House Dust Mite Allergy Treatment
with Sublingual Immunotherapy (SLIT) in London

House Dust Mite is a microscopic creature, related to spiders and ticks, that lives primarily in mattresses, pillows, duvets, carpets, and upholstered furniture. They thrive in warm, humid indoor conditions and are virtually impossible to eradicate entirely from the home.

Allergy is a reaction of hypersensitivity to proteins found in the excretions and body fragments of the dust mite — not the mite itself. These proteins trigger a cascade of IgE-mediated inflammation in susceptible individuals. The condition can be manifested in the form of rhinitis, asthma, or both. In some cases sensitisation also plays a role in eczema and atopic dermatitis.

Because mites are present indoors throughout the year, HDM allergy causes perennial (year-round) symptoms rather than the seasonal pattern seen with pollen allergies. Symptoms frequently worsen in autumn and winter when homes are heated and ventilated less frequently, increasing indoor mite concentrations.

Oral Dendritic Cells Capture the Allergen

Langerhans cells and myeloid dendritic cells in the oral mucosa capture the allergen and migrate to cervical lymph nodes. In the absence of danger signals, these cells promote T-regulatory (Treg) cell differentiation rather than the allergy-driving Th2 response.

Immune Deviation: Th2 to Th1 and Treg

SLIT drives a shift in allergen-specific CD4+ T cells from the pro-allergic Th2 profile to Th1 and Treg profiles. Treg cells secrete the anti-inflammatory cytokines IL-10 and TGF-beta, which suppress the allergic inflammatory cascade throughout the body.

Specific IgE Falls; IgG4 Blocking Antibodies Rise

Allergen-specific IgE antibodies — the antibodies responsible for triggering allergic reactions — progressively decrease over the treatment course. Simultaneously, IgG4 “blocking” antibodies increase, competitively interrupting the IgE-mediated inflammatory cascade before it can cause symptoms.

Mast Cells, Basophils & Eosinophils Become Less Reactive

Oral tissues contain relatively few mast cells, explaining SLIT’s excellent safety profile. Over time, innate immune cells responsible for acute and chronic allergic inflammation become progressively less reactive, reducing both immediate symptoms and long-term airway remodelling.

Initial Allergy Consultation & Assessment

A comprehensive consultation with one of our specialist allergists, including a detailed clinical history, skin prick testing, and/or measurement of serum HDM-specific IgE. We will confirm your sensitisation, assess severity, review current medications, and determine whether SLIT is your most appropriate treatment option.

Personalised Treatment Plan & First Dose in Clinic

Your personalised SLIT programme using standardised Stallergenes allergen extract is prescribed, and your first dose is administered under medical supervision at our clinic. You are observed for 20–30 minutes. We provide full written instructions on home self-administration from the following day.

Daily Home Administration — Build-Up Phase

You dispense the prescribed drops under your tongue each morning, hold for one to two minutes, then swallow. Doses are gradually increased during the build-up phase, typically over several weeks to months, according to your personalised schedule. This phase progressively trains your immune system.

Maintenance Phase & Regular Clinic Reviews

Once the target maintenance dose is reached, you continue daily dosing at the same level. Most patients notice symptom improvement within three to six months, with continued progress over the full treatment course. Regular review appointments allow us to monitor your response and adjust treatment as needed.

Completion & Lasting Benefit

A full course typically lasts three to five years. Following completion, the benefits — reduced symptoms, lower medication requirements, improved lung function, and better quality of life — are maintained for several years without further treatment. This post-treatment sustained efficacy is unique to immunotherapy and cannot be achieved with conventional allergy medicines.

A commonly debated question among allergy sufferers is whether feather or synthetic pillows are preferable. Our Medical Director, Professor Michael Rudenko, has examined this question in detail.

Contrary to popular belief, modern feather pillows with closely woven ticking may actually harbour fewer detectable allergens than some synthetic alternatives, as the tighter weave can act as a more effective barrier. However, when it comes to washability and allergen management, synthetic-fill pillows have the practical advantage of being washable at higher temperatures (>55°C) to kill mites and destroy allergens.

The most important factor is regular washing at above 55°C — the temperature at which house dust mites are killed and their allergens destroyed. Whichever pillow type you choose, a good-quality dust mite barrier cover is strongly recommended.

Read Prof Michael Rudenko’s full paper: ‘The Advantages of Using Feather Pillows versus Synthetic’ (PDF)

Is the Dust Under Your Furniture Harmful?

Many people are surprised to discover that visible dust accumulations beneath beds, sofas, and wardrobes can contain very high concentrations of dust mite allergen. These undisturbed reservoirs of settled dust become airborne during vacuuming, moving furniture, or general activity — and can trigger significant allergic reactions. Regular, thorough vacuuming of these areas with a HEPA-filter vacuum is strongly advised.

Many people with year-round allergies are sensitised to house dust mite allergens, but not all homes contain the same levels of mites. Dust mites thrive in warm, humid conditions and live in bedding, carpets, and upholstered furniture — however, levels vary considerably from home to home.

You can now test dust samples from your bed or carpets to check for mite allergen concentrations using the Ventia™ rapid allergen test. The Ventia™ test will indicate whether dust contains high, medium, or low allergen levels within just 10 minutes. Each kit contains everything you need for two tests.

Knowing your home’s allergen burden can help your allergist tailor avoidance advice and prioritise which rooms or items to address first. It also allows you to monitor the impact of avoidance measures over time.

Buy the Ventia™ test kit at inbio.com

How long does it take for SLIT to work?

Most patients begin to notice a reduction in symptoms within three to six months of starting treatment. Significant improvement typically becomes evident during the first year, with continued gains over the full treatment course. The most substantial and lasting benefits are usually experienced after two to three years of consistent daily dosing.

How do I take the SLIT drops at home?

After your first supervised dose at our clinic, subsequent doses are taken at home each morning. You dispense the prescribed number of drops under your tongue and hold the liquid there for one to two minutes before swallowing. It is advisable not to eat, drink, or brush your teeth for around 15 minutes either side of your dose. Drops are stored in the refrigerator unless otherwise directed by your allergist.

Is SLIT safe for children?

Yes. SLIT has an excellent safety profile in children and is recommended from the age of five years upwards. Multiple large randomised trials have confirmed its tolerability in paediatric populations. The most common side effects are mild and transient local reactions such as oral itching or mild throat irritation. Starting immunotherapy in childhood also carries the additional benefit of potentially preventing rhinitis from progressing to asthma — the allergic march.

What are the side effects of SLIT?

The most common side effects are local reactions: oral or lip itching, tingling, mild swelling, or throat irritation. These are usually most noticeable in the first few weeks and tend to diminish as the body acclimatises. Serious systemic reactions, including anaphylaxis, are exceptionally rare with SLIT — substantially less frequent than with subcutaneous injection immunotherapy. This is why SLIT is generally safe for home administration after the first supervised clinic dose.

Can I continue SLIT if I have asthma?

Yes. SLIT is an appropriate treatment for patients with mild-to-moderate HDM-triggered asthma, provided the asthma is well controlled before commencing. Patients with severe or poorly controlled asthma require careful assessment. Your allergist will review your lung function as part of the pre-treatment assessment and can advise on the safest approach for your individual situation.

How long does treatment last and are the benefits permanent?

A standard SLIT course lasts three to five years. Following completion, clinical benefits are typically maintained for several years without ongoing treatment. The 2024 five-year longitudinal data confirm sustained improvement in lung function and airway inflammation markers even after the end of the treatment period. Some patients may benefit from a repeat course if symptoms return over the longer term.

I have started immunotherapy abroad — can I continue at your clinic?

Yes. We regularly accept patients who have begun immunotherapy — whether SLIT drops or allergy injections — in the US, mainland Europe, Australia, New Zealand, or elsewhere and are relocating to London or the surrounding area. We will need to contact your treating doctor to obtain details of your current programme and allergen product, subject to vaccine availability. Please contact us prior to your first appointment with your existing treatment documentation where possible.