergies simultaneously.
I am excited about this new way of treating my patients, and I hope that similar drugs for other allergens will be on the horizon.