Mapping the Treatment Journey of Children on Subcutaneous House Dust Mite Immunotherapy: A Qualitative Study

Shidi Xu,1,* Zhujun Gu,1,* Jie Zhao,1 Jiehua Xu,1 Jun Xie2 1Department of Respiratory Medicine, Affiliated Children’s Hospital of Jiangnan University (Wuxi Children’s Hospital), Wuxi, Jiangsu, People’s Republic of China; 2Nursing Department, Affiliated Children’s Hospital of Jiangnan University (Wuxi Children’s Hospital), Wuxi, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jun Xie, Nursing Department, Affiliated Children’s Hospital of Jiangnan University (Wuxi Children’s Hospital), Wuxi, Jiangsu, 214023, People’s Republic of China, Email [email protected]: Although subcutaneous immunotherapy (SCIT) is a first-line treatment for the prevalent house dust mite allergy (affecting ~30% of children in humid regions), the longitudinal realities of managing this years-long therapy for children and their parents/carers are poorly documented.Methods: We conducted semi-structured interviews with 15 child-caregiver dyads (children aged 6– 12 years) undergoing SCIT. Data were analyzed using framework analysis to map challenges across four treatment phases: diagnosis/screening, initiation, maintenance, and follow-up.Results: Key findings included: Diagnostic delays (mean 10.2 months) due to non-specific symptoms (86.7% morning sneezing). Injection anxiety (initial Visual Analog Scale (VAS): 7.8/10) improved with play-based interventions (64% reduction). School challenges: 64.2% faced symptom management difficulties; 57.1% experienced peer stigma. Economic burden: Annual direct costs averaged ¥ 8750 (US$1250).Conclusion: This study identifies modifiable gaps in SCIT delivery, advocating for: Early symptom recognition tools, Child-friendly anxiety-reduction protocols, and School-based support programs. The proposed “hospital-school-family” tripartite system may optimize outcomes globally.Plain Language Summary: Why was this study done?Many children with dust mite allergies get long-term treatment called SCIT (allergy shots). But parents/carers often struggle with delays in diagnosis, fear of injections, and challenges at school. We wanted to understand their full journey to find ways to help.What did the researchers do?We talked to 15 children (ages 6– 12) and their parents during SCIT treatment. They shared experiences from diagnosis through years of therapy, including problems like missed school days and bullying.What did we find?It took 10 months on average to get diagnosed because symptoms looked like colds.Play-based tools (like reward stickers) cut needle fear by 64%.Over half of kids hid symptoms at school due to embarrassment.What does this mean?Doctors and schools can work together to:Early detection of allergic symptomsReduction of injection-related anxietyPeer education on allergy managementThis helps children breathe easier—both physically and socially.Keywords: subcutaneous immunotherapy, SCIT, pediatric allergy, patient journey mapping, treatment adherence, health-related quality of life, multidisciplinary care