Worldwide surveys on anaphylaxis to sublingual immunotherapy with house dust mite tablets are urgently needed.

In the 1980s, a global number of 72 fatalities were reported in the UK and the USA following the application of subcutaneous immunotherapy (SCIT). This resulted in a significant limitation of SCIT use and in the search of other routes of administration, among which sublingual immunotherapy (SLIT) showed the best balance between efficacy and safety. Data from controlled studies suggest that tablets-related anaphylaxis is an uncommon event. However, in the Eudravigilance (European database of suspected adverse drug reactions from Europe) we found reports of life-threatening events or severe local reactions under SLIT increasing over the last few years. Therefore, all efforts to minimize the related risk have to be strongly encouraged.