What sublingual immunotherapy is and how it treats allergic shiners
In allergic rhinitis, swelling of the nasal lining slows drainage from the veins around the eyes, and the pooled blood shows through the thin lower-lid skin as a bluish-grey shadow, the allergic shiner. Sublingual immunotherapy delivers a small, standardised dose of the allergen under the tongue every day. Over months, this repeated low-dose exposure shifts the immune response from allergic reaction towards tolerance, so that less nasal swelling follows each exposure to dust mites.
- Acarizax This dust mite allergen tablet dissolves under the tongue and is licensed in Singapore for allergic rhinitis from 12 to 65 years and for allergic asthma from 18 to 65.
- OralTek These dust mite allergen drops or spray are given under the tongue and are licensed in Singapore from age 5, which makes them the option for children aged 5 to 11.
- Why dust mites In Singapore studies of 576 and 7,373 people, allergic sensitisation was almost entirely to house dust mites, and more than 80% of those tested had dust mite antibodies. The warm, humid climate allows dust mites to thrive in bedding throughout the year, so exposure is constant rather than seasonal.
- Other names Clinics also list SLIT as dust mite immunotherapy or allergy desensitisation.
Sublingual immunotherapy suitability for allergic shiners and dust mite allergy
| Situation | What SLIT does | Evidence | Better-supported option if it does not suit |
|---|---|---|---|
| Dark circles with a blocked or runny nose, worse in the morning, and a positive dust mite test | Treats the allergy behind the shiners | A (rhinitis), C (circles) | None better supported for the cause |
| Rhinitis controlled by a nasal steroid spray | Optional, for an effect that lasts after treatment stops | A | Continued steroid spray |
| Dark circles without nasal allergy | No effect | D | Treatment by circle type |
| Brown, pigmented circles | No effect | D | Pico laser and lightening creams (Grade B) |
| Uncontrolled or severe asthma | Unsuitable until asthma is controlled, because of the higher risk of a severe reaction | Not advised | Asthma treatment first |
A skin prick or blood test confirms the dust mite allergy before treatment, because the tablet and drops act only on dust mite allergy and have no effect on other allergens. The types of dark circles are set out on What causes dark eye circles.
Sublingual immunotherapy results in randomised trials and meta-analyses
- EvidenceEvidence for allergic rhinitis, Grade A. Dust mite SLIT tablets reduced rhinitis symptoms and medicine use in a 2022 systematic review and meta-analysis of tablet trials, and in a 2026 network meta-analysis of 16 randomised trials covering 7,329 patients treated for at least 12 months.
- EvidenceEvidence in children. In a randomised trial of 1,460 children aged 5 to 11, the dust mite tablet reduced the combined rhinitis score by 22% compared with placebo after about a year, and a Japanese trial in children and adolescents reported a comparable reduction of 23%.
- EvidenceEvidence for the dark circles, Grade C. No trial has measured allergic shiners after immunotherapy. A study of children with allergic rhinitis found that shiner darkness increased with rhinitis severity, so any lightening of the shiners is expected to follow control of the allergy, but this has not been shown directly.
Allergic shiners before and after sublingual immunotherapy, from first dose to 3 years
- First dose The first tablet is taken in the clinic, followed by about 30 minutes of observation.
- Weeks 8 to 14 Nasal symptoms begin to improve, and in one Japanese trial the effect started at weeks 8 to 10.
- About 1 year The trials measured their main result at about 1 year of daily treatment.
- 3 years The recommended course lasts 3 years, a duration intended to give an effect that persists after the tablets are stopped.
Shiners also lighten with any measure that clears the nose, such as a steroid nasal spray, so before-and-after photographs rarely isolate the effect of SLIT alone.
Sublingual immunotherapy price in Singapore (2026)
| Item | Singapore price | Notes |
|---|---|---|
| Acarizax tablets | S$200 a month before goods and services tax (GST) | Price published by one ENT clinic (dated 2021), about S$7,200 over 3 years |
| OralTek drops | S$470 a quarter before GST | Same clinic, same date |
| Skin prick test | S$54.50 per allergen, or S$490.50 for a 12-allergen package | Including GST |
| Dust mite blood test for specific immunoglobulin E (IgE) | S$66 to 111 per allergen | Including GST |
Only one Singapore clinic publishes a SLIT price, and because that price dates from 2021, the current figure should be confirmed with the prescribing doctor. Consultation fees are charged in addition to these prices.
Sublingual immunotherapy procedure, from testing and first dose to daily use
- Diagnosis Dust mite allergy is confirmed with a skin prick or blood test before a prescription is issued.
- First dose The first dose is taken in the clinic, with about 30 minutes of observation.
- Daily use One tablet is placed under the tongue each day until it dissolves, and food and drink are avoided for a few minutes afterwards so that the allergen remains in contact with the immune cells in the lining of the mouth.
- Duration Treatment continues for about 3 years, with periodic review visits.
- Who prescribes SLIT is prescribed by ENT specialists, allergists and some GP clinics, rather than by aesthetic clinics.
Sublingual immunotherapy side effects and risks
- Common Itching of the mouth or ears, throat irritation and lip swelling are common in the first days. Each episode usually lasts 30 to 60 minutes, and the reactions settle within the first weeks.
- Severe allergic reactions Severe allergic reactions are rare and are the reason the first dose is taken under supervision.
- Who should not take it SLIT is unsuitable for people with uncontrolled or severe asthma, and the product information lists further exclusions.
Sublingual immunotherapy vs nasal steroid sprays, antihistamines and dark circle treatments
| SLIT | Steroid nasal spray | Antihistamine tablet | Rejuran I or Juvelook | |
|---|---|---|---|---|
| Treats | The dust mite allergy | Nasal swelling | Itch and sneezing | Thin under-eye skin |
| Effect on shiners | Indirect, by treating the allergy (C) | Indirect, by clearing the nose | Indirect, weaker than a steroid spray | Masks veins by thickening skin (C) |
| Duration | About 3 years | Daily while symptomatic | Daily while symptomatic | Three sessions, then maintenance |
| Singapore price | About S$200 a month | Pharmacy price, varies | Pharmacy price, varies | From S$388 a session |
Steroid nasal sprays are the usual first step for allergic rhinitis. They reduce the swelling inside the nose that slows venous drainage, whereas antihistamine tablets act mainly on itch and sneezing. In a systematic review of randomised trials, the sprays controlled allergic rhinitis better than antihistamine tablets. SLIT is added when symptoms persist despite the spray, or when the aim is an effect that persists after treatment stops. All dark circle treatments are compared on the Dark eye circles treatment in Singapore page.
Frequently asked questions about allergic shiners and sublingual immunotherapy
What are allergic shiners?
Allergic shiners are bluish-grey dark circles caused by nasal allergy, in which swelling inside the nose slows drainage from the veins around the eyes. They are often worse in the morning, when nasal congestion is usually at its peak.
Does sublingual immunotherapy get rid of dark circles?
Sublingual immunotherapy treats the dust mite allergy behind allergic shiners (Grade A for the rhinitis). No trial has measured the shiners themselves, so its effect on the circles is indirect (Grade C).
How much does sublingual immunotherapy cost in Singapore?
The one published Singapore price is S$200 a month before GST for Acarizax tablets, or about S$7,200 over 3 years, with allergy testing and consultations charged separately.
Can children have sublingual immunotherapy in Singapore?
Children can receive sublingual immunotherapy in Singapore, with OralTek drops licensed from age 5 and Acarizax tablets from age 12.
How long does sublingual immunotherapy take to work?
Nasal symptoms usually begin to improve after 8 to 14 weeks, and the full course lasts about 3 years, the duration intended to give an effect that persists after treatment stops.
General information, not medical advice. A registered medical practitioner should be consulted before any treatment. Dark Eye Circles Singapore does not sell treatments.
Sources and price references (checked 9 October 2026)
- Andiappan AK, et al. Allergic airway diseases in a tropical urban environment are driven by dominant mono-specific sensitization against house dust mites. Allergy. 2014;69(4):501–9. doi:10.1111/all.12364 (PMID 24456108) — 576 and 7,373 ethnic Chinese in Singapore; sensitisation almost exclusively to house dust mite; more than 80% HDM-sIgE positive https://doi.org/10.1111/all.12364
- Kulalert P, et al. Efficacy and safety of house dust mite sublingual immunotherapy tablets in allergic rhinitis: A systematic review and meta-analysis. World Allergy Organ J. 2022;15(9):100691. doi:10.1016/j.waojou.2022.100691 (PMID 36119654) — Systematic review and meta-analysis of HDM SLIT-tablet RCTs in allergic rhinitis https://doi.org/10.1016/j.waojou.2022.100691
- Guo S, et al. Efficacy of house dust mite allergen immunotherapy in allergic rhinitis: a network meta-analysis based on component-resolved classification. Front Immunol. 2026;17:1947642. doi:10.3389/fimmu.2026.1947642 (PMID 42755948) — Network meta-analysis, 16 RCTs, 7,329 patients, at least 12 months https://doi.org/10.3389/fimmu.2026.1947642
- Schuster A, et al. Efficacy and safety of SQ house dust mite sublingual immunotherapy-tablet (12 SQ-HDM) in children with allergic rhinitis/rhinoconjunctivitis with or without asthma (MT-12): a randomised, double-blind, placebo-controlled, phase III trial. Lancet Reg Health Eur. 2025;48:101136. doi:10.1016/j.lanepe.2024.101136 (PMID 39678704) — Randomised, double-blind, placebo-controlled, 1,460 children aged 5–11; total combined rhinitis score reduced 22% https://doi.org/10.1016/j.lanepe.2024.101136
- Masuyama K, et al. Efficacy and safety of SQ house dust mite sublingual immunotherapy-tablet in Japanese children. Allergy. 2018;73(12):2352–2363. doi:10.1111/all.13544 (PMID 30043449) — Japanese children and adolescents; HDM SLIT tablet reduced rhinitis score by 23% vs placebo https://doi.org/10.1111/all.13544
- Okamoto Y, et al. House dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy. 2017;72(3):435–443. doi:10.1111/all.12996 (PMID 27471838) — Japanese RCT; onset of action at weeks 8–10 https://doi.org/10.1111/all.12996
- Bernstein DI, et al. SQ house dust mite sublingual immunotherapy tablet subgroup efficacy and local application site reaction duration. Ann Allergy Asthma Immunol. 2018;121(1):105–110. doi:10.1016/j.anai.2018.04.007 (PMID 29656145) — Local application site reactions mild to moderate; median duration 30–60 minutes on day 1 https://doi.org/10.1016/j.anai.2018.04.007
- Chen CH, et al. Quantitative assessment of allergic shiners in children with allergic rhinitis. J Allergy Clin Immunol. 2009;123(3):665–671. doi:10.1016/j.jaci.2008.12.1108 (PMID 19281911) — Cross-sectional; shiners correlate with rhinitis severity; no SLIT outcome data https://doi.org/10.1016/j.jaci.2008.12.1108
- Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ. 1998;317(7173):1624–1629. doi:10.1136/bmj.317.7173.1624 (PMID 9848901) — Systematic review of 16 RCTs; intranasal steroids superior to antihistamines https://doi.org/10.1136/bmj.317.7173.1624
- ALK-Abelló. ACARIZAX 12 SQ-HDM oral lyophilisate — Summary of Product Characteristics (UK electronic Medicines Compendium) — first dose under supervision; treatment for 3 years https://www.medicines.org.uk/emc/product/12905/smpc
- ACARIZAX Singapore patient information — indicated in adolescents and adults 12–65 years for allergic rhinitis, 18–65 for allergic asthma (checked 2026-10-09) https://www.entclinic.sg/pdf/AcarizaxPatientInformationBooklet(HouseDustMiteImmunotherapy).pdf
- Dr Annabelle Leong (ENT) — desensitisation can only be prescribed by a doctor; Acarizax licensed in Singapore above age 12; OralTek licensed for age 5 and above (checked 2026-10-09) https://www.drannabelle.com/blog/desensitisation-treatment-for-house-dust-mite-slit-in-singapore/
- SLIT price: The ENT Clinic — Acarizax S$200 per month before GST; OralTek S$470 per quarter before GST (prices dated 1 Jul 2021) (checked 2026-10-09) https://www.entclinic.sg/blog/allergen-immunotherapy-for-allergic-rhinitis/
- Allergy test price: ATA Medical — skin prick S$54.50 per allergen; 12-allergen package S$490.50, including GST (checked 2026-10-09) https://atamed.sg/skin-prick-test-singapore
- Allergy test price: DTAP Clinic — single-allergen IgE S$66–111, including GST; SLIT available at most branches (checked 2026-10-09) https://www.dtapclinic.com/allergy-testing/
- Allergy test price: Dr Joel Foo — skin prick S$54.50; dust mite IgE S$73.03 each, including GST (checked 2026-10-09) https://drjoelfoo.sg/allergy-test/
Dark Eye Circles in Singapore: this series
Treatment reviews for dark eye circles:
- Best Eye Cream for Dark Circles in Singapore
- Collagen Skin Booster Under Eye Singapore
- Juvelook Under Eye Singapore
- Pico Laser for Dark Circles Singapore
- Rejuran Under Eye Singapore
- Tear Trough Filler Singapore
Comparisons for dark eye circles: