What are the symptoms of house dust mite allergy

Written by Nancy Treesh On February 26, 2020 - 52 min read

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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]

A.

siro: 1 allergen
Euroglyphus maynei: 5 allergens
B. tropicalis: 14 allergens
D. farinae: 32 allergens
L. destructor: 5 allergens
G. domesticus: 1 allergen
D. pteronyssinus: 23 allergens
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]

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Contribution of dust mite and cat specific IgE to entire IgE: relevance to asthma prevalence. J Allergy Clin Immunol. ;(2) doi/
Parkin J, Cohen B. An overview of the immune system. Lancet. ;() doi/S(00)
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/
Perennial symptoms (with possible seasonal exacerbations)
Sheffer A, Bartal M, Bousquet J. Global strategy for asthma management and prevention. WHO Workshop Report Publication;
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/
Improvement in symptoms at high altitudes.
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

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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

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1. E.g.
  
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14. For home dust mites it can be istered as
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  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?

Do not permit pets in the bedroom
Replace fabric covered seatingwith leather or vinyl
Use a vacuum cleaner with a HEPA filter if possible
Replace carpet with linoleum or floor boards which can be wiped clean
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
Washing bedding every weeks at °C to kill dust mites
Humidifiers make the problem worse and are not recommended.
Encase pillows,mattresses, doonas, blankets, and furniturein mite-impermeable protective coverings to reduce dust mite infiltration.
Remove soft toys from the bedroom
Indoor humidity levels should be kept between % (inexpensive humidity monitors can be purchased at most hardware stores)
Tightly woven fabrics with a pore size of ≤6 microns are extremely effective at controlling the passage of mite.
Dampen dust when dusting or cleaning surfaces
Remove or reduce curtains (especially horizontal blinds) and soft furnishings in bedrooms
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?

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
4.

Global strategy for asthma management and prevention. Accessed 02/01/
9.

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

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
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
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.
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
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
Nasal steroid spray/drops: often used as first line management in children aged over 2 and adults, mainly to treat nasal congestion or blockage.
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
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)
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
8.

Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate. 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
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
van der Valk JP, de Jong NW, Gerth van Wijk R. Review on immunotherapy in airway allergen sensitised patients. Neth J Med. ;– 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

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

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

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

Global strategy for asthma management and prevention.

Accessed 02/01/

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

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

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

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

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:

Medications
Aeroallergen avoidance / minimisation
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.

A typical treatment may require monthly injections over years.

Sub-lingual immunotherapy (SLIT): Under your tongue, via little dissolvable tablets.

E.g.

Acarizax®or Actair®
A typical treatment may require giving the allergen sublingually (under the tongue) on a daily basis for years.
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?

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?

Do not permit pets in the bedroom
Replace fabric covered seatingwith leather or vinyl
Use a vacuum cleaner with a HEPA filter if possible
Replace carpet with linoleum or floor boards which can be wiped clean
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
Washing bedding every weeks at °C to kill dust mites
Humidifiers make the problem worse and are not recommended.
Encase pillows,mattresses, doonas, blankets, and furniturein mite-impermeable protective coverings to reduce dust mite infiltration.
Remove soft toys from the bedroom
Indoor humidity levels should be kept between % (inexpensive humidity monitors can be purchased at most hardware stores)
Tightly woven fabrics with a pore size of ≤6 microns are extremely effective at controlling the passage of mite.
Dampen dust when dusting or cleaning surfaces
Remove or reduce curtains (especially horizontal blinds) and soft furnishings in bedrooms
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?

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
4.

Global strategy for asthma management and prevention. Accessed 02/01/
9.

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

;–CrossRef 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
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.

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
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
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.
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
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
Nasal steroid spray/drops: often used as first line management in children aged over 2 and adults, mainly to treat nasal congestion or blockage.
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
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)
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
8.

Allergopharma. Summary of product characteristics, Acaroid® Milbenpräparate.

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

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

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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:

Medications
Aeroallergen avoidance / minimisation
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.

A typical treatment may require monthly injections over years.

Sub-lingual immunotherapy (SLIT): Under your tongue, via little dissolvable tablets.

E.g.

Acarizax®or Actair®
A typical treatment may require giving the allergen sublingually (under the tongue) on a daily basis for years.
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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