Published Online: May 5, 2014
House dust mite allergy is a major global problem and allergen avoidance is often not possible or not sufficiently effective. Allergy immunotherapy, with administration of the allergen via either injection or by mouth, has shown some effect in smaller studies. Now, in a study recently published in The Journal of Allergy and Clinical Immunology, H. Mosbech and colleagues present the first results of a large study on the treatment of house dust mite asthma.
The authors of this study treated more than 600 patients during the course of a year. Patients were divided into four groups and given either a placebo or three different doses of house dust mite allergen, which was administered via a tablet placed beneath the tongue. These tablets were made to dissolve rapidly so the allergen would be readily absorbed. To measure the possible benefits of this treatment, before and at the end of the treatment regime each patient’s dose of inhaled steroid was reduced to a level just able to control their asthma.
With this design the authors were able to demonstrate the positive effect of this treatment. The group of asthma patients who had taken the highest daily dose of allergen were able to reduce their need for inhaled steroid significantly more (mean: 42%) than the placebo group (mean: 15%). Importantly, side effects in these two groups were of nearly the same severity and frequency, apart from more itching in the mouth and in some cases local swelling in the group receiving house dust mite allergen. The authors did not see a similar drug sparing effect in the groups receiving the lower allergen doses.
This study provides proof of concept for a promising treatment principle that is much more convenient for patients than conventional injection therapy. However, it would be relevant to see if a higher allergen dose or selection of patients with need for more medication would result in an even more prominent effect. Such studies are already underway and results are awaited.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.