Update on House Dust Mite Allergen Avoidance Measures for Asthma

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Abstract

Purpose of Review

To critically review the evidence in favor or against the use of house dust mite (HDM) allergen avoidance measures in patients with asthma.

Recent Findings

Systematic reviews and meta-analyses suggested no positive effect of mite allergen avoidance strategies on asthma outcomes, resulting in a lack of consensus regarding the utility of these measures. However, such analyses have a number limitations and might not be the most adequate tool to evaluate current evidence and to derive clinical recommendations regarding mite allergen avoidance in asthmatic patients. We should not disproportionately rely on the results of meta-analyses and systematic reviews to inform clinical practice and asthma guidelines in this area. Recent high-quality evidence from randomized controlled trial in children confirmed that mite allergen–impermeable bed encasings reduce emergency hospital attendance with acute severe asthma exacerbations.

Summary

Until better evidence is available, we suggest that physicians should adopt a pragmatic approach to mite allergen avoidance and advise sensitized patients to implement a multifaceted set of measures to achieve as great a reduction in exposure as possible. Potential predictors of positive response (e.g., patient’s sensitization and exposure status) can pragmatically be evaluated using the size of skin test wheal or the titer of allergen-specific IgE. Finally, the intervention should be started as early as possible.

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Most cited references 61

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The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.

David L Rosenstreich, Peyton Eggleston, Meyer Kattan … (1997)

It has been hypothesized that asthma-related health problems are most severe among children in inner-city areas who are allergic to a specific allergen and also exposed to high levels of that allergen in bedroom dust. From November 1992 through October 1993, we recruited 476 children with asthma (age, four to nine years) from eight inner-city areas in the United States. Immediate hypersensitivity to cockroach, house-dust-mite, and cat allergens was measured by skin testing. We then measured major allergens of cockroach (Bla g 1), dust mites (Der p 1 and Der f 1), and cat dander (Fel d 1) in household dust using monoclonal-antibody-based enzyme-linked immunosorbent assays. High levels of exposure were defined according to proposed thresholds for causing disease. Data on morbidity due to asthma were collected at base line and over a one-year period. Of the children, 36.8 percent were allergic to cockroach allergen, 34.9 percent to dust-mite allergen, and 22.7 percent to cat allergen. Among the children's bedrooms, 50.2 percent had high levels of cockroach allergen in dust, 9.7 percent had high levels of dust-mite allergen, and 12.6 percent had high levels of cat allergen. After we adjusted for sex, score on the Child Behavior Checklist, and family history of asthma, we found that children who were both allergic to cockroach allergen and exposed to high levels of this allergen had 0.37 hospitalization a year, as compared with 0.11 for the other children (P=0.001), and 2.56 unscheduled medical visits for asthma per year, as compared with 1.43 (P<0.001). They also had significantly more days of wheezing, missed school days, and nights with lost sleep, and their parents or other care givers were awakened during the night and changed their daytime plans because of the child's asthma significantly more frequently. Similar patterns were not found for the combination of allergy to dust mites or cat dander and high levels of the allergen. The combination of cockroach allergy and exposure to high levels of this allergen may help explain the frequency of asthma-related health problems in inner-city children.

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Results of a home-based environmental intervention among urban children with asthma.

Wayne J. Morgan, Ellen Crain, Rebecca Gruchalla … (2004)

Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes. Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma. The objective of this study was to determine whether an environmental intervention tailored to each child's allergic sensitization and environmental risk factors could improve asthma-related outcomes. We enrolled 937 children with atopic asthma (age, 5 to 11 years) in seven major U.S. cities in a randomized, controlled trial of an environmental intervention that lasted one year (intervention year) and included education and remediation for exposure to both allergens and environmental tobacco smoke. Home environmental exposures were assessed every six months, and asthma-related complications were assessed every two months during the intervention and for one year after the intervention. For every 2-week period, the intervention group had fewer days with symptoms than did the control group both during the intervention year (3.39 vs. 4.20 days, P<0.001) and the year afterward (2.62 vs. 3.21 days, P<0.001), as well as greater declines in the levels of allergens at home, such as Dermatophagoides farinae (Der f1) allergen in the bed (P<0.001) and on the bedroom floor (P=0.004), D. pteronyssinus in the bed (P=0.007), and cockroach allergen on the bedroom floor (P<0.001). Reductions in the levels of cockroach allergen and dust-mite allergen (Der f1) on the bedroom floor were significantly correlated with reduced complications of asthma (P<0.001). Among inner-city children with atopic asthma, an individualized, home-based, comprehensive environmental intervention decreases exposure to indoor allergens, including cockroach and dust-mite allergens, resulting in reduced asthma-associated morbidity. Copyright 2004 Massachusetts Medical Society

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Respiratory allergy caused by house dust mites: What do we really know?

Moises A. Calderon, Allan Linneberg, Jörg Kleine-Tebbe … (2015)

The house dust mite (HDM) is a major perennial allergen source and a significant cause of allergic rhinitis and allergic asthma. However, awareness of the condition remains generally low. This review assesses the links between exposure to HDM, development of the allergic response, and pathologic consequences in patients with respiratory allergic diseases. We investigate the epidemiology of HDM allergy to explore the interaction between mites and human subjects at the population, individual, and molecular levels. Core and recent publications were identified by using "house dust mite" as a key search term to evaluate the current knowledge of HDM epidemiology and pathophysiology. Prevalence data for HDM allergen sensitization vary from 65 to 130 million persons in the general population worldwide to as many as 50% among asthmatic patients. Heterogeneity of populations, terminology, and end points in the literature confound estimates, indicating the need for greater standardization in epidemiologic research. Exposure to allergens depends on multiple ecological strata, including climate and mite microhabitats within the domestic environment, with the latter providing opportunity for intervention measures to reduce allergen load. Inhaled mite aeroallergens are unusually virulent: they are able to activate both the adaptive and innate immune responses, potentially offering new avenues for intervention. The role of HDM allergens is crucial in the development of allergic rhinitis and asthma, but the translation of silent sensitization into symptomatic disease is still incompletely understood. Improved understanding of HDMs, their allergens, and their microhabitats will enable development of more effective outcomes for patients with HDM allergy.

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Author and article information

Contributors

Adnan Custovic:

ORCID: http://orcid.org/0000-0001-5218-7071

a.custovic@imperial.ac.uk

Journal

Journal ID (nlm-ta): Curr Allergy Asthma Rep

Journal ID (iso-abbrev): Curr Allergy Asthma Rep

Title: Current Allergy and Asthma Reports

Publisher: Springer US (New York )

ISSN (Print): 1529-7322

ISSN (Electronic): 1534-6315

Publication date (Electronic): 19 June 2020

Publication date PMC-release: 19 June 2020

Publication date (Print): 2020

Volume: 20

Issue: 9

Electronic Location Identifier: 50

Affiliations

[1 ]GRID grid.417895.6, ISNI 0000 0001 0693 2181, Imperial College Healthcare NHS Trust, ; London, UK

[2 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, National Heart and Lung Institute, , Imperial College London, ; London, UK

Author information

Adnan Custovic http://orcid.org/0000-0001-5218-7071

Article

Publisher ID: 948

DOI: 10.1007/s11882-020-00948-y

PMC ID: 7305068

PubMed ID: 32561997

SO-VID: bdc25119-2d06-4dc9-982c-8e743a69b348

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Funding

Funded by: Imperial College London

Custom metadata

ScienceOpen disciplines: Immunology

Keywords: house dust mite,asthma,avoidance,exposure,allergen,mite

Data availability:

ScienceOpen disciplines: Immunology

Keywords: house dust mite, asthma, avoidance, exposure, allergen, mite

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Update on House Dust Mite Allergen Avoidance Measures for Asthma

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Abstract

Purpose of Review

Recent Findings

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Annual Reviews HIV/AIDS: Public Health and Society

Most cited references 61

The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.

Results of a home-based environmental intervention among urban children with asthma.

Respiratory allergy caused by house dust mites: What do we really know?

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