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polysensitised patients. However, to validate the clinical effectiveness of HDM AIT in polysensitised patients, further investigation is warranted. First, it is necessary to compare the clinical effectiveness of HDM AIT in clinically relevant monosensitised and polysensitised patients in well-powered randomised, placebo-controlled studies. In addition, further research should be performed to compare the clinical effectiveness of single-allergen AIT with HDM extract and multiple-allergen AIT. For grass pollen, two well-designed studies (18,44) compared single-allergen AIT and multiple-allergen AIT in polysensitised patients; however, there was a discrepancy between the findings of the two studies. For HDM, there is a lack of well-design studies comparing single-allergen AIT and multiple-allergen AIT in polysensitised patients. Conclusion In conclusion, single-allergen AIT with HDM extracts showed similar clinical effectiveness in polysensitised and monosensitised patients. Although well-designed and well-powered studies are required to validate the clinical effectiveness of HDM AIT in polysensitised patients, clinicians may consider administering HDM AIT in AR patients polysensitised to HDM and other allergens in countries where HDM plays a major role as a dominant allergen. Authorship contribution Acquisition of data: JYK, DHH; analysis and interpretation of data: JYK, DYH, MJJ; drafting the manuscript for critical intellectual content: JYK, MJJ; review and improvement of the manuscript: DHH, CSR; conception and design of the study: JYK, DHH. Conflict of interest All authors had no conflict of interest on this study. Financial disclosure None References 1. Wilson DR, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis. Allergy. 2005; 60(1): 4-12. 2. Compalati E, Passalacqua G, Bonini M, Canonica GW. The efficacy of sublingual immunotherapy for house dust mites respiratory allergy: results of a GA2LEN metaanalysis. Allergy. 2009; 64(11): 1570-1579. 3. Nelson H, Blaiss M, Nolte H, Wurtz SO, Andersen JS, Durham SR. Efficacy and safety of the SQ-standardized grass allergy immunotherapy tablet in mono- and polysensitized subjects. Allergy. 2013; 68(2): 252-255. 4. Bernstein DI, Murphy KR, Nolte H, Kaur A, Maloney J. Efficacy of short-ragweed sublingual immunotherapy tablet MK-3641 in monosensitized and polysensitized subjects. Allergy, Asthma Clin Immunol. 2014; 10(Suppl 2): A31. 5. Di Bona D, Plaia A, Leto-Barone MS, La Piana S, Di Lorenzo G. Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: a meta-analysis-based comparison. J Allergy Clin Immunol. 2012; 130(5): 1097- 1107 e1092. 6. Damask C. Immunotherapy: Treating with Fewer Allergens? Otolaryngol Clin North Am. 2017; 50(6): 1153-1165. 7. Demoly P, Passalacqua G, Pfaar O, Sastre J, Wahn U. Management of the polyallergic patient with allergy immunotherapy: a practice-based approach. Allergy Asthma Clin Immunol. 2016; 12: 2. 8. Pepper AN, Calderon MA, Casale TB. Sublingual I mmunotherapy for the Polyallergic Patient. J Allergy Clin Immunol Pract. 2017; 5(1): 41-45. 9. Wahn U. Allergen immunotherapy for the polyallergic patient. Curr Opin Allergy Clin Immunol. 2016; 16(6): 571-575. 10. Bahceciler NN, Galip N, Cobanoglu N. Multiallergen-specific immunotherapy in polysensitized patients: where are we? Immunotherapy. 2013; 5(2): 183-190. 11. Bousquet J, Lockey R, Mailing H, et al. Allergen immunotherapy: therapeutic vaccines for allergic diseases. Ann Allergy, Asthma Immunol. 1998; 81(5 I): 401-405. 12. Crimi N, Li Gotti F, Mangano G, et al. A randomized, controlled study of specific immunotherapy in monosensitized subjects with seasonal rhinitis: effect on bronchial hyperresponsiveness, sputum inflammatory markers and
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