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Background: Sublingual immunotherapy (SLIT) for perennial allergic rhinitis (AR) has not been extensively studied in preschoolers. We investigated the efficacy and safety of house dust mite (HDM) SLIT‐tablet for children aged 1–4 years. Methods: Children aged 1–4 years with AR were divided into SLIT (n = 22) and control (n = 12) groups based on their guardians' preferences. The SLIT group received a daily dose of 10,000 JAU of HDM SLIT‐tablet for 12 months, whereas the control group received symptomatic treatment only. Results: The baseline median age was 41 and 34 months in the SLIT and control groups, respectively, and the median AR symptom score was 4 for both groups. Compared with baseline, the AR symptom score had decreased significantly in the SLIT group after 12 months (score: 3, p =.002), whereas it tended to increase in the control group (score: 6, p =.08). Adverse reactions to SLIT were mild and occurred in eight patients (36%). In the SLIT group, Dermatophagoides (D.) farinae‐specific IgE (sIgE) levels increased during the first 6 months and decreased to baseline levels at 12 months. In the control group, D. farinae‐sIgE levels had increased significantly at 12 months compared to baseline (p =.01). D. farinae‐specific IgG4 and HDM IgE‐blocking factor levels were significantly increased at 12 months compared to baseline in the SLIT group only (p <.001). A lower wheezing frequency was seen in the SLIT group (0.3%) compared to the control group (0.7%). Conclusion: This pilot study demonstrated the efficacy, safety, and immunomodulatory effects of HDM SLIT‐tablet in preschoolers with AR. [ABSTRACT FROM AUTHOR]