Rare adverse events due to house dust mite sublingual immunotherapy in pediatric practice: two case reports

Area of Science:

• Allergy and Immunology
• Pediatric Medicine
• Immunotherapy

Background:

• Sublingual immunotherapy (SLIT) is a non-injectable method for administering allergens.
• Compared to subcutaneous immunotherapy, SLIT is associated with fewer severe systemic reactions.
• Local adverse reactions are common but typically resolve without treatment cessation.

Observation:

• Two pediatric cases with persistent asthma and allergic rhinitis were treated with house dust mite SLIT.
• One child experienced severe wheezing (grade 2 systemic reaction), and another had intractable vomiting (grade 3 local reaction).
• These reactions recurred upon re-administration of the same dose.

Findings:

• Both pediatric patients successfully completed 3-year SLIT.
• Treatment success was achieved through patient-based dose adjustments of the maintenance regimen.
• This demonstrates the feasibility of continuing SLIT despite initial adverse events.

Implications:

• SLIT can be a viable long-term immunotherapy option for pediatric allergic diseases.
• Individualized dose titration is crucial for managing adverse reactions and ensuring treatment adherence.
• Further research into optimizing SLIT protocols for children is warranted.