Consensus on the treatment of allergic asthma with sublingual house dust mite immunotherapy in the field of pneumology

ABSTRACT

Introduction: Many patients sensitized to mites remain symptomatic and uncontrolled despite traditional treatment. Sublingual immunotherapy (SLIT) has demonstrated to reduce the symptoms of allergic rhinitis, the need for additional drug treatments, and to reduce the number of moderate and severe exacerbations in patients with allergic asthma caused by mites that had not been adequately controlled.

Areas covered: After reviewing the most recent literature, a scientific committee composed by five pneumologists experts in asthma proposed 41 items that addressed the diagnosis of allergic asthma caused by mites, the role of house dust mite (HDM) SLIT tablet in the therapeutic plan and in the control of the disease, and the profile of patients with asthma candidates for this therapy. Through a modified Delphi method, the items were send to 106 pneumologists involved in asthma to be agreed.

Expert opinion: The high degree of consensus reached by the panel of pneumologists shows the importance of HDM SLIT tablet in the treatment of allergic asthma caused by mites, particularly taking into account that they barely use this therapy because until now they did not have a registered treatment with solid evidence of efficacy and safety.

KEYWORDS:

• Allergy
• asthma
• immunotherapy
• mites
• subcutaneous
• sublingual

Article highlights

• The first step to consider treatment with House Dust Mite (HDM) Sublingual Allergen Immunotherapy (SLIT) tablet is to make an accurate diagnosis by associating asthma symptoms with mite allergy.

• Skin prick test using standardized extracts of mites of the genus Dermatophagoides spp. is the method of choice for the diagnosis of mite sensitivity, as it has the same meaning as the measurement of specific serum IgE against mites and is less expensive and more accessible.

• Allergen immunotherapy is the only treatment option with the potential to alter the natural course of allergic disease, which supports its value as an additional treatment in allergic asthma.

• HDM SLIT tablet is an add-on treatment that improves symptoms of mild and moderate rhinitis and asthma, reducing and delaying moderate and severe exacerbations, and allowing for a progressive reduction in symptomatic asthma treatment.

• HDM SLIT tablet is an additional treatment indicated when there is partial control and, in some cases, when there is poor control of the disease. In cases of partial control, it is an option to consider before escalating treatment with inhaled corticosteroids.

• The scientific evidence supporting the efficacy and safety of HDM SLIT tablet is more consistent than that of subcutaneous immunotherapy, making it the preferred immunotherapy option.

Acknowledgments

The authors wish to thank Luzan 5 Health Consulting and Fernando Sánchez Barbero PhD for their support on the preparation of this manuscript.

Declaration of interest

Vicente Plaza has received in the last three years honoraria as a speaker in meeting sponsored by Astrazeneca, Chiesi, and Novartis; and as an advisor for ALK-Abelló, Astrazeneca, Bial, Boehringer-Ingelheim, MundiPharma, and Sanofi. He received financial support for attending conferences from Astrazeneca, Chiesi, and Novartis; and received grants for research projects from Astrazeneca, Chiesi, and Menarini.

Aurelio Arnedillo has received in the last three years fees for participating in scientific lectures and/or for scientific advice and/or for attending congresses from the following companies: ALK-Abelló, Astrazeneca, Bial, Boehringer-Ingelheim, Chiesi, Esteve, Ferrer, Gebro, Griphols, GSK, Menarini, MSD, Mundipharma, Novartis, Orion, Roche, Rovi, Teva, and Zambon.

Marina Blanco has received in the last three years honoraria for participating as a speaker in meetings sponsored by Astrazeneca, Chiesi, GSK, Teva, and Novartis; as well as financial support for attending conferences.

José María Ignacio has received in the last three years honoraria for participating as speaker in meetings sponsored by Astrazeneca and GSK; advisor for ALK-Abelló, Astrazeneca, and GSK; and financial support for attending congresses by Chiesi, Menarini, and Novartis.

Isabel Urrutia has received in the last three years honoraria for participating as a speaker in meetings sponsored by Teva, Chiessi, Bial Aristegui, GSK, Mundipharma, Novartis, and Astrazeneca; financial support as an advisor from Sanofi, ALK-Abelló, GSK, and Astrazeneca; and grants for research projects from Novartis, Astrazenenca, GSK, Mundipharma, and Menarini.

The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Supplementary material

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Additional information

Funding

This work has been founded by ALK.