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NICE has published two new technology appraisals recommending sublingual immunotherapy treatments.  

Itulazax, 12 standardised quality betula verrucosa pollen sublingual lyophilisate (12 SQBet SLIT), is an option to treat moderate to severe allergic rhinitis or conjunctivitis caused by pollen from the birch homologous group of trees in people aged 5 years and over with:

• Symptoms despite using symptom-relieving medicines
• A positive sensitisation test (skin prick test or specific immunoglobulin E) to a member of the birch homologous group.

The recommended dose for adults and children (5 years or older) is one sublingual lyophilisate (12 SQ-Bet) daily.

Acarizax, 12 standard quality house dust mite sublingual lyophilisate (12 SQ-HDM SLIT) is an option to treat moderate to severe house dust mite allergic rhinitis in people aged 5 to 65 years if it is:

• Diagnosed by clinical history and a positive test of house dust mite sensitisation (skin prick test or specific immunoglobulin E [IgE]), and 
• Persistent despite using symptom-relieving medicine.

The recommended dose for children and adults (5-65 years) is one sublingual lyophilisate (12 SQ-HDM) daily. Onset of the clinical effect is to be expected 8-14 weeks after initiation.

International treatment guidelines refer to a treatment period of 3 years for allergy immunotherapy to achieve disease modification. However, for both treatments, the manufacturers recommend that if no improvement is observed during the first year of treatment there is no indication for continuing treatment.