The Management of House Dust Mite-Induced Allergic Rhinitis

This article is sponsored by ALK, Inc.

The house dust mite (HDM), a widespread allergen in our environment, is a common cause of allergic rhinitis (AR).1 In 2013, approximately 84% of households in the United States reported detectable levels of dust mite allergens.2 Dermatophagoides farinae and Dermatophagoides pteronyssinus are the two common species of HDM most often implicated in the development of AR.3 Commonly employed therapeutic approaches for the management of HDM-induced AR include HDM avoidance, pharmacotherapy (i.e., antihistamines, decongestants, and nasal corticosteroids), and allergen immunotherapy (AIT).3

Immunotherapy is the only therapeutic option for AR that offers long-term benefits and modifies the course of allergic disease by inducing desensitization through allergen exposure.4 Traditional subcutaneous immunotherapy (SCIT) involves injecting allergen extracts subcutaneously, first at low concentrations, followed by gradual increases until the maintenance dose is reached.4 Although SCIT has been found effective and well-tolerated overall, its disadvantages include the need for regular office visits for injection, and the risk of systemic allergic reaction.5

SLIT-tablets: The Latest Form of Allergen Immunotherapy

Sublingual immunotherapy tablets (SLIT-tablets) are the most recently developed form of AIT and are an option to extend AIT to more patients. According to the American College of Allergy, Asthma & Immunology, SLIT-tablets are the only FDA-approved SLIT option. The popularity of SLIT-tablets is on the rise; as of 2018, 73.5% of US allergists reported experience using SLIT therapy.6 Each SLIT-tablet is formulated to contain a standardized dose of the allergen for delivery to the oral mucosa by placing the tablet under the tongue.7 As of April 2018, the American Academy of Allergy, Asthma & Immunology’s (AAAAI) Allergy & Asthma Medication Guide lists four SLIT-tablets available for the treatment of allergies caused by common environmental allergens: ORALAIR®, GRASTEK®, RAGWITEK®, and ODACTRA® House Dust Mite (Dermatophagoides farinae and Dermatophagoides pteronyssinus) Allergen Extract Tablet for Sublingual Use 12SQ-HDM.* ODACTRA is an allergen extract indicated as immunotherapy for house dust mite (HDM)-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. ODACTRA is approved for use in adults 18 through 65 years of age. *ORALAIR® is a registered trademark of Stallergenes S.A.; GRASTEK®, RAGWITEK®, and ODACTRA® are registered trademarks of ALK-Abelló A/S.

ODACTRA—the first and only tablet for the treatment of HDM-induced AR—received FDA approval on March 1, 2017, for use in people with HDM-induced AR aged 18 to 65 years. ODACTRA is a rapidly dissolving, once-daily tablet that can be taken year-round.8 It was approved based on 3 studies (Environmental Exposure Chamber, European Field Efficacy and North American Field Efficacy) conducted in approximately 2500 individuals in the US, Canada, and Europe. In the Environmental Exposure Chamber Study, ODACTRA demonstrated statistically significant reduction in the nasal symptoms of AR as early as weeks 8 and 16 and continued to reduce symptoms towards week 24.9 The European Field Efficacy Study found that treatment with ODACTRA resulted in statistically significant reduction in combined nasal symptom and medication usage scores, starting as early as week 14 and continuing for 52 weeks.10 Subsequently, daily treatment with ODACTRA for up to 52 weeks resulted in a 17% improvement in the total combined rhinitis score in the North American Field Efficacy Study.11