The video version of this podcast can be found here: ·      https://youtu.be/ua-LV78WIo8This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in March  2025 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only.  I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.   Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through  There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast:  ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for March 2025 can be found here: ·      https://www.nice.org.uk/guidance/published?from=2025-03-01&to=2025-03-26&ndt=Guidance&ndt=Quality+standard The links to the guidance covered in this episode can be found here: The NICE technology appraisal on 12 SQ-HDM SLIT for treating allergic rhinitis and allergic asthma caused by house dust mites [TA1045] can be found here: ·      https://www.nice.org.uk/guidance/ta1045TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome! I’m Fernando, a GP in the UK. In today’s episode, we’ll be looking at the NICE updates published in February 2025, focusing specifically on what’s relevant to Primary Care.We’ve got a short and snappy episode today, as there’s only one clinical area to discuss: the use of house dust mite sublingual immunotherapy for allergic rhinitis. It’s an interesting subject, so let’s dive straight in.The marketing authorisation for house dust mite sublingual immunotherapy, marketed as Acarizax (12 SQ HDM SLIT), covers both allergic rhinitis and allergic asthma. But before we move on to the NICE recommendations. What is Acarizax?Acarizax (12 SQ HDM SLIT) is a sublingual immunotherapy (SLIT) treatment designed to help manage allergic rhinitis caused by house dust mites. It contains extracts from house dust mites and works by gradually desensitising the immune system to these allergens, helping to reduce allergy symptoms over time.Acarizax is taken as a sublingual tablet that is placed under the tongue once a day. The tablet should be kept under the tongue until it dissolves completely.By continuously exposing the immune system to small doses of the allergen, Acarizax aims to reduce the severity of allergic reactions to house dust mites over time, offering symptom relief and reducing the need for other allergy medications.Treatment usually starts a few months before the allergy season to build up tolerance and itt is recommended for long-term use, generally for at least 3 years, to achieve and maintain effectiveness.Having said all this, NICE only recommends it as an option for treating moderate to severe allergic rhinitis in people aged 12 to 65 years who:Have been diagnosed through clinical history and have a positive test for house dust mite sensitisation (either a skin prick test or specific immunoglobulin E), andContinue to experience persistent symptoms despite standard treatment.NICE has not recommended it for allergic asthma.Now, let’s quickly explore why NICE made these recommendations.First-line treatment for allergic rhinitis includes oral or intranasal antihistamines. For moderate to severe persistent symptoms, or if initial treatments are ineffective, intranasal corticosteroids are recommended. Combinations of oral antihistamines and intranasal corticosteroids can be used if symptoms persist, and further add-on treatments—such as intranasal anticholinergics, intranasal decongestants, and leukotriene receptor antagonists can be considered depending on the symptoms.Asthma treatment follows the NICE guidelines as well. The current BTS and SIGN guidelines do not specify when allergy immunotherapy should be used for allergic asthma. It was argued that patients whose asthma is ‘not well controlled by inhaled corticosteroids’ could be eligible for this treatment, and it might be used before biological treatments are recommended in secondary care, but it is not expected to replace them.NICE reviewed the evidence provided by the company, which suggested potential symptom reduction with this new treatment for both asthma and rhinitis. However, the clinical benefit in practice might be limited, as the sizes of the trials were small and the design did not fully reflect NHS conditions. Therefore we should consider the uncertainty around the long-term effectiveness of this treatment, especially given the need for continuous treatment alongside standard therapies.The evidence also shows potential quality of life improvements for patients with allergic rhinitis and allergic asthma, although the modelling assumptions introduce uncertainty. Young people aged 12 to 17 years may benefit more, which could reduce their need for symptomatic medications. However, there’s still uncertainty regarding seasonal variations, adolescent effectiveness, and asthma control.When it comes to long-term use, it offers a plausible benefit for patients with allergic rhinitis and allergic asthma, potentially reducing symptoms and the need for secondary care. However, the cost-effectiveness estimates are uncertain, mainly due to limited long-term trial data and the ongoing need for follow-up care.In conclusion, because standard treatments sometimes fail to control symptoms of allergic rhinitis, NICE recommends considering acarizax as an option after all appropriate symptom-relieving medications have been tried, and symptoms persist.However, NICE did not recommend sublingual immunotherapy for house dust mite allergic asthma because it’s not considered cost-effective for this group. That said, the same patients who are eligible for treatment of allergic rhinitis may also have allergic asthma, and having asthma would not prevent them from receiving treatment for their rhinitis.So that is it, a review of the NICE updates relevant to primary care.We have come to the end of this episode. Remember that this is not medical advice but only my summary and my interpretation of the guidelines. You must always use your clinical judgement. Thank you for listening and goodbye. 

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