Current and emerging sublingual immunotherapies for dust mite allergy

Introduction House dust mites (HDMs) are the most prevalent inhalant allergens globally, inducing a spectrum of allergic diseases including allergic rhinitis (AR) and asthma, which substantially impair patients’ quality of life. Sublingual immunotherapy (SLIT) is recognized as a promising disease-modifying intervention for HDM-related allergic disorders.Areas covered: This paper presents a narrative review of up-to-date clinical evidence regarding SLIT for HDM allergy (HDM-SLIT), covering its therapeutic efficacy, patient selection criteria, dose optimization strategies, safety profiles, underlying immunological mechanisms, and unresolved clinical challenges.Expert opinion HDM-SLIT has been established as a disease-modifying therapy for HDM-induced AR and asthma, with supporting evidence demonstrating its clinical efficacy, favorable safety profile, and long-lasting tolerability. Future developments in precision allergology, including multiomics-derived biomarkers and digital health applications, show considerable potential to guide clinical decision-making. However, the translation of these advances into routine clinical practice remains limited by gaps in insurance reimbursement, suboptimal patient adherence, inconsistent regulatory standards across regions, insufficient product standardization, and inequitable access to healthcare resources.