Abstract: Objective To observe the systemic reactions （SRs） associated with subcutaneous immunotherapy （SCIT） using dust mite allergen and to analyze potential risk factors. Methods The occurrence of SRs among 230 patients with allergic rhinitis （AR） who received house dust mite SCIT from December 2019 to December 2022 was retrospectively analyzed, and related risk factors were identified. Results A total of 5 422 injections were given to 230 patients, with an SRs incidence rate of 2.4% per injection and 20.0% per patient. Most SRs were grade I （51.9%）, and no fatal SRs occurred. Symptoms primarily affected the respiratory system for 111 times （84.7%）. Elevated peripheral blood eosinophil count （OR （95% CI）=6.02 （1.76, 20.60）, P = 0.004） and high levels of house dust mite-specific IgE （OR （95% CI）=1.01 （1.00, 1.01）, P = 0.016） were identified as risk factors for SRs, respectively. Conclusions Children with AR allergic to dust mites may experience SRs during SCIT with standardized dust mite allergen preparations, whereas the overall safety of SCIT is good. High eosinophil count and high levels of house dust mite-specific IgE are risk factors for SRs during SCIT.