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Clinical effectiveness of house dust mite immunotherapy in mono- versus poly-sensitised patients with allergic rhinitis: a systematic review and meta-analysis* Abstract Selecting an appropriate allergen-specific immunotherapy (AIT) regimen for polysensitised allergic rhinitis (AR) patients is challenging for clinicians. Although previous studies showed comparable effectiveness of single-allergen AIT with house dust mite (HDM) extract between monosensitised and polysensitised AR patients, there is no systematic review and meta-analysis demonstrating the comparable effectiveness of HDM AIT. In this meta-analysis, we analysed nine studies to compare the clinical effectiveness of HDM AIT. The primary outcome was nasal symptom score and secondary outcomes were medication and quality of life scores. The changes in nasal symptom score after HDM AIT did not significantly differ between monosensitised and polysensitised patients. The clinical effectiveness of HDM AIT regarding medication and quality of life score was not significantly different between monosensitised and polysensitised patients). In conclusion, single-allergen AIT with HDM extract showed comparable clinical effectiveness between polysensitised and monosensitised patients with AR. Key words: allergen immunotherapy, allergic rhinitis, house dust mites, immunologic desensitisation, meta-analysis Jin Youp Kim1,2, Doyeon Hwang3 , Myoung-jin Jang4 , Chae-Seo Rhee5,6,7,8, Doo Hee Han5 1 Department of Otorhinolaryngology–Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea 2 Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Korea 3 Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea 4 Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea 5 Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea 6 Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Korea 7 Institute of Allergy and Clinical Immunology, and 8 Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Korea Rhinology 59: 4, 352 - 359, 2021 https://doi.org/10.4193/Rhin20.588 *Received for publication: November 19, 2020 Accepted: April 6, 2021 352 Introduction Allergen-specific immunotherapy (AIT) has been administered for several decades as an established treatment option for allergic rhinitis (AR) to alter the underlying immunologic mechanism. Subcutaneous immunotherapy (SCIT), a conventional form of immunotherapy, and sublingual immunotherapy (SLIT) are the most commonly prescribed forms of immunotherapy. Although the efficacy of AIT has been reported in numerous studies, including systematic review and meta-analysis (1-5), selecting the proper regimen for AIT is still controversial (6-10). Because AIT targets specific allergens, the ideal candidate for AIT is an AR patient sensitised to a single allergen; furthermore, the effectiveness of single-allergen AIT (AIT with a single-allergen extract) has been well demonstrated in previous studies (11-13). However, about 70–80% of AR patients are sensitised to more than one allergen in practice (14,15), and selecting the most appropriate AIT regimen in polysensitised AR patients is challenging. Considering the mechanism of AIT that modifies the immunologic response to a specific allergen, multiple-allergen AIT (AIT with multiple-allergen extracts) seems to be a better

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