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12 SQ-HDM SLIT for treating allergic rhinitis and allergic asthma caused by house dust mites (review of TA834)

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1 Recommendations

1.1

12 standard quality house dust mite sublingual lyophilisate (SQ‑HDM SLIT) is not recommended, within its marketing authorisation, for treating the following conditions diagnosed by clinical history and a positive test of house dust mite sensitisation (skin prick test or specific IgE):

  • persistent moderate to severe house dust mite allergic rhinitis in people aged 12 to 65 years despite using symptom-relieving treatment

  • house dust mite allergic asthma in adults that:

    • is not well controlled by inhaled corticosteroids and

  • is associated with mild to severe house dust mite allergic rhinitis.

1.2

This recommendation is not intended to affect treatment with 12 SQ‑HDM SLIT that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop. For children or young people, this decision should be made jointly by the healthcare professional, the child or young person, and their parents or carers.

Why the committee made these recommendations

Standard care for moderate to severe house dust mite allergic rhinitis for people aged 12 to 65 years includes treatments to relieve symptoms such as intranasal corticosteroids and antihistamines. Standard care for house dust mite allergic asthma in adults includes inhaled corticosteroids and short-acting beta agonists. It may also include additional long-acting beta agonists and leukotriene receptor antagonists.

Clinical trial evidence suggests that 12 SQ‑HDM SLIT plus standard care may reduce rhinitis symptoms and medicine use compared with placebo plus standard care in people with house dust mite allergic rhinitis. For people with house dust mite allergic asthma, clinical trial evidence suggests that 12 SQ‑HDM SLIT plus standard care may reduce asthma exacerbations compared with placebo plus standard care. But these results are uncertain. It is unclear how the treatment would benefit people in clinical practice because the trial populations and the way the trials were done does not reflect NHS clinical practice.

There are uncertainties in the economic modelling. This is because of uncertainties in the clinical evidence and the model structures do not reflect how people would have treatment in NHS clinical practice.

More evidence is needed to determine the clinical and cost effectiveness of 12 SQ‑HDM SLIT in NHS clinical practice. So, it is not recommended.