{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:09:33Z","timestamp":1789016973863,"version":"build-2803163510"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sublingual immunotherapy (SLIT) is effective for allergic rhinitis (AR), though its efficacy exhibits inter-individual variability and is dose-dependent. Standardized protocols may not achieve optimal outcomes in all pediatric patients, highlighting the need for individualized dose-adjustment strategies. The nasal allergen challenge (NAC), the gold standard for assessing nasal mucosal reactivity, provides an objective tool to evaluate treatment response and guide dose personalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the short-term (6-month) efficacy of individualized SLIT dose adjustment in children with dust mite\u2013induced AR, and to assess its effects on upper and lower airway inflammation and lung function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective cohort study, 235 children (3\u201314 years) with dust mite\u2013induced AR were assigned to a standard-dose group (SD,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009133) or a dose-adjustment group (DA,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009102). The DA group received an incrementally increased maintenance dose based on tolerance (up to 7 drops of potency No. 4). Outcomes were assessed at baseline and after 6 months, including symptom and medication scores (TNSS, TMS, CSMS, VAS, RQLQ), NAC reactivity, lung function (FEV\u2081 Z-score), fractional exhaled nitric oxide (FeNO), and nasal nitric oxide (nNO). Baseline characteristics were generally balanced between groups, except for age and disease duration, which were adjusted for in multivariable analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After 6 months, all symptom scores improved significantly in both groups (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), with greater improvement in the DA group after adjusting for age and disease duration (TNSS: B\u2009=\u2009\u22120.648, 95% CI: \u22121.186 to \u22120.109,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.019; TMS: B\u2009=\u2009\u22120.141, 95% CI: \u22120.184 to \u22120.098,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001; CSMS: B\u2009=\u2009\u22120.304, 95% CI: \u22120.448 to \u22120.161,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001; VAS: B\u2009=\u2009\u22120.893, 95% CI: \u22121.295 to \u22120.490,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001; RQLQ: B\u2009=\u2009\u22121.282, 95% CI: \u22122.152 to \u22120.413,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004). A higher proportion of patients in the DA group showed reduced NAC reactivity (adjusted OR\u2009=\u20091.67, 95% CI: 1.01\u20132.75,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.046). Both groups exhibited significant reductions in FeNO and nNO (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). The DA group also showed a significant increase in FEV\u2081 Z-score from baseline (mean change\u2009=\u20090.725, 95% CI: 0.299\u20131.150, d\u2009=\u20090.822,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), and the value was significantly higher than that in the SD group (mean difference\u2009=\u20090.872, 95% CI: 0.138\u20131.605, d\u2009=\u20090.714,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.021).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this prospective pediatric cohort, individualized SLIT dose adjustment based on tolerance was associated with better short-term outcomes, reduced nasal mucosal reactivity, and improved lung function. These findings support the feasibility of tolerance-guided dose personalization and warrant confirmation in randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1904191","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:32:04Z","timestamp":1789014724000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tolerance-guided dose adjustment in sublingual immunotherapy for children with dust mite\u2013induced allergic rhinitis: a 6-month prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Meilan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Kunming Children\u2019s Hospital","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengcai","family":"Li","sequence":"additional","affiliation":[{"name":"Department 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