NICE has recommended sublingual immunotherapy tablets for children with moderate to severe allergic rhinitis caused by birch tree pollen or house dust mites, expanding access to disease-modifying allergy treatment on the NHS.

NHS access extended to younger children

The recommendations cover ITULAZAX for children aged 5 to 17 with allergic rhinitis caused by birch tree pollen, and ACARIZAX for children aged 5 to 11 with house dust mite allergic rhinitis.

Both are recommended for children whose symptoms remain uncontrolled despite symptomatic treatments. NICE has previously recommended the treatments for older age groups, with the latest decisions extending access to eligible children from the age of five.

Allergic rhinitis can cause sneezing, a runny or blocked nose and congestion, and can affect sleep, concentration, school attendance and everyday activities.

The recommendations are expected to expand access to allergen immunotherapy, which aims to modify the immune response to the allergen rather than simply treating symptoms with medicines such as antihistamines and nasal sprays.

NICE’s appraisal documents state that house dust mite sublingual immunotherapy is intended for children aged 5 to 11 with persistent moderate to severe allergic rhinitis despite symptom-relieving medication, following diagnosis through clinical history and a positive test for house dust mite sensitisation.

The move comes amid concerns about the increasing burden of allergic disease in children. The Lancet Countdown in Europe 2026 report found that climate change has extended the high-pollen season by one to two weeks compared with the 1990s.

The recommendations also follow the launch of the UK’s first National Allergy Strategy in April, which called for greater prioritisation of allergy care across the NHS.

Childhood allergy can affect sleep and school

Around 10 to 15 per cent of children in the UK are estimated to have allergic rhinitis, with pollen and house dust mites among the common triggers.

For children with more severe disease, symptoms can have an impact beyond the allergy itself. Research cited by ALK found that around eight in 10 children with moderate to severe hay fever or house dust mite allergy experience sleep difficulties, while children sitting GCSE examinations with active hay fever have been reported to be 40 per cent more likely to drop a grade between mock and final exams.

Professor George Du Toit, consultant in paediatric allergy at Guy’s and St Thomas’ Hospitals, said: “Severe allergic rhinitis in children deserves to be taken as seriously as any other chronic childhood condition. Many of my patients have spent years on multiple symptom-relieving medications without ever reaching meaningful control.

“These NICE recommendations represent a clinically significant shift. For the first time, eligible children can access a treatment on the NHS that targets the underlying cause of their condition, with growing evidence that early intervention can also reduce the long-term risk of allergic asthma developing. For the children and families who have been most affected, this is a long-overdue moment for paediatric allergy in the UK.”

The British Society for Allergy and Clinical Immunology also welcomed the recommendations, with its president Dr Robin Gore saying that access to allergen immunotherapy for children with severe allergic rhinitis had previously been poor.

“Allergic rhinitis causes a significant burden for many children and when first-step treatments have failed, access to disease-modifying immunotherapy has been poor,” Gore said. “Therefore, the approval by NICE of allergen immunotherapy tablets for children with severe allergic rhinitis caused by either birch tree pollen or house dust mite is an important step that will lead to better access to high quality rhinitis therapy, longer lasting treatment responses and improved quality of life.”

Immunotherapy targets the allergic response

Sublingual immunotherapy involves taking a controlled dose of the allergen under the tongue each day. The aim is to gradually modify the immune response and reduce the severity of allergic symptoms over time.

The tablets are taken at home after an initial supervised dose, with treatment generally continuing for several years. Common side effects include temporary local reactions such as throat irritation.

The NICE recommendations mean eligible children in England can now be referred for NHS treatment where the relevant clinical criteria are met.

The decision follows the Scottish Medicines Consortium’s recent acceptance of ACARIZAX for patients with severe house dust mite allergic rhinitis, adding to developments in access to allergen immunotherapy across Great Britain.

For children whose severe allergic rhinitis remains poorly controlled despite standard treatments, the recommendations provide a new NHS treatment option that addresses the allergic response itself rather than relying solely on symptom control.