What are the symptoms of house dust mite allergy

1.

Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

Allergo J Int. ;–CrossRefPubMedPubMedCentral Scholar

  • 2.

    Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. ; Scholar

  • 3.

    Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al. Home dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract. ;–CrossRefPubMed Scholar

  • 4.

    Global strategy for asthma management and prevention. Accessed 02/01/

  • 5.

    Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M, et al.

    Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy. ;CrossRefPubMed Scholar

  • 6.

    Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol. ;(5)–efPubMed Scholar

  • 7.

    Rosewich M, Arendt S, El Moussaoui S, Schulze J, Schubert R, Zielen S. Bronchial allergen provocation: a useful method to assess the efficacy of specific immunotherapy in children.

    Pediatr Allergy Immunol. ;–CrossRefPubMed Scholar

  • 8.

    Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate. Scholar

  • 9.

    Brehler R, Kahlert H, Thum-Oltmer S. Hypoallergene Präparate in der SCIT. Allergo J Int. ;–CrossRef Scholar

  • van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– Scholar

  • Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines revision. J Allergy Clin Immunol. ;–efPubMed Scholar

  • Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J.

    Effective treatment of home dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial. J Allergy Clin Immunol. ;–efPubMed Scholar

  • Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K. Home dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy. ;–CrossRefPubMed Scholar

  • Emminger W, Hernandez MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, et al. The SQ home dust mite SLIT-tablet is well tolerated in patients with home dust mite respiratory allergic disease. Int Arch Allergy Immunol. ;–CrossRefPubMedPubMedCentral Scholar

  • Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al.

    Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. ;–CrossRefPubMed Scholar

  • Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al. Safety of home dust mite sublingual immunotherapy standardized quality tablet in children allergic to home dust mites. Ann Allergy Asthma Immunol. ;–CrossRefPubMed Scholar

  • What are home dust mites?

    Dust mites are a microscopic type of insect that lives in bedding, sofas, curtains, carpets or any woven material.
    Dust mites do not bite and do not cause harm to humans, other than by triggering allergie.
    Mites absorb humidity from the atmosphere (i.e.

    they do not drink), and feed on organic matter (including shed human and animal skin).
    Mites absorb humidity from the atmosphere (i.e. theydo not drink), and feed on organic matter (including shed human and animal skin).
    They require sufficient humidity and nests to live in (which are not visible to the naked eye).

    How can I get rid of dust mites?

    In most parts of the world, it’s impossible to completely eliminate dust mites from your home.

    However, you can take steps to minimize your exposure to dust mite allergens by keeping your home as dust-free as possible.

    Vacuuming and dusting are not enough to remove dust mites, because these creatures can live deep inside your upholstery, mattresses, carpets, etc. You can cover mattresses, pillows, and upholstered furniture with zippered dust-proof covers – the material of these covers is designed with pores that are too little for dust mites to pass through. Wash sheets, blankets and other bedding every week in boiling water (no more than °F) to kill dust mites.

    Replace carpeting with hard flooring and avoid plush rugs, fabric draperies, and anything else that cannot easily be washed regularly.

    Use a dehumidifier to reduce the humidity in your home under 50%, making it a less suitable environment for dust mites.

    Clean hard surfaces with a wet mop or cloth to avoid stirring dry allergens up into the air.

    Use HEPA filters to trap dust mites and other allergens. Change the filters every three months to ensure they remain effective.

    This sheet was reviewed and updated 2/2/

    REVIEW ARTICLE
    Year : | Volume : 33 | Issue : 1 | Page :

    An Indian perspective on dust mites

    SN Gaur
    Department of Respiratory Medicine, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India

    Date of Web Publication Jun

    Correspondence Address:
    Dr.

    S N Gaur
    Gaur Clinic, A, Patparganj Village, Delhi —
    India

    Source of Support: None, Conflict of Interest: None

    [SCOPUS][CROSSREF][PUBMED]

    DOI:/_9_19

    Abstract

    Dust mites are the most significant group of indoor allergens. The dust mites own been classified as home dust mites and storage mites, however, with recent knowledge the diverse dust mite species are now labelled as domestic mites. The dust mites own been isolated at numerous Indian locations and their sensitization in Indian population has also been documented.

    In view of high sensitization in India, it is significant to recognize the role of dust mites and their allergens in the precipitation of allergic diseases including allergic rhinitis and asthma. Allergies to dust mites can be confirmed by a classical clinical history of perennial, early morning and indoor symptoms substantiated by a positive skin prick test to these allergens. Further management of allergies to mites is possible using appropriate allergen avoidance measures and allergen immunotherapy. Multifaceted avoidance measures can be used, but, allergen avoidance by the means of an allergen impermeable bed encasings has the best evidence and is recommended in diverse guidelines.

    Allergen immunotherapy, the disease-modifying modality, has been proven to efficacious for home dust mite allergies.

    Keywords:Allergen-impermeable bed encasings, domestic mites, immunotherapy, indoor allergens

    How to cite this article:
    Gaur S N. An Indian perspective on dust mites. Indian J Allergy Asthma Immunol ;

    Introduction

    Allergy to dust mites has been strongly associated with the development of respiratory allergic diseases, such as asthma and allergic rhinitis.

    In addition to these, they own the potential to cause conjunctivitis, atopic dermatitis, and in rare cases anaphylaxis, which may result from ingestion of mite-infested food.[1]

    Dust mites are a potent source of indoor allergens; their specific biology allows them to thrive in indoor domestic conditions and also allows them (their allergens) to be in shut contact with living persons.[1] Home dust has been considered as a trigger of asthma for > years; however, it was only in that home dust mites (HDMs) were reported as the actual source of home dust allergens.[2] This review discusses the classification of the allergenic mites, diseases causes by them, with a focus on the Indian perspective in views of prevalence and distribution of dust mites in India, and finally evaluates the available management strategies against dust mites.

    Allergenic Dust Mites

    Mites are included in the subclass Acari along with the ticks, while the allergenic domestic mites belong to the order Astigmata.[3] Being a part of Astigmata, means that they do not own external respiratory openings or stigmata.

    Allergenic dust mites are broadly classified as HDMs and storage mites.

    The HDM predominantly include the two Dermatophagoides species, Dermatophagoides pteronyssinus and Dermatophagoides farinae. Although storage mites are commonly found in the storage facilities for grains, they are also found in the home dust.[1] The best-recognized storage mites are Acarus siro, Blomia tropicalis, Glycyphagus domesticus, Lepidoglyphus destructor, and Tyrophagus putrescentiae.[4],[5]

    As both HDM and storage mites are found in the indoor environment, a new term domestic mites has been coined. Under the domestic mites, every the above-mentioned species which can be regularly found in the indoor environment, including bedding, sofas, and kitchen floors, are included [Figure 1].[3]

    Environmental conditions conducive for growth of dust mites

    Temperature (25C30C) and humidity (55%75% RH) are required by the dust mites to thrive well.

    In addition, they require human or pet skin scales, which are colonized by fungi, yeasts, and bacteria. These factors along with the fact that they are light sensitive and photophobic probably explain their distribution pillows, mattresses, carpets, soft toys, upholstered materials, and clothing.[3],[6] Among these beds are the best sources of food and conditions for mites to proliferate [Table 1].[7],[8] Knowledge on the sources of dust mites is essential to implement targeted avoidance strategies.

    Clinically relevant defined as a cutoff of >2 g/g of dust, which can induce allergic sensitization and asthma.

    Allergens of dust mites

    The identified allergens from dust mites as mentioned on are as follows:[5]

    1. A.

      siro: 1 allergen

    2. Euroglyphus maynei: 5 allergens
    3. B. tropicalis: 14 allergens
    4. D. farinae: 32 allergens
    5. L. destructor: 5 allergens
    6. G. domesticus: 1 allergen
    7. D. pteronyssinus: 23 allergens
    8. T. putrescentiae: 8 allergens.

    Many allergens from D. pteronyssinus and D. farinae show significant homology. The allergens from D. pteronyssinus own been identified as proteases Der p1, 3, 6, 9, 20), lipid-binding proteins Der p2, 7, 13, 14), contractile proteins Der p10, 11, 16, 17, 24), glycosidases and carbohydrate-binding proteins (Der f 4, 12, 15, 18, 23), glutathione S transferase Der p8), heat shock protein, and some allergens own unidentified function Der p5, 19, 21, and 22).[6] Der p23 is a recently identified dust mite allergen, for which IgE is common however, it represents only a little percentage of the entire antidust mite IgE.[1]

    Among the HDM allergens, Group 1 and 2 bind to >50% of the quantity of IgE that binds to HDM extracts (i.e., major allergens).

    Der p 23 also has similar IgE binding prevalence, but not every studies own found high titers. The medium or mid-tier allergens binding IgE in 30%50% of mite-allergic patients are group 4, 5, 7, and [3]

    It should also be noted that the sensitization to the diverse major and minor allergens has been found to comparable in patients from diverse geographical locations (Asia, Europe, and North America).[9] Group 1 (Der p1, Der f 1) and Group 2 (Der p2, Der f 2) allergens are the major allergens in the diverse geographical locations.

    The major allergens (Group 1 Der p1, Der f 1 and Group 2 Der p2, Der f 2) from dust mites own been isolated from Indian homes and own also been estimated in the sera of Indian patients.[10],[11] In view of the available Indian data, these allergens can be considered as important.

    Diseases Associated With Dust Mites

    Diseases caused by the dust mites can be differentiated as per the method of exposure [Figure 2].[1]

    Dust Mites in India

    Prevalence

    Numerous Indian studies own documented the presence of the allergenic dust mites in diverse parts of the country [Table 2].[12],[13],[14],[15],[16],[17],[18],[19]

    Data from the diverse studies own shown the pan-Indian presence of the domestic mites.

    Clinicians should, therefore, be aware on the importance of the diverse mites and utilize the information appropriately. Among the diverse species, however, most work has been done on the Dermatophagoides species including data on sensitization, allergen avoidance, and allergen immunotherapy.

    Sensitization data

    Dust mites own been recognized as an significant sensitizer in the Indian populations. Love the studies on the presence of these mites in diverse geographical areas, a number of studies own also observed the sensitization to the diverse mite species [Table 3].[20],[21],[22],[23],[24],[25]

    From the available data as summarized in [Table 2] and [Table 3], it becomes evident that the two Dermatophagoides species (D.

    farinae and D. pteronyssinus) are the most significant sensitizers across India and should be evaluated in every patients with perennial respiratory allergic diseases.

    Management of Allergies to Dust Mites

    Diagnosis

    Diagnosis of dust mite allergy is dependent on clinical history of the patient and documented sensitization for which skin prick tests are considered as the gold standard. Pointers of dust mite allergy on the clinical history include:[3]

    1. Wu YH, Chan CC, Rao CY, et al.

      Characteristics, determinants, and spatial variations of ambient fungal levels in the subtropical Taipei metropolis. Atmos Environ. ;41(12) doi/nv

    2. Davila I, Valero A, Entrenas LM, Valveny N, Herraez L. Relationship between serum entire IgE and disease severity in patients with allergic asthma in Spain. J Investig Allergol Clin Immunol. ;25(2)
    3. Crameri R, Zeller S, Glaser AG, Vilhelmsson M, Rhyner C. Cross-reactivity among fungal allergens: a clinically relevant phenomenon? Mycoses. ;52(2) doi/jx.
    4. Arlian LG. Arthropod allergens and human health. Annu Rev Entomol. ; doi/
    5. New TR. Matthew J. Colloff: Dust mites. J Insect Conserv. ;13(6) doi/s
    6. Sharma D, Dutta BK, Singh AB, Shome BR.

      Aerobiological, biochemical and immunological studies on some of the dominant Aspergillus species of South Assam (India). Aerobiologia. ;23(3) doi/s

    7. Custovic A, Wijk RG. The effectiveness of measures to change the indoor environment in the treatment of allergic rhinitis and asthma: ARIA update (in collaboration with GA(2)LEN). Allergy. ;60(9) doi/jx.
    8. Baird FJ, Lopata AL. The dichotomy of pathogens and allergens in vaccination approaches. Front Microbiol. ; doi/fmicb
    9. Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate: systematic review of the literature.

      Clin Infect Dis. ;32(3) doi/

    10. Wright LS, Phipatanakul W. Environmental remediation in the treatment of allergy and asthma: latest updates. Curr Allergy Asthma Rep. ;14(3) doi/s
    11. Parronchi P, Brugnolo F, Sampognaro S, Maggi E. Genetic and environmental factors contributing to the onset of allergic disorders. Int Arch Allergy Immunol. ;(1) doi/
    12. Chowdhary A, Kathuria S, Randhawa HS, Gaur SN, Klaassen CH, Meis JF.

      Isolation of multiple-triazole-resistant Aspergillus fumigatus strains carrying the TR/L98H mutations in the cyp51A gene in India. J Antimicrob Chemother. ;67(2) doi: /jac/dkr

    13. Zureik M, Neukirch C, Leynaert B, Liard R, Bousquet J, Neukirch F. Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey. BMJ. ;() doi/bmj
    14. Lam HT, Ekerljung L, Bjerg A, Van TTN, Lundback B, Ronmark E. Sensitization to airborne allergens among adults and its impact on allergic symptoms: a population survey in northern Vietnam.

      Clin Transl Allergy. ;4(1) doi/

    15. Tobias KR, Ferriani VP, Chapman MD, Arruda LK. Exposure to indoor allergens in homes of patients with asthma and/or rhinitis in southeast Brazil: effect of mattress and pillow covers on mite allergen levels. Int Arch Allergy Immunol. ;(4) doi/
    16. van der Heide S, de Monchy JG, de Vries K, Bruggink TM, Kauffman HF. Seasonal variation in airway hyperresponsiveness and natural exposure to home dust mite allergens in patients with asthma. J Allergy Clin Immunol. ;93(2) doi/(94)
    17. Mosbech H. Home dust mite allergy.

      Allergy. ;40(2) doi/jtbx.

    18. Larenas-Linnemann D, Michels A, Dinger H, et al. Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub) tropics. Clin Transl Allergy. ; doi/
    19. Bousquet J, Lockey R, Malling HJ. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol. ;(4 Pt 1) doi/S(98)
    20. Portnoy J, Chew GL, Phipatanakul W, et al.

      Environmental assessment and exposure reduction of cockroaches: a practice parameter. J Allergy Clin Immunol. ;(4)e doi/

    21. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. ;63 Suppl doi/jx.
    22. Aggarwal S, Chhabra SK, Saxena RK, Agarwal MK. Heterogeneity of immune responses to various Aspergillus species in patients with allergic respiratory diseases.

      Indian J Chest Dis Allied Sci. ;42(4)

    23. Nurmatov U, van Schayck CP, Hurwitz B, Sheikh A. Home dust mite avoidance measures for perennial allergic rhinitis: an updated Cochrane systematic review. Allergy. ;67(2) doi/jx.
    24. Galli SJ, Tsai M. IgE and mast cells in allergic disease. Nat Med. ;18(5) doi/nm
    25. van der Linden JW, Snelders E, Kampinga GA, et al. Clinical implications of azole resistance in Aspergillus fumigatus, The Netherlands, Emerg Infect Dis. ;17(10) doi/eid
    26. Abramson SL, Turner-Henson A, Anderson L, et al. Allergens in school settings: results of environmental assessments in 3 city school systems.

      J Sch Health. ;76(6) doi/jx.

    27. Sears MR, Herbison GP, Holdaway MD, Hewitt CJ, Flannery EM, Silva PA. The relative risks of sensitivity to grass pollen, home dust mite and cat dander in the development of childhood asthma. Clin Exp Allergy. ;19(4) doi/jtbx.
    28. Howard SJ, Cerar D, Anderson MJ, et al.

      What are the symptoms of home dust mite allergy

      Frequency and evolution of Azole resistance in Aspergillus fumigatus associated with treatment failure. Emerg Infect Dis. ;15(7) doi/eid

    29. Strong P, Clark H, Reid K. Intranasal application of chitin microparticles down-regulates symptoms of allergic hypersensitivity to Dermatophagoides pteronyssinus and Aspergillus fumigatus in murine models of allergy. Clin Exp Allergy. ;32(12) doi/jx.
    30. Crameri R, Garbani M, Rhyner C, Huitema C. Fungi: the neglected allergenic sources. Allergy. ;69(2) doi/all
    31. Janeway CA Jr, Travers P, Walport M, Shlomchik MJ. Immunobiology: The Immune System in Health and Disease.

      5th ed. New York: Garland Science;

    32. Horner WE, Helbling A, Salvaggio JE, Lehrer SB. Fungal allergens. Clin Microbiol Rev. ;8(2) doi/CMR
    33. Fang Z, Ouyang Z, Hu L, Wang X, Zheng H, Lin X. Culturable airborne fungi in outdoor environments in Beijing, China. Sci Entire Environ. ;() doi/env
    34. Morgan WJ, Crain EF, Gruchalla RS, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. ;(11) doi/NEJMoa
    35. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis.

      Thorax. ;70(3) doi/thoraxjnl

    36. Van Asselt L. Interactions between domestic mites and fungi. Indoor Built Environ. ;8(4) doi/
    37. Odds FC, Brown AJ, Gow NA. Antifungal agents: mechanisms of action. Trends Microbiol. ;11(6) doi/SX(03)
    38. Simon-Nobbe B, Denk U, Poll V, Rid R, Breitenbach M. The spectrum of fungal allergy. Int Arch Allergy Immunol. ;(1) doi/
    39. Custovic A, Simpson A. The role of inhalant allergens in allergic airways disease. J Investig Allergol Clin Immunol. ;22(6) ; qiuz follow
    40. Ezeamuzie CI, Al-Ali S, Khan M, et al. IgE-mediated sensitization to mould allergens among patients with allergic respiratory diseases in a desert environment. Int Arch Allergy Immunol.

      ;(4) doi/

    41. Gioulekas D, Damialis A, Papakosta D, Spieksma F, Giouleka P, Patakas D. Allergenic fungi spore records (15 years) and sensitization in patients with respiratory allergy in Thessaloniki- Greece. J Investig Allergol Clin Immunol. ;14(3)
    42. Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergol Immunopathol (Madr). ;41(2) doi/
    43. D’Amato G, Chatzigeorgiou G, Corsico R, et al.

      Evaluation of the prevalence of skin prick test positivity to Alternaria and Cladosporium in patients with suspected respiratory allergy. A European multicenter study promoted by the Subcommittee on Aerobiology and Environmental Aspects of Inhalant Allergens of the European Academy of Allergology and Clinical Immunology. Allergy. ;52(7) doi/jtbx.

    44. Arshad SH. Does exposure to indoor allergens contribute to the development of asthma and allergy? Curr Allergy Asthma Rep.

      What are the symptoms of home dust mite allergy

      ;10(1) doi/s

    45. Kurup VP, Banerjee B. Fungal allergens and peptide epitopes. Peptides. ;21(4) doi/S(00)
    46. Tungtrongchitr A, Sookrung N, Munkong N, et al. The levels of cockroach allergen in relation to cockroach species and allergic diseases in Thai patients. Asian Pac J Allergy Immunol. ;22(2- 3)
    47. Liccardi G, Baldi G, Ciccarelli A, et al. Sensitization to cockroach allergens in the urban atopic populations living in Campania district (southern Italy). A multicenter study. Eur Ann Allergy Clin Immunol. ;46(1)
    48. O’Gorman CM, Fuller HT. Prevalence of culturable airborne spores of selected allergenic and pathogenic fungi in outdoor air.

      Atmos Environ. ;42(18) doi/nv

    49. Symptoms which are aggravated when the patient comes in contact with household dust and domestic/indoors activities
    50. Schwartz S, Ruhnke M, Ribaud P, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood. ;(8) doi/blood
    51. Calderon MA, Demoly P, Gerth van Wijk R, et al. EAACI: A European Declaration on Immunotherapy. Designing the future of allergen specific immunotherapy. Clin Transl Allergy. ;2(1) doi/
    52. Lockhart SR, Frade JP, Etienne KA, Pfaller MA, Diekema DJ, Balajee SA. Azole resistance in Aspergillus fumigatus isolates from the ARTEMIS global surveillance study is primarily due to the TR/L98H mutation in the cyp51A gene.

      Antimicrob Agents Chemother. ;55(9) doi/AAC

    53. Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. (8):Cd doi/CDpub2.
    54. Baxi SN, Phipatanakul W. The role of allergen exposure and avoidance in asthma. Adolesc Med State Art Rev. ;21(1) 71, viii-ix.
    55. Patterson TF, Kirkpatrick WR, White M, et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore). ;79(4) doi/
    56. Compalati E, Passalacqua G, Bonini M, Canonica GW. The efficacy of sublingual immunotherapy for home dust mites respiratory allergy: results of a GA2LEN meta-analysis.

      Allergy. ;64(11) doi/jx.

    57. Saggini A, Maccauro G, Tripodi D, et al. Allergic inflammation: role of cytokines with special emphasis on IL Int J Immunopathol Pharmacol. ;24(2) doi/
    58. Sporik R, Holgate ST, Platts-Mills TA, Cogswell JJ. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med. ;(8) doi/NEJM
    59. Miceli MH, Kauffman CA. Isavuconazole: a new broad-spectrum triazole antifungal agent.

      Clin Infect Dis. ;61(10) doi/cid/civ

    60. Calderon MA, Casale TB, Nelson HS, Demoly P. An evidence-based analysis of home dust mite allergen immunotherapy: a call for more rigorous clinical studies. J Allergy Clin Immunol. ;(6) doi/
    61. Macan J, Plavec D, Kanceljak B, Milkovic-Kraus S. Exposure levels and skin reactivity to German cockroach (Blattella germanica) in Croatia. Croat Med J. ;44(6)
    62. Koppelman GH.

      Gene-environment interaction in allergic disease: more questions, more answers? J Allergy Clin Immunol. ;(6) doi/

    63. Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol. ;51(4) doi/
    64. Nelson HS. Update on home dust mite immunotherapy: are more studies needed? Curr Opin Allergy Clin Immunol. ;14(6) doi/ACI
    65. Shapiro RS, Robbins N, Cowen LE. Regulatory circuitry governing fungal development, drug resistance, and disease. Microbiol Mol Biol Rev.

      ;75(2) doi/MMBR

    66. Resch Y, Michel S, Kabesch M, Lupinek C, Valenta R, Vrtala S. Diverse IgE recognition of mite allergen components in asthmatic and nonasthmatic children. J Allergy Clin Immunol. ;(4) doi/
    67. Platts-Mills TA, Hayden ML, Chapman MD, Wilkins SR. Seasonal variation in dust mite and grass-pollen allergens in dust from the houses of patients with asthma. J Allergy Clin Immunol. ;79(5) doi/(87)
    68. Dave ND, Xiang L, Rehm KE, Marshall GD Jr. Stress and allergic diseases. Immunol Allergy Clin North Am. ;31(1) doi/
    69. Walsh TJ, Anaissie EJ, Denning DW, et al.

      Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. ;46(3) doi/

    70. Verweij PE, Mellado E, Melchers WJ. Multiple-triazole-resistant aspergillosis. N Engl J Med. ;(14) doi /NEJMc
    71. Vidal C, Lojo S, Juangorena M, Gonzalez-Quintela A. Association between asthma and sensitization to allergens of Dermatophagoides pteronyssinus. J Investig Allergol Clin Immunol. ;26(5) doi/jiaci
    72. Al-Shair K, Atherton GT, Harris C, Ratcliffe L, Newton PJ, Denning DW.

      Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis. Clin Infect Dis. ;57(6) doi/cid/cit

    73. Denning DW, Stevens DA. Antifungal and surgical treatment of invasive aspergillosis: review of 2, published cases. Rev Infect Dis. ;12(6) doi/clinids/
    74. Adkinson NF Jr, Bochner BS, Burks AW, et al. Middleton’s allergy: principles and practice. Elsevier Health Sciences;
    75. Custovic A, Sonntag HJ, Buchan IE, Belgrave D, Simpson A, Prosperi MCF.

      Evolution pathways of IgE responses to grass and mite allergens throughout childhood. J Allergy Clin Immunol. ;(6)e doi/

    76. de Saint Georges-Gridelet D. Vitamin requirements of the European home dust mite, Dermatophagoides pteronyssinus (Acari: Pyroglyphidae), in relation to its fungal association. J Med Entomol. ;24(4) doi/jmedent/
    77. Sun BQ, Lai XX, Gjesing B, Spangfort MD, Zhong NS. Prevalence of sensitivity to cockroach allergens and IgE cross-reactivity between cockroach and home dust mite allergens in Chinese patients with allergic rhinitis and asthma.

      Chin Med J (Engl). ;(24) doi/

    78. Huang SK, Zhang Q, Qiu Z, Chung KF. Mechanistic impact of outdoor air pollution on asthma and allergic diseases. J Thorac Dis. ;7(1) doi/
    79. Gregory LG, Lloyd CM. Orchestrating home dust mite-associated allergy in the lung. Trends Immunol. ;32(9) doi/
    80. Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol. ;(2 Suppl 2):S doi/
    81. Segvic Klaric M, Pepeljnjak S. A year-round aeromycological study in Zagreb area, Croatia.

      Ann Agric Environ Med. ;13(1)

    82. Matsuse H, Fukushima C, Fukahori S, et al. Differential effects of dexamethasone and itraconazole on Aspergillus fumigatus-exacerbated allergic airway inflammation in a murine model of mite-sensitized asthma. Respiration. ;85(5) doi/
    83. Arendrup MC, Mavridou E, Mortensen KL, et al. Development of azole resistance in Aspergillus fumigatus during azole therapy associated with change in virulence. PLoS One. ;5(4):e doi/
    84. An S, Shen C, Liu X, et al.

      Alpha-actinin is a new type of home dust mite allergen. PLoS One. ;8(12):e doi/

    85. Kim CW, Hong CS. Allergy to miscellaneous household arthropods. Protein Pept Lett. ;14(10) doi/
    86. Salazar F, Ghaemmaghami AM. Allergen recognition by innate immune cells: critical role of dendritic and epithelial cells. Front Immunol. ; doi/fimmu
    87. Mari A, Schneider P, Wally V, Breitenbach M, Simon-Nobbe B. Sensitization to fungi: epidemiology, comparative skin tests, and IgE reactivity of fungal extracts. Clin Exp Allergy. ;33(10) doi/jx.
    88. Erwin EA, Ronmark E, Wickens K, et al.

      Contribution of dust mite and cat specific IgE to entire IgE: relevance to asthma prevalence. J Allergy Clin Immunol. ;(2) doi/

    89. Parkin J, Cohen B. An overview of the immune system. Lancet. ;() doi/S(00)
    90. Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: revision. J Allergy Clin Immunol. ;(3) doi/
    91. Perennial symptoms (with possible seasonal exacerbations)
    92. Sheffer A, Bartal M, Bousquet J. Global strategy for asthma management and prevention. WHO Workshop Report Publication;
    93. Eifan AO, Calderon MA, Durham SR. Allergen immunotherapy for home dust mite: clinical efficacy and immunological mechanisms in allergic rhinitis and asthma.

      Expert Opin Biol Ther. ;13(11) doi/

    94. Improvement in symptoms at high altitudes.
    95. Krieger J, Jacobs DE, Ashley PJ, et al. Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence. J Public Health Manag Pract. ;16(5 Suppl):S doi/PHH.0beddcbd9.

    Standardized skin prick test allergens own recommended by various international authorities, and it becomes increasingly significant for the diagnosis of dust mite allergens. As documented in the section on allergens of dust mites, there are numerous allergens in the dust mites.

    The presence of the significant allergenic components is essential for appropriate diagnosis of patients. In an experimental research, Casset et al. evaluated the presence of the major and the significant minor allergens amongst diagnostic extracts from diverse manufactures in Italy.[26] Only two diagnostic extract manufacturers (including Merck) had the presence of the major (Der p1, Der p2) and the significant minor allergens (Der p5, Der p7, Der p10, and Der p21). The other eight diagnostic extracts had either one or more missing minor allergens.

    Recently, an Indian study evaluating the potency of dust mite allergen extracts has reported low potency of indigenously manufactured extracts.

    The authors had concluded that there is an urgent need for policymakers to institute stringent criteria for standardization of antigens in India.[27]

    Nasal provocation tests, currently not available in India, own also been used to confirm the diagnosis of allergy to dust mites.

    Allergen avoidance

    Dust mites are ubiquitous allergens, and a number of interventions own been recommended to minimize exposure and thereby limit the symptoms due to exposure.

    It is significant to note that household avoidance strategies are more likely to control or minimize allergic disease rather than prevent sensitization itself.[28]

    The avoidance strategies purpose to reduce exposure and are targeted against the source of allergens or to reduce the environmental conditions conducive for the growth of dust mites [Table 4].[28],[29]

    Allergen immunotherapy

    Allergen immunotherapy (AIT) is the only disease modifying therapy for the treatment of allergic diseases.[30] AIT has been recommended and is utilized for patients with HDM allergy.

    For AIT, the evidence is maximum and strongest for the two Dermatophagoides species. Limited data are available for the other mite species.

    The Indian Guidelines on the practice of AIT also own recommended HDM as an significant and potential target for the use of AIT.[30]

    Among the two routes of applications, subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), numerous trials and meta-analyses own been published. A summary of the available meta-analysis is provided in [Table 5].[31]

    Table 5: Summary of meta-analysis for home dust mites allergen immunotherapy

    Click here to view

    Importantly, the number needed to treat to own one asthmatic patient from deteriorating was calculated to be 6 for HDM SCIT.[32]

    It should be noted that while a dose of 520 g of the major allergen is considered to be an effective dose in SCIT, corresponding data for SLIT are insufficient.[31]

    The expected benefits of AIT for HDM allergy are in line with the benefits for AIT and own been captured in [Box 1].[31],[33],[34]

    Conclusion

    Dust mites are significant sources of indoor allergens, and the clinicians should be aware of their presence in the Indian environment.

    Diverse allergenic mites own been isolated in India, and their corresponding sensitization rates own also been published. Indian clinicians should consider the role of dust mites in the development of respiratory allergies in their patients and should use appropriate diagnostic, avoidance, and immunotherapy schedules for optimal treatment outcomes.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.

    References

    1. Miller JD. The role of dust mites in allergy.

    Clin Rev Allergy Immunol doi: /s [Epub ahead of print].

    2. Bergmann KC, Raulffs M, Sander I. Home dust mites known to be an allergen source for 50 years: Der p1 still detectable in the original sample. Allergo J Int ;
    3. Snchez-Borges M, Fernandez-Caldas E, Thomas WR, Chapman MD, Lee BW, Caraballo L, et al. International Consensus (ICON) on: Clinical consequences of mite hypersensitivity, a global problem.

    World Allergy Organ J ;

    4. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI molecular allergology user's guide. Pediatr Allergy Immunol ;27 Suppl
    5. Allergen Nomenclature. WHO/IUIS Allergen Nomenclature Sub-Committee. Available from: [Last accessed on Mar 15].
    6. Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, et al. Environmental assessment and exposure control of dust mites: A practice parameter.

    Ann Allergy Asthma Immunol ;

    7. Kim KH, Jahan SA, Kabir E. A review on human health perspective of air pollution with honor to allergies and asthma. Environ Int ;
    8. Kader R, Kennedy K, Portnoy JM. Indoor environmental interventions and their effect on asthma outcomes. Curr Allergy Asthma Rep ;
    9. Batard T, Baron-Bodo V, Martelet A, Le Mignon M, Lemoine P, Jain K, et al. Patterns of IgE sensitization in home dust mite-allergic patients: Implications for allergen immunotherapy. Allergy ;
    Bhagwat K.

    Levels of indoor allergens in the homes of allergic patients from India. Allergy ;73 Suppl

    van Ree R. Presentation at the ICAAICON Golden Jubilee National Conference of Indian College of Allergy, Asthma & Applied Immunology. New Delhi; October,
    Jogdand SB, Ingole AC. Role of environment on dynamics of home dust mites (HDM) at Pune. Int J Life Sci ;
    Jogdand SB.

    Arachnida: Acarina: Astigmata (House dust mites). Vol. Fauna of Maharashtra, State Fauna Series. Zool Surv India; p.

    Tripathi DM, Parikh KM. Mite fauna and other allergens present in the home dust in Bombay. Lung India ;
    [Full text]
    Gupta A, Chatterjee M. Some new records of mites infesting stored grains in Kolkata and its Neighbourhood. Rec Zool Surv India ;
    Colloff M. Dust Mites. 1st ed. Netherlands: Springer;
    Khanna V.

    Acari: Home dust mites. Zool Survey India. State Fauna Series 6, Fauna of Delhi; p.

    Sharma D, Dutta BK, Singh AB. Dust mites population in indoor houses of suspected allergic patients of South Assam, India. ISRN Allergy ;
    Kaur N, Kaur H. A study on the occurrence, prevalence and species composition of mite fauna in human dwellings of Patiala city, Punjab (India). Indian J Sci Res ;
    Tham EH, Lee AJ, Bever HV. Aeroallergen sensitization and allergic disease phenotypes in Asia. Asian Pac J Allergy Immunol ;
    Mondal P, Dey D, Sarkar T, Laha A, Moitra S, Bhattacharyya S, et al. Evaluation of sensitivity toward storage mites and home dust mites among nasobronchial allergic patients of Kolkata, India.

    J Med Entomol ;

    Balachandra B. Sensitization to allergens in patients from Bangalore, India. Allergy ;73 Suppl
    Hassan G, Tanvir M, Qureshi W, Rasool R, Ashraf T. Aeroallergen sensitization pattern and clinical profile of patients from Jammu and Kashmir, India. Allergy ;73 Suppl
    Nagaraju K, Karthik N. Sensitization patterns to aeroallergens and food allergens in Indian patients. Allergy ;73 Suppl
    Doshi A, Tripathi DM. Early home dust mite sensitivity in Mumbai children. Indian J Pediatr ;
    Casset A, Mari A, Purohit A, Resch Y, Weghofer M, Ferrara R, et al. Varying allergen composition and content affects the in vivo allergenic activity of commercial Dermatophagoides pteronyssinus extracts.

    Int Arch Allergy Immunol ;

    Christopher DJ, Ashok N, Ravivarma A, Shankar D, Peterson E, Dinh PT, et al. Low potency of Indian dust mite allergen skin prick test extracts compared to FDA-approved extracts: A double-blinded randomized control trial. Allergy Rhinol (Providence) ;
    Wilson JM, Platts-Mills TA. Home environmental interventions for home dust mite. J Allergy Clin Immunol Pract ;
    Matsui EC, Abramson SL, Sandel MT; Section on Allergy and Immunology, Council on Environmental Health. Indoor environmental control practices and asthma management.

    Pediatrics ; pii: e

    Gaur SN, Kumar R, Singh AB, Agarwal MK, Arora N. Guidelines for practice of allergen immunotherapy in India: an update. Indian J Allergy Asthma Immunol ;
    Caldern MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al. Home dust mite respiratory allergy: An overview of current therapeutic strategies. J Allergy Clin Immunol Pract ;
    Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. ;(8):CD
    Biagtan M, Viswanathan R, Bush RK.

    Immunotherapy for home dust mite sensitivity: Where are the knowledge gaps? Curr Allergy Asthma Rep ;

    Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial. J Allergy Clin Immunol ;
    Figures

    [Figure 1], [Figure 2]

    Tables

    [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

    Document Type: Narrative Review

    Authors

    1 Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    2 Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    /IJMR

    Abstract

    Allergies are pathological manifestations originating from a trigger-sensitized immune system.

    Aspergillus species own been reported to be one of the significant inhalant allergens in diverse geographical regions of the world. Home dust mite (HDM) allergens frolic a major role in causing allergic diseases. The emerging literature indicates the allergenicity and contribution of Aspergillus species and HDMs. Allergies erupt when innocuous foreign components are confused as foes by the immune surveillance. The incidence of fungal sensitization in patients with allergic respiratory diseases has been reported from % to even 80% in various studies worldwide.

    Human skin scales provide food for both mites and fungi. Fungi may either constitute a food supplement for mites or may own an indirect effect by decomposing human dander, thus making it more accessible for HDMs. There is a mutual relationship between fungi and HDMs. In addition to avoid exposure to an allergen as a secondary or tertiary preventive strategy, which is often not sufficiently effective against domestic mites, the treatment of mite allergy is mainly based on allergen-specific immunotherapy (AIT). Treatment with azole antifungal drugs in patients with severe asthma is effective and improves patient quality of life.

    Keywords


    • Salazar F, Ghaemmaghami AM.

      Allergen recognition by innate immune cells: critical role of dendritic and epithelial cells. Front Immunol. ; doi/fimmu

    • Sears MR, Herbison GP, Holdaway MD, Hewitt CJ, Flannery EM, Silva PA. The relative risks of sensitivity to grass pollen, home dust mite and cat dander in the development of childhood asthma. Clin Exp Allergy. ;19(4) doi/jtbx.
    • Janeway CA Jr, Travers P, Walport M, Shlomchik MJ. Immunobiology: The Immune System in Health and Disease. 5th ed. New York: Garland Science;
    • Sporik R, Holgate ST, Platts-Mills TA, Cogswell JJ. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood.

      A prospective study. N Engl J Med. ;(8) doi/NEJM

    • Denning DW, Stevens DA. Antifungal and surgical treatment of invasive aspergillosis: review of 2, published cases. Rev Infect Dis. ;12(6) doi/clinids/
    • Galli SJ, Tsai M. IgE and mast cells in allergic disease. Nat Med. ;18(5) doi/nm
    • O’Gorman CM, Fuller HT. Prevalence of culturable airborne spores of selected allergenic and pathogenic fungi in outdoor air. Atmos Environ. ;42(18) doi/nv
    • Parkin J, Cohen B. An overview of the immune system.

      What are the symptoms of home dust mite allergy

      Lancet. ;() doi/S(00)

    • Liccardi G, Baldi G, Ciccarelli A, et al. Sensitization to cockroach allergens in the urban atopic populations living in Campania district (southern Italy). A multicenter study. Eur Ann Allergy Clin Immunol. ;46(1)
    • Kurup VP, Banerjee B. Fungal allergens and peptide epitopes. Peptides. ;21(4) doi/S(00)
    • Sheffer A, Bartal M, Bousquet J. Global strategy for asthma management and prevention.

      WHO Workshop Report Publication;

    • Vidal C, Lojo S, Juangorena M, Gonzalez-Quintela A. Association between asthma and sensitization to allergens of Dermatophagoides pteronyssinus. J Investig Allergol Clin Immunol. ;26(5) doi/jiaci
    • Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergol Immunopathol (Madr). ;41(2) doi/
    • van der Heide S, de Monchy JG, de Vries K, Bruggink TM, Kauffman HF. Seasonal variation in airway hyperresponsiveness and natural exposure to home dust mite allergens in patients with asthma.

      J Allergy Clin Immunol. ;93(2) doi/(94)

    • Mari A, Schneider P, Wally V, Breitenbach M, Simon-Nobbe B. Sensitization to fungi: epidemiology, comparative skin tests, and IgE reactivity of fungal extracts. Clin Exp Allergy. ;33(10) doi/jx.
    • Huang SK, Zhang Q, Qiu Z, Chung KF. Mechanistic impact of outdoor air pollution on asthma and allergic diseases. J Thorac Dis. ;7(1) doi/
    • Fang Z, Ouyang Z, Hu L, Wang X, Zheng H, Lin X. Culturable airborne fungi in outdoor environments in Beijing, China. Sci Entire Environ. ;() doi/env
    • Aggarwal S, Chhabra SK, Saxena RK, Agarwal MK.

      Heterogeneity of immune responses to various Aspergillus species in patients with allergic respiratory diseases. Indian J Chest Dis Allied Sci. ;42(4)

    • Sharma D, Dutta BK, Singh AB, Shome BR. Aerobiological, biochemical and immunological studies on some of the dominant Aspergillus species of South Assam (India). Aerobiologia. ;23(3) doi/s
    • Strong P, Clark H, Reid K. Intranasal application of chitin microparticles down-regulates symptoms of allergic hypersensitivity to Dermatophagoides pteronyssinus and Aspergillus fumigatus in murine models of allergy.

      Clin Exp Allergy. ;32(12) doi/jx.

    • Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. ;63 Suppl doi/jx.
    • Saggini A, Maccauro G, Tripodi D, et al. Allergic inflammation: role of cytokines with special emphasis on IL Int J Immunopathol Pharmacol. ;24(2) doi/
    • Horner WE, Helbling A, Salvaggio JE, Lehrer SB. Fungal allergens. Clin Microbiol Rev. ;8(2) doi/CMR
    • Gioulekas D, Damialis A, Papakosta D, Spieksma F, Giouleka P, Patakas D. Allergenic fungi spore records (15 years) and sensitization in patients with respiratory allergy in Thessaloniki- Greece.

      J Investig Allergol Clin Immunol. ;14(3)

    • Erwin EA, Ronmark E, Wickens K, et al. Contribution of dust mite and cat specific IgE to entire IgE: relevance to asthma prevalence. J Allergy Clin Immunol. ;(2) doi/
    • Segvic Klaric M, Pepeljnjak S. A year-round aeromycological study in Zagreb area, Croatia. Ann Agric Environ Med. ;13(1)
    • Zureik M, Neukirch C, Leynaert B, Liard R, Bousquet J, Neukirch F. Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey.

      BMJ. ;() doi/bmj

    • Custovic A, Simpson A. The role of inhalant allergens in allergic airways disease. J Investig Allergol Clin Immunol. ;22(6) ; qiuz follow
    • Tungtrongchitr A, Sookrung N, Munkong N, et al. The levels of cockroach allergen in relation to cockroach species and allergic diseases in Thai patients. Asian Pac J Allergy Immunol. ;22(2- 3)
    • Sun BQ, Lai XX, Gjesing B, Spangfort MD, Zhong NS. Prevalence of sensitivity to cockroach allergens and IgE cross-reactivity between cockroach and home dust mite allergens in Chinese patients with allergic rhinitis and asthma.

      Chin Med J (Engl). ;(24) doi/

    • D’Amato G, Chatzigeorgiou G, Corsico R, et al. Evaluation of the prevalence of skin prick test positivity to Alternaria and Cladosporium in patients with suspected respiratory allergy. A European multicenter study promoted by the Subcommittee on Aerobiology and Environmental Aspects of Inhalant Allergens of the European Academy of Allergology and Clinical Immunology. Allergy. ;52(7) doi/jtbx.
    • Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol. ;(2 Suppl 2):S doi/
    • Tobias KR, Ferriani VP, Chapman MD, Arruda LK.

      Exposure to indoor allergens in homes of patients with asthma and/or rhinitis in southeast Brazil: effect of mattress and pillow covers on mite allergen levels. Int Arch Allergy Immunol. ;(4) doi/

    • Crameri R, Garbani M, Rhyner C, Huitema C. Fungi: the neglected allergenic sources. Allergy. ;69(2) doi/all
    • Kim CW, Hong CS. Allergy to miscellaneous household arthropods. Protein Pept Lett. ;14(10) doi/
    • Arlian LG. Arthropod allergens and human health. Annu Rev Entomol.

      ; doi/

    • Davila I, Valero A, Entrenas LM, Valveny N, Herraez L. Relationship between serum entire IgE and disease severity in patients with allergic asthma in Spain. J Investig Allergol Clin Immunol. ;25(2)
    • Koppelman GH. Gene-environment interaction in allergic disease: more questions, more answers? J Allergy Clin Immunol. ;(6) doi/
    • Ezeamuzie CI, Al-Ali S, Khan M, et al. IgE-mediated sensitization to mould allergens among patients with allergic respiratory diseases in a desert environment. Int Arch Allergy Immunol. ;(4) doi/
    • Dave ND, Xiang L, Rehm KE, Marshall GD Jr.

      What are the symptoms of home dust mite allergy

      Stress and allergic diseases. Immunol Allergy Clin North Am. ;31(1) doi/

    • Simon-Nobbe B, Denk U, Poll V, Rid R, Breitenbach M. The spectrum of fungal allergy. Int Arch Allergy Immunol. ;(1) doi/
    • Parronchi P, Brugnolo F, Sampognaro S, Maggi E. Genetic and environmental factors contributing to the onset of allergic disorders. Int Arch Allergy Immunol. ;(1) doi/
    • Platts-Mills TA, Hayden ML, Chapman MD, Wilkins SR. Seasonal variation in dust mite and grass-pollen allergens in dust from the houses of patients with asthma. J Allergy Clin Immunol. ;79(5) doi/(87)
    • Patterson TF, Kirkpatrick WR, White M, et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes.

      I3 Aspergillus Study Group. Medicine (Baltimore). ;79(4) doi/

    • Custovic A, Sonntag HJ, Buchan IE, Belgrave D, Simpson A, Prosperi MCF. Evolution pathways of IgE responses to grass and mite allergens throughout childhood. J Allergy Clin Immunol. ;(6)e doi/
    • Lam HT, Ekerljung L, Bjerg A, Van TTN, Lundback B, Ronmark E. Sensitization to airborne allergens among adults and its impact on allergic symptoms: a population survey in northern Vietnam.

      Clin Transl Allergy. ;4(1) doi/

    • Macan J, Plavec D, Kanceljak B, Milkovic-Kraus S. Exposure levels and skin reactivity to German cockroach (Blattella germanica) in Croatia. Croat Med J. ;44(6)
    • Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis. ;32(3) doi/
    • Baird FJ, Lopata AL. The dichotomy of pathogens and allergens in vaccination approaches. Front Microbiol. ; doi/fmicb
    • Wu YH, Chan CC, Rao CY, et al. Characteristics, determinants, and spatial variations of ambient fungal levels in the subtropical Taipei metropolis.

      Atmos Environ. ;41(12) doi/nv

    • Resch Y, Michel S, Kabesch M, Lupinek C, Valenta R, Vrtala S. Diverse IgE recognition of mite allergen components in asthmatic and nonasthmatic children. J Allergy Clin Immunol. ;(4) doi/
    • Crameri R, Zeller S, Glaser AG, Vilhelmsson M, Rhyner C. Cross-reactivity among fungal allergens: a clinically relevant phenomenon? Mycoses. ;52(2) doi/jx.
    • Indoor humidity levels should be kept between % (inexpensive humidity monitors can be purchased at most hardware stores)
    • Nurmatov U, van Schayck CP, Hurwitz B, Sheikh A.

      Home dust mite avoidance measures for perennial allergic rhinitis: an updated Cochrane systematic review. Allergy. ;67(2) doi/jx.

    • 9.

      Brehler R, Kahlert H, Thum-Oltmer S. Hypoallergene Präparate in der SCIT. Allergo J Int. ;–CrossRef Scholar

    • Larenas-Linnemann D, Michels A, Dinger H, et al. Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub) tropics. Clin Transl Allergy.

      ; doi/

    • 4.

      Global strategy for asthma management and prevention. Accessed 02/01/

    • Dampen dust when dusting or cleaning surfaces
    • Emminger W, Hernandez MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, et al. The SQ home dust mite SLIT-tablet is well tolerated in patients with home dust mite respiratory allergic disease. Int Arch Allergy Immunol. ;–CrossRefPubMedPubMedCentral Scholar

    • Shapiro RS, Robbins N, Cowen LE. Regulatory circuitry governing fungal development, drug resistance, and disease. Microbiol Mol Biol Rev. ;75(2) doi/MMBR
    • Humidifiers make the problem worse and are not recommended.
    • Sub-lingual immunotherapy (SLIT): Under your tongue, via little dissolvable tablets.
      1. E.g.

        Acarizax®or Actair®

      2. Al-Shair K, Atherton GT, Harris C, Ratcliffe L, Newton PJ, Denning DW. Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis. Clin Infect Dis. ;57(6) doi/cid/cit
      3. van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– Scholar

      4. Lockhart SR, Frade JP, Etienne KA, Pfaller MA, Diekema DJ, Balajee SA. Azole resistance in Aspergillus fumigatus isolates from the ARTEMIS global surveillance study is primarily due to the TR/L98H mutation in the cyp51A gene.

        Antimicrob Agents Chemother. ;55(9) doi/AAC

      5. Brozek JL, Bousquet J, Baena-Cagnani CE, et al.

        What are the symptoms of home dust mite allergy

        Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: revision. J Allergy Clin Immunol. ;(3) doi/

      6. de Saint Georges-Gridelet D. Vitamin requirements of the European home dust mite, Dermatophagoides pteronyssinus (Acari: Pyroglyphidae), in relation to its fungal association. J Med Entomol. ;24(4) doi/jmedent/
      7. Arshad SH. Does exposure to indoor allergens contribute to the development of asthma and allergy?

        Curr Allergy Asthma Rep. ;10(1) doi/s

      8. 8.

        Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate. Scholar

      9. Specific immunotherapy is the only treatment which modifies the immune response to allergens rather than just treating the symptoms.
      10. Aeroallergen avoidance / minimisation
      11. 5.

        Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M, et al. Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy. ;CrossRefPubMed Scholar

      12. Walsh TJ, Anaissie EJ, Denning DW, et al.

        Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. ;46(3) doi/

      13. N.B. Despite the above advice, studies are yet to show that physical or chemical cleaning methods reduce dust mite levels to a degree that improves symptoms.
      14. For home dust mites it can be istered as
      15. Sub-cutaneous immunotherapy (SCIT): Under the skin, via little injections.
        1. A typical treatment may require monthly injections over years.
        2. Calderon MA, Demoly P, Gerth van Wijk R, et al.

          EAACI: A European Declaration on Immunotherapy. Designing the future of allergen specific immunotherapy. Clin Transl Allergy. ;2(1) doi/

        3. 8.

          Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate. Scholar

        4. Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J. Effective treatment of home dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial. J Allergy Clin Immunol. ;–efPubMed Scholar

        5. Mosbech H.

          What are the symptoms of home dust mite allergy

          Home dust mite allergy. Allergy. ;40(2) doi/jtbx.

        6. 1.

          Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

          Allergo J Int. ;–CrossRefPubMedPubMedCentral Scholar

        7. Replace carpet with linoleum or floor boards which can be wiped clean
        8. Remove or reduce curtains (especially horizontal blinds) and soft furnishings in bedrooms
        9. Eifan AO, Calderon MA, Durham SR. Allergen immunotherapy for home dust mite: clinical efficacy and immunological mechanisms in allergic rhinitis and asthma. Expert Opin Biol Ther. ;13(11) doi/
        10. 7.

          Rosewich M, Arendt S, El Moussaoui S, Schulze J, Schubert R, Zielen S. Bronchial allergen provocation: a useful method to assess the efficacy of specific immunotherapy in children.

          Pediatr Allergy Immunol. ;–CrossRefPubMed Scholar

        11. Encase pillows,mattresses, doonas, blankets, and furniturein mite-impermeable protective coverings to reduce dust mite infiltration.
        12. A typical treatment may require giving the allergen sublingually (under the tongue) on a daily basis for years.
        13. 6.

          Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol. ;(5)–efPubMed Scholar

        14. Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J. Effective treatment of home dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial.

          J Allergy Clin Immunol. ;–efPubMed Scholar

        15. Antihistamines (tablets/nasal spray): effective in managing histamine-related symptoms such as itching, watery nose/eyes and sneezing. This medication is not helpful for nasal blockage.
        16. Arendrup MC, Mavridou E, Mortensen KL, et al. Development of azole resistance in Aspergillus fumigatus during azole therapy associated with change in virulence. PLoS One. ;5(4):e doi/
        17. Morgan WJ, Crain EF, Gruchalla RS, et al.

          Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. ;(11) doi/NEJMoa

        18. Portnoy J, Chew GL, Phipatanakul W, et al. Environmental assessment and exposure reduction of cockroaches: a practice parameter. J Allergy Clin Immunol. ;(4)e doi/
        19. Adkinson NF Jr, Bochner BS, Burks AW, et al. Middleton’s allergy: principles and practice. Elsevier Health Sciences;
        20. van der Linden JW, Snelders E, Kampinga GA, et al. Clinical implications of azole resistance in Aspergillus fumigatus, The Netherlands, Emerg Infect Dis. ;17(10) doi/eid
        21. Gregory LG, Lloyd CM. Orchestrating home dust mite-associated allergy in the lung.

          Trends Immunol. ;32(9) doi/

        22. 2.

          Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. ; Scholar

        23. 3.

          Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al. Home dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract. ;–CrossRefPubMed Scholar

        24. An S, Shen C, Liu X, et al. Alpha-actinin is a new type of home dust mite allergen. PLoS One. ;8(12):e doi/
        25. Abramson SL, Turner-Henson A, Anderson L, et al.

          Allergens in school settings: results of environmental assessments in 3 city school systems. J Sch Health. ;76(6) doi/jx.

        26. 4.

          Global strategy for asthma management and prevention. Accessed 02/01/

        27. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. ;70(3) doi/thoraxjnl
        28. Nasal irrigation: washing out the nasal cavity has been shown to reduce the quantity of allergens in the nose (see MEG nasal irrigation information pamphlet)
        29. Medications
        30. Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al.

          Safety of home dust mite sublingual immunotherapy standardized quality tablet in children allergic to home dust mites. Ann Allergy Asthma Immunol. ;–CrossRefPubMed Scholar

        31. Allergen specific immunotherapy
        32. 7.

          Rosewich M, Arendt S, El Moussaoui S, Schulze J, Schubert R, Zielen S. Bronchial allergen provocation: a useful method to assess the efficacy of specific immunotherapy in children. Pediatr Allergy Immunol. ;–CrossRefPubMed Scholar

        33. Dust mites do not own natural protection against sunlight, so exposing mattresses, rugs and carpet to sunlight for more than 3 hours can kill mites
        34. Allergen specific immunotherapy is available for dust mite allergy in severe cases.
        35. Compalati E, Passalacqua G, Bonini M, Canonica GW.

          The efficacy of sublingual immunotherapy for home dust mites respiratory allergy: results of a GA2LEN meta-analysis. Allergy. ;64(11) doi/jx.

        36. Baxi SN, Phipatanakul W. The role of allergen exposure and avoidance in asthma. Adolesc Med State Art Rev. ;21(1) 71, viii-ix.
        37. Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial.

          JAMA. ;–CrossRefPubMed Scholar

        38. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines revision. J Allergy Clin Immunol. ;–efPubMed Scholar

        39. Calderon MA, Casale TB, Nelson HS, Demoly P. An evidence-based analysis of home dust mite allergen immunotherapy: a call for more rigorous clinical studies. J Allergy Clin Immunol. ;(6) doi/
        40. Verweij PE, Mellado E, Melchers WJ. Multiple-triazole-resistant aspergillosis.

          N Engl J Med. ;(14) doi /NEJMc

        41. Tightly woven fabrics with a pore size of ≤6 microns are extremely effective at controlling the passage of mite.
        42. Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. ;–CrossRefPubMed Scholar

        43. Emminger W, Hernandez MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, et al. The SQ home dust mite SLIT-tablet is well tolerated in patients with home dust mite respiratory allergic disease.

          Int Arch Allergy Immunol. ;–CrossRefPubMedPubMedCentral Scholar

        44. Replace fabric covered seatingwith leather or vinyl
        45. Matsuse H, Fukushima C, Fukahori S, et al. Differential effects of dexamethasone and itraconazole on Aspergillus fumigatus-exacerbated allergic airway inflammation in a murine model of mite-sensitized asthma. Respiration. ;85(5) doi/
        46. Schwartz S, Ruhnke M, Ribaud P, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood. ;(8) doi/blood
        47. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al.

          Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines revision. J Allergy Clin Immunol. ;–efPubMed Scholar

        48. 2.

          Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. ; Scholar

        49. Washing bedding every weeks at °C to kill dust mites
        50. Nasal steroid spray/drops: often used as first line management in children aged over 2 and adults, mainly to treat nasal congestion or blockage.
        51. Use a vacuum cleaner with a HEPA filter if possible
        52. 3.

          Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al.

          Home dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract. ;–CrossRefPubMed Scholar

        53. Remove soft toys from the bedroom
        54. Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al. Safety of home dust mite sublingual immunotherapy standardized quality tablet in children allergic to home dust mites. Ann Allergy Asthma Immunol. ;–CrossRefPubMed Scholar

        55. Custovic A, Wijk RG. The effectiveness of measures to change the indoor environment in the treatment of allergic rhinitis and asthma: ARIA update (in collaboration with GA(2)LEN).

          Allergy. ;60(9) doi/jx.

        56. Howard SJ, Cerar D, Anderson MJ, et al. Frequency and evolution of Azole resistance in Aspergillus fumigatus associated with treatment failure. Emerg Infect Dis. ;15(7) doi/eid
        57. 6.

          Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol. ;(5)–efPubMed Scholar

        58. Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma.

          Cochrane Database Syst Rev. (8):Cd doi/CDpub2.

        59. 5.

          Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M, et al. Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy. ;CrossRefPubMed Scholar

        60. 1.

          Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

          Allergo J Int. ;–CrossRefPubMedPubMedCentral Scholar

        61. Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K. Home dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy. ;–CrossRefPubMed Scholar

        62. van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– Scholar

        63. Wright LS, Phipatanakul W.

          Environmental remediation in the treatment of allergy and asthma: latest updates. Curr Allergy Asthma Rep. ;14(3) doi/s

        64. Krieger J, Jacobs DE, Ashley PJ, et al. Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence. J Public Health Manag Pract. ;16(5 Suppl):S doi/PHH.0beddcbd9.
        65. Bousquet J, Lockey R, Malling HJ. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol. ;(4 Pt 1) doi/S(98)
        66. Do not permit pets in the bedroom
        67. Chowdhary A, Kathuria S, Randhawa HS, Gaur SN, Klaassen CH, Meis JF.

          Isolation of multiple-triazole-resistant Aspergillus fumigatus strains carrying the TR/L98H mutations in the cyp51A gene in India. J Antimicrob Chemother. ;67(2) doi: /jac/dkr

        68. Nelson HS. Update on home dust mite immunotherapy: are more studies needed? Curr Opin Allergy Clin Immunol. ;14(6) doi/ACI
        69. Van Asselt L. Interactions between domestic mites and fungi. Indoor Built Environ. ;8(4) doi/
        70. Miceli MH, Kauffman CA. Isavuconazole: a new broad-spectrum triazole antifungal agent. Clin Infect Dis. ;61(10) doi/cid/civ
        71. 9.

          Brehler R, Kahlert H, Thum-Oltmer S.

          Hypoallergene Präparate in der SCIT. Allergo J Int. ;–CrossRef Scholar

        72. New TR. Matthew J. Colloff: Dust mites. J Insect Conserv. ;13(6) doi/s
        73. It involves exposure to a little quantity of the allergen in order to induce tolerance.
        74. Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol. ;51(4) doi/
        75. Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K.

          Home dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy. ;–CrossRefPubMed Scholar

        76. Odds FC, Brown AJ, Gow NA. Antifungal agents: mechanisms of action. Trends Microbiol. ;11(6) doi/SX(03)
        77. Immunotherapy is generally only considered in older children and adults when symptoms are not well controlled with other measures

    Patient information on Home Dust Mite Allergy

    What is home dust mite allergy?

    An allergy to dust mites may result in a condition called allergic rhinitis (refer to Allergic Rhinitispatient information sheet).
    Patients with asthma may discover their asthma is exacerbated as a result of a dust mite allergy.

    Symptoms are generally persistent and present throughout the year.

    What are the symptoms of dust mite allergy?

    Some common dust mite allergy symptoms include sneezing, runny nose, irritated eyes, scratchy throat, coughing, wheezing, and shortness of breath.

    These same symptoms can be caused by a variety of other allergens as well, so consult your allergist for testing.

    What are the aeroallergen avoidance strategies to manage dust mite allergy?

    1. Do not permit pets in the bedroom
    2. Replace fabric covered seatingwith leather or vinyl
    3. Use a vacuum cleaner with a HEPA filter if possible
    4. Replace carpet with linoleum or floor boards which can be wiped clean
    5. Dust mites do not own natural protection against sunlight, so exposing mattresses, rugs and carpet to sunlight for more than 3 hours can kill mites
    6. Washing bedding every weeks at °C to kill dust mites
    7. Humidifiers make the problem worse and are not recommended.
    8. Encase pillows,mattresses, doonas, blankets, and furniturein mite-impermeable protective coverings to reduce dust mite infiltration.
    9. Remove soft toys from the bedroom
    10. Indoor humidity levels should be kept between % (inexpensive humidity monitors can be purchased at most hardware stores)
    11. Tightly woven fabrics with a pore size of ≤6 microns are extremely effective at controlling the passage of mite.
    12. Dampen dust when dusting or cleaning surfaces
    13. Remove or reduce curtains (especially horizontal blinds) and soft furnishings in bedrooms
    14. N.B.

      Despite the above advice, studies are yet to show that physical or chemical cleaning methods reduce dust mite levels to a degree that improves symptoms.

    Who is this information for?

    This information is for children and adults with dust mite allergy.

    What medications are available to manage dust mite allergy?

    1. 7.

      Rosewich M, Arendt S, El Moussaoui S, Schulze J, Schubert R, Zielen S.

      Bronchial allergen provocation: a useful method to assess the efficacy of specific immunotherapy in children. Pediatr Allergy Immunol. ;–CrossRefPubMed Scholar

    2. 4.

      Global strategy for asthma management and prevention. Accessed 02/01/

    3. 9.

      Brehler R, Kahlert H, Thum-Oltmer S. Hypoallergene Präparate in der SCIT. Allergo J Int. ;–CrossRef Scholar

    4. 3.

      Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al.

      Home dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract. ;–CrossRefPubMed Scholar

    5. Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J. Effective treatment of home dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial. J Allergy Clin Immunol. ;–efPubMed Scholar

    6. 6.

      Zielen S, Kardos P, Madonini E.

      Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol. ;(5)–efPubMed Scholar

    7. Emminger W, Hernandez MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, et al. The SQ home dust mite SLIT-tablet is well tolerated in patients with home dust mite respiratory allergic disease. Int Arch Allergy Immunol. ;–CrossRefPubMedPubMedCentral Scholar

    8. Antihistamines (tablets/nasal spray): effective in managing histamine-related symptoms such as itching, watery nose/eyes and sneezing.

      This medication is not helpful for nasal blockage.

    9. 5.

      Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M, et al. Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy. ;CrossRefPubMed Scholar

    10. Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. ;–CrossRefPubMed Scholar

    11. Nasal steroid spray/drops: often used as first line management in children aged over 2 and adults, mainly to treat nasal congestion or blockage.
    12. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al.

      Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines revision. J Allergy Clin Immunol. ;–efPubMed Scholar

    13. Nasal irrigation: washing out the nasal cavity has been shown to reduce the quantity of allergens in the nose (see MEG nasal irrigation information pamphlet)
    14. 2.

      Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis.

      Allergy. ; Scholar

    15. 8.

      Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate. Scholar

    16. 1.

      Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

      Allergo J Int. ;–CrossRefPubMedPubMedCentral Scholar

    17. Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K. Home dust mite sublingual tablet is effective and safe in patients with allergic rhinitis.

      What are the symptoms of home dust mite allergy

      Allergy. ;–CrossRefPubMed Scholar

    18. van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– Scholar

    19. Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al. Safety of home dust mite sublingual immunotherapy standardized quality tablet in children allergic to home dust mites. Ann Allergy Asthma Immunol. ;–CrossRefPubMed Scholar

    1.

    Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

    Allergo J Int. ;–CrossRefPubMedPubMedCentral Scholar

  • 2.

    Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. ; Scholar

  • 3.

    Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al. Home dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract. ;–CrossRefPubMed Scholar

  • 4.

    Global strategy for asthma management and prevention.

    Accessed 02/01/

  • 5.

    Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M, et al. Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy. ;CrossRefPubMed Scholar

  • 6.

    Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol. ;(5)–efPubMed Scholar

  • 7.

    Rosewich M, Arendt S, El Moussaoui S, Schulze J, Schubert R, Zielen S. Bronchial allergen provocation: a useful method to assess the efficacy of specific immunotherapy in children.

    Pediatr Allergy Immunol. ;–CrossRefPubMed Scholar

  • 8.

    Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate. Scholar

  • 9.

    Brehler R, Kahlert H, Thum-Oltmer S. Hypoallergene Präparate in der SCIT. Allergo J Int. ;–CrossRef Scholar

  • van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– Scholar

  • Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al.

    Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines revision. J Allergy Clin Immunol. ;–efPubMed Scholar

  • Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J. Effective treatment of home dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial. J Allergy Clin Immunol. ;–efPubMed Scholar

  • Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K. Home dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy. ;–CrossRefPubMed Scholar

  • Emminger W, Hernandez MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, et al.

    The SQ home dust mite SLIT-tablet is well tolerated in patients with home dust mite respiratory allergic disease. Int Arch Allergy Immunol. ;–CrossRefPubMedPubMedCentral Scholar

  • Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. ;–CrossRefPubMed Scholar

  • Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al. Safety of home dust mite sublingual immunotherapy standardized quality tablet in children allergic to home dust mites. Ann Allergy Asthma Immunol. ;–CrossRefPubMed Scholar

  • What else gets into dust that might cause allergies?

    The dust in your home may contain pet hair and dander, mold or pollen spores, and dust mite or cockroach body parts and droppings, every of which are common allergens.

    These allergens can cause an allergic reaction when you inhale or come into contact with them.

    What are dust mites?

    Dust mites are tiny creatures that frequently make their home in places love furniture, carpets, and bedding. They are too little to be seen without a microscope or magnifying glass. They own eight legs and are not true insects, but relatives of spiders.

    Dust mites feed on the flakes of skin shed by humans (and animals) every day. They prefer environments with 70 to 80% humidity, and temperatures of 68 to 77°F.

    What treatment options are available to manage dust mite allergy?

    Treatment options available to manage allergic rhinitis include:

    1. Medications
    2. Aeroallergen avoidance / minimisation
    3. Allergen specific immunotherapy

    Is allergen specific immunotherapy available for dust mite allergy?

  • Allergen specific immunotherapy is available for dust mite allergy in severe cases.
  • It involves exposure to a little quantity of the allergen in order to induce tolerance.
  • Specific immunotherapy is the only treatment which modifies the immune response to allergens rather than just treating the symptoms.
  • For home dust mites it can be istered as
  • Sub-cutaneous immunotherapy (SCIT): Under the skin, via little injections.
    1. A typical treatment may require monthly injections over years.
  • Sub-lingual immunotherapy (SLIT): Under your tongue, via little dissolvable tablets.
    1. E.g.

      Acarizax®or Actair®

    2. A typical treatment may require giving the allergen sublingually (under the tongue) on a daily basis for years.
    3. Immunotherapy is generally only considered in older children and adults when symptoms are not well controlled with other measures

    Concerns or questions?
    You can contact your ENT Specialist at the Melbourne ENT Group (MEG):

    Assessment by Orthodontist, dentist of Oral Maxillo-facial Surgeon is also recommended.

    Your GP is also the best contact for ongoing care and concerns.

    Download PDF

    Patient information on Home Dust Mite Allergy

    What is home dust mite allergy?

    An allergy to dust mites may result in a condition called allergic rhinitis (refer to Allergic Rhinitispatient information sheet).
    Patients with asthma may discover their asthma is exacerbated as a result of a dust mite allergy.

    Symptoms are generally persistent and present throughout the year.

    What are the symptoms of dust mite allergy?

    Some common dust mite allergy symptoms include sneezing, runny nose, irritated eyes, scratchy throat, coughing, wheezing, and shortness of breath.

    These same symptoms can be caused by a variety of other allergens as well, so consult your allergist for testing.

    What are the aeroallergen avoidance strategies to manage dust mite allergy?

    1. Do not permit pets in the bedroom
    2. Replace fabric covered seatingwith leather or vinyl
    3. Use a vacuum cleaner with a HEPA filter if possible
    4. Replace carpet with linoleum or floor boards which can be wiped clean
    5. Dust mites do not own natural protection against sunlight, so exposing mattresses, rugs and carpet to sunlight for more than 3 hours can kill mites
    6. Washing bedding every weeks at °C to kill dust mites
    7. Humidifiers make the problem worse and are not recommended.
    8. Encase pillows,mattresses, doonas, blankets, and furniturein mite-impermeable protective coverings to reduce dust mite infiltration.
    9. Remove soft toys from the bedroom
    10. Indoor humidity levels should be kept between % (inexpensive humidity monitors can be purchased at most hardware stores)
    11. Tightly woven fabrics with a pore size of ≤6 microns are extremely effective at controlling the passage of mite.
    12. Dampen dust when dusting or cleaning surfaces
    13. Remove or reduce curtains (especially horizontal blinds) and soft furnishings in bedrooms
    14. N.B.

      Despite the above advice, studies are yet to show that physical or chemical cleaning methods reduce dust mite levels to a degree that improves symptoms.

    Who is this information for?

    This information is for children and adults with dust mite allergy.

    What medications are available to manage dust mite allergy?

    1. 7.

      Rosewich M, Arendt S, El Moussaoui S, Schulze J, Schubert R, Zielen S. Bronchial allergen provocation: a useful method to assess the efficacy of specific immunotherapy in children.

      Pediatr Allergy Immunol. ;–CrossRefPubMed Scholar

    2. 4.

      Global strategy for asthma management and prevention. Accessed 02/01/

    3. 9.

      Brehler R, Kahlert H, Thum-Oltmer S. Hypoallergene Präparate in der SCIT. Allergo J Int.

      What are the symptoms of home dust mite allergy

      ;–CrossRef Scholar

    4. 3.

      Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al. Home dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract. ;–CrossRefPubMed Scholar

    5. Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J. Effective treatment of home dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial.

      J Allergy Clin Immunol. ;–efPubMed Scholar

    6. 6.

      Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol. ;(5)–efPubMed Scholar

    7. Emminger W, Hernandez MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, et al. The SQ home dust mite SLIT-tablet is well tolerated in patients with home dust mite respiratory allergic disease. Int Arch Allergy Immunol. ;–CrossRefPubMedPubMedCentral Scholar

    8. Antihistamines (tablets/nasal spray): effective in managing histamine-related symptoms such as itching, watery nose/eyes and sneezing.

      This medication is not helpful for nasal blockage.

    9. 5.

      Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M, et al. Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy. ;CrossRefPubMed Scholar

    10. Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. ;–CrossRefPubMed Scholar

    11. Nasal steroid spray/drops: often used as first line management in children aged over 2 and adults, mainly to treat nasal congestion or blockage.
    12. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al.

      Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines revision. J Allergy Clin Immunol. ;–efPubMed Scholar

    13. Nasal irrigation: washing out the nasal cavity has been shown to reduce the quantity of allergens in the nose (see MEG nasal irrigation information pamphlet)
    14. 2.

      Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. ; Scholar

    15. 8.

      Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate.

      Scholar

    16. 1.

      Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

      Allergo J Int. ;–CrossRefPubMedPubMedCentral Scholar

    17. Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K. Home dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy. ;–CrossRefPubMed Scholar

    18. van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– Scholar

    19. Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al. Safety of home dust mite sublingual immunotherapy standardized quality tablet in children allergic to home dust mites. Ann Allergy Asthma Immunol. ;–CrossRefPubMed Scholar

    1.

    Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al.

    Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

    Allergo J Int. ;–CrossRefPubMedPubMedCentral Scholar

  • 2.

    Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. ; Scholar

  • 3.

    Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, et al. Home dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract.

    ;–CrossRefPubMed Scholar

  • 4.

    Global strategy for asthma management and prevention. Accessed 02/01/

  • 5.

    Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M, et al. Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy. ;CrossRefPubMed Scholar

  • 6.

    Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial.

    J Allergy Clin Immunol. ;(5)–efPubMed Scholar

  • 7.

    Rosewich M, Arendt S, El Moussaoui S, Schulze J, Schubert R, Zielen S. Bronchial allergen provocation: a useful method to assess the efficacy of specific immunotherapy in children. Pediatr Allergy Immunol. ;–CrossRefPubMed Scholar

  • 8.

    Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate. Scholar

  • 9.

    Brehler R, Kahlert H, Thum-Oltmer S.

    Hypoallergene Präparate in der SCIT. Allergo J Int. ;–CrossRef Scholar

  • van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– Scholar

  • Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines revision. J Allergy Clin Immunol. ;–efPubMed Scholar

  • Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J. Effective treatment of home dust mite-induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial.

    J Allergy Clin Immunol. ;–efPubMed Scholar

  • Okamoto Y, Fujieda S, Okano M, Yoshida Y, Kakudo S, Masuyama K. Home dust mite sublingual tablet is effective and safe in patients with allergic rhinitis. Allergy. ;–CrossRefPubMed Scholar

  • Emminger W, Hernandez MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, et al. The SQ home dust mite SLIT-tablet is well tolerated in patients with home dust mite respiratory allergic disease. Int Arch Allergy Immunol. ;–CrossRefPubMedPubMedCentral Scholar

  • Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial.

    JAMA. ;–CrossRefPubMed Scholar

  • Maloney J, Prenner BM, Bernstein DI, Lu S, Gawchik S, Berman G, et al. Safety of home dust mite sublingual immunotherapy standardized quality tablet in children allergic to home dust mites. Ann Allergy Asthma Immunol. ;–CrossRefPubMed Scholar

  • What else gets into dust that might cause allergies?

    The dust in your home may contain pet hair and dander, mold or pollen spores, and dust mite or cockroach body parts and droppings, every of which are common allergens. These allergens can cause an allergic reaction when you inhale or come into contact with them.

    What are dust mites?

    Dust mites are tiny creatures that frequently make their home in places love furniture, carpets, and bedding.

    They are too little to be seen without a microscope or magnifying glass. They own eight legs and are not true insects, but relatives of spiders.

    Dust mites feed on the flakes of skin shed by humans (and animals) every day. They prefer environments with 70 to 80% humidity, and temperatures of 68 to 77°F.

    What treatment options are available to manage dust mite allergy?

    Treatment options available to manage allergic rhinitis include:

    1. Medications
    2. Aeroallergen avoidance / minimisation
    3. Allergen specific immunotherapy

    Is allergen specific immunotherapy available for dust mite allergy?

  • Allergen specific immunotherapy is available for dust mite allergy in severe cases.
  • It involves exposure to a little quantity of the allergen in order to induce tolerance.
  • Specific immunotherapy is the only treatment which modifies the immune response to allergens rather than just treating the symptoms.
  • For home dust mites it can be istered as
  • Sub-cutaneous immunotherapy (SCIT): Under the skin, via little injections.
    1. A typical treatment may require monthly injections over years.
  • Sub-lingual immunotherapy (SLIT): Under your tongue, via little dissolvable tablets.
    1. E.g.

      Acarizax®or Actair®

    2. A typical treatment may require giving the allergen sublingually (under the tongue) on a daily basis for years.
    3. Immunotherapy is generally only considered in older children and adults when symptoms are not well controlled with other measures

    Concerns or questions?
    You can contact your ENT Specialist at the Melbourne ENT Group (MEG):

    Assessment by Orthodontist, dentist of Oral Maxillo-facial Surgeon is also recommended.

    Your GP is also the best contact for ongoing care and concerns.

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