House dust mites–driven allergic rhinitis: could its natural history be modified?

ABSTRACT

Introduction

Allergic rhinitis (AR) is the most common IgE-mediated disease. House dust mites (HDMs)-sensitization is the main cause of AR. HDM-driven AR is characterized by a typical natural history consisting of possible progression to asthma. Allergen Immunotherapy (AIT) is, at present, a unique treatment to modify the natural history of allergic diseases. Tablets AIT (TAIT) represents a new era in AIT. There is evidence that TAIT could prevent asthma in AR patients.

Areas covered

The literature search methodology was based on the articles cited by PubMed from 1980 to 2020. AIT’s rationale is to restore an immunological and, consequently, clinical tolerance toward the causal allergen. The progression from rhinitis to asthma may be influenced by a relevant risk factor, such as the persistent type 2 inflammation of airways. HDMs are perennial allergens and allergen exposure is the condicio sine qua non to maintain inflammation. AIT could modify the progression toward asthma restoring physiologic immune response to the causal allergen and consequently dampening type 2 inflammation.

Expert opinion

Patients with HDM-driven AR are susceptible to develop asthma over time. Many studies explored this topic. Cross-sectional and longitudinal studies identified some markers which predict the risk of developing asthma. They include bronchial airflow limitation, bronchial hyperresponsiveness, type 2 inflammation, and rhinitis duration. TAIT could block this progression by acting on this vicious circle. Future studies should explore this issue using adequate methodology.

KEYWORDS:

• Allergen immunotherapy
• allergic rhinitis
• asthma march
• disease-modifying treatment
• natural history
• tablets

Article highlights

• Allergic rhinitis is characterized by a type 2 high inflammation, closely associated with the causal allergen exposure

• House dust mite (HDM) allergen is a common cause of allergic rhinitis, is ubiquitous, and is present during the whole year. Consequently, patients with allergic rhinitis due to HDM have persistent allergic inflammation

• Persistent allergic inflammation involves upper and lower airways, namely HDM-allergic rhinitis and rhinitis duration are relevant risk factors for the asthma development.

• Allergen immunotherapy (AIT) is, at present, the unique treatment able to improve symptom and reduce medications as restores the physiological tolerance toward the causal allergen and dampens allergic inflammation. As a result, AIT is a disease-modifier and could prevent asthma onset.

• Tablet AIT (TAIT) represents the new choice and deserves adequate attention as it is patient-friendly. Future studies should investigate the TAIT disease-modifier potentiality.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.