House dust mite immunotherapy

Indications

House dust mite immunotherapy is used for: Allergic Rhinitis

Adult Dose

Allergic Rhinitis Sublingual allergy immunotherapy (SLIT) tablet indicated for dust mite-induced allergic rhinitis with or without conjunctivitis, confirmed by in vitro testing for IgE antibodies to Dermatophagoides farinae or Dermatophagoides pteronyssinus house dust mites, or skin testing to licensed house dust mite allergen extracts, in people aged 18-65 years 1 tablet SL qDay

Child Dose

<18 years: Safety and efficacy not established

Renal Dose

Administration

Sublingual Administration Remove foil from blister with dry hands Place the tablet under the tongue; it will dissolve within 10 sec; do not swallow for at least 1 min Wash hands after handling tablet Not for administration with food or beverage; do not take food or beverage for 5 min after taking tablet Administer first dose under the supervision of a physician with experience in the diagnosis and treatment of allergic reactions; observe patient for at least 30 minutes following initial dose; if patient tolerates first dose, subsequent doses may be taken at home Prescribe autoinjectable epinephrine to patients and instruct them in proper use of emergency self-injection of epinephrine

Contra Indications

Severe, unstable, or uncontrolled asthma History of severe systemic allergic reaction History of severe local reaction after taking sublingual allergen immunotherapy History of eosinophilic esophagitis Hypersensitivity to product or components

Precautions

Therapy may cause systemic allergic reactions, including anaphylaxis, which may be life-threatening (see Black Box warning) May cause local reaction in mouth or throat that could compromise upper airway; discontinue therapy if patient experiences persistent and escalating adverse reactions in mouth or throat Eosinophilic esophagitis may occur; discontinue therapy and consider diagnosis of eosinophilic esophagitis in patients who experience persistent gastroesophageal symptoms including dysphagia or chest pain Withhold immunotherapy if patient experiences acute asthma exacerbation; reevaluate patients who experience recurrent asthma exacerbations; discontinue therapy if necessary Concomitant dosing with other allergen immunotherapy may increase likelihood of local or systemic adverse reactions to either subcutaneous or sublingual allergen immunotherapy Stop therapy and allow complete healing of oral cavity in patients with oral inflammation, including oral lichen planus, mouth ulcers or thrush, or oral wounds such as those following oral surgery or dental extraction

Pregnancy-Lactation

Pregnancy Available data on pregnant women are insufficient to inform associated risks in pregnancy Animal studies In a fetal/embryo developmental toxicity study performed in mice, administration during gestation did not reveal adverse developmental outcomes in fetuses Lactation Data are not available to assess effects on breastfed children or on milk production and excretion in nursing women Consider developmental and health benefits of breastfeeding along with the mother’s clinical need for drug and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

Interactions

Patients taking beta-adrenergic blockers may be unresponsive to usual doses of epinephrine used to treat serious systemic reactions, including anaphylaxis; beta-adrenergic blockers may antagonize cardiostimulating and bronchodilating effects of epinephrine Patients taking alpha-adrenergic blockers may be unresponsive to usual doses of epinephrine used to treat serious systemic reactions, including anaphylaxis; alpha-adrenergic blockers may antagonize vasoconstricting and hypertensive effects of epinephrine; ergot alkaloids may also reverse pressor effects of epinephrine Adverse effects of epinephrine may be potentiated in patients taking tricyclic antidepressants, levothyroxine sodium, monoamine oxidase inhibitors, and the antihistamines chlorpheniramine and diphenhydramine Patients who receive epinephrine while taking cardiac glycosides or diuretics should be observed carefully for development of cardiac arrhythmias

Side Effects

Side effects of House dust mite immunotherapy : >10% Itching in the ear (51.7%) Itching in the mouth (61.3%) Swelling of the uvula/back of the mouth (19.8%) Swelling of the lips (18%) Swelling of the tongue (15.8%) Nausea (14.2%) Tongue pain (14.2%) Tongue ulcer/sore on the tongue (11.6%) Stomach pain (11.3%) Mouth ulcer/sore in the mouth (10.3%) Throat irritation/tickle (67%) Throat swelling (13.6%) 1-10% Taste alteration/food tastes different (10%) Diarrhea (6.9%)

Mode of Action

Mechanisms of action of allergen immunotherapy have not been fully established