Dust mite allergy sufferers set for a new NHS treatment

An oral immunotherapy designed to treat dust mite allergy, made by Denmark's ALK-Abello, could soon become an option for thousands of people seeking treatment for persistent symptoms through the NHS.

Final draft guidance (PDF) published by health technology assessment (HTA) agency NICE this morning recommends that ALK-Abello's Acarizax (12 SQ-HDM SLIT) product as an option for treating moderate to severe house dust mite allergic rhinitis in people aged 12 to 65.

To be eligible, patients will have to have a confirmed diagnosis of dust mite allergy and need to persistently take medicines to treat symptoms such as intranasal corticosteroids and antihistamines. The allergy is considered persistent if symptoms are present for four or more days a week for a month and have not been resolved with standard treatments.

Allergic asthma use turned down

NICE has, however, decided not to recommend the drug for treating allergic asthma due to house dust mites, arguing that the data behind this use is not strong enough compared to placebo when added to current therapies like inhaled corticosteroids and short-acting beta-agonists.

Acarizax is taken as a daily oral therapy under the tongue over three years and is an allergy immunotherapy (AIT) designed to expose the body to low doses of allergens and stimulate immune tolerance. It is the first of its kind to be cleared by NICE, according to a statement from the organisation.

An estimated 13,000 people in England suffer from this type of allergy, which can be chronic and debilitating and can prevent people from going to work or school, according to NICE's director of medicines evaluation, Helen Knight.

"This medicine has been found to improve symptoms, helping people to live their lives and has potential to be truly life-changing," she said, adding that it has been shown in clinical trials to be particularly beneficial for those whose symptoms cannot be managed with standard medicines.

"As someone with lived experience of allergies, I am pleased that NICE has recommended 12 SQ-HDM SLIT," commented Dr Helen Evans-Howells, a patient expert and a GP.

"This drug could be life-changing for those affected by severe symptoms, which include significant fatigue, congestion, and facial swelling," she added. "The evidence clearly shows it offers an effective solution for those who have struggled with standard treatments."

Unequal access

ALK-Abello said the guidance will allow patients to gain access to Acarizax in England, Wales, and Northern Ireland, pointing out that there is significantly less use of AIT in the UK compared to other European countries. The product has been approved in the UK since 2021 and has a list price of around £80 per pack of 30 tablets, ahead of discounts.

NICE's decision does, however, create a disparity in access within the UK. The Scottish Medicines Consortium (SMC) said it could not recommend the drug in July 2023 because ALK-Abello had not made a formal application for it.

Allergic rhinitis disease affects around a quarter of adults in the UK, with house dust mite the most common airborne allergen, affecting approximately half of them – upwards of 5 million people.

Patient organisation Allergy UK welcomed the development, noting that, while initial access to Acarizax will generally require a specialist allergy referral, it can be continued as a home treatment thereafter so patients will not have to attend frequent hospital appointments.

The guidance is expected to be finalised by 5th March.

Image by Gilles San Martin from Namur, Belgium, via Wikimedia Commons