Dust mite allergy is a significant risk factor (not only) for the development of asthma
Dust mite allergy is the most common cause of year-round allergic rhinitis in our country. Its prevalence is increasing every year, but non-specific manifestations also cause its underdiagnosis. Early initiation of treatment is crucial to prevent the development of complications.
Dust mites and their allergens
Dust mites are microscopic arthropods from the order of arachnids, about 0.4 mm in size. The most common species found in our country are Dermatophagoides pteronyssinus and Dermatophagoides farinae. They feed on flakes of the human epidermis and prefer warm and humid environments. Therefore, in households, they are most commonly found in bedding (mattresses, duvets, and pillows). They can also be found in carpets, upholstered furniture, curtains, and stuffed toys. The causative allergens come from their feces or body remnants.
Mite allergy is a typical IgE-mediated type I hypersensitivity reaction. Sensitization to house dust mites can be observed in 5 to 30% of the population. So far, 24 mite allergens have been identified, and 97% of allergic individuals are sensitized to the allergen Der p1. The allergen Der p11 is most commonly associated with atopic dermatitis. Up to two-thirds of children and half of adults with asthma bronchiale suffer from allergies, with 40–85% of these patients being specifically allergic to dust mites.
Non-specific symptoms of mite allergy cause underdiagnosis
Just like allergies to pet hair or mold, mite allergy is characterized by its year-round course. Symptoms are most pronounced at night and in the morning after waking up. Dust mites are most prevalent at the turn of summer and autumn and winter and spring when relative humidity is higher. Therefore, during these periods, patients may sometimes notice a worsening of symptoms.
Typical manifestations include allergic rhinitis (watery nasal discharge, sneezing, itching, and burning of the nose, nasal obstruction) and/or conjunctivitis (burning, tearing of the eyes, redness of the conjunctiva). Non-specific manifestations can also include fatigue or sleep disturbances. Mite allergy is also a risk factor for the development of asthma. Moreover, it significantly contributes to the worsening of atopic dermatitis symptoms in children. Most patients notice the first signs of allergy in childhood or adolescence.
Critical to diagnosis = carefully taken medical history
Most individuals with mite allergy initially visit a general practitioner. A carefully and purposefully taken medical history is essential, as a large portion of patients consider allergy to be a common cold. The standard diagnostic method of choice is highly sensitive skin prick tests, conducted by a doctor specializing in allergology and clinical immunology. These can be supplemented by determining the level of specific IgE antibodies in the blood.
Current treatment options
The treatment of mite allergy today relies on lifestyle measures, pharmacotherapy, and specific allergen immunotherapy.
Primary prevention mainly involves lifestyle measures aimed at minimizing exposure to mite allergens as much as possible. This can include using special covers for mattresses that are impermeable to mites, although a disadvantage might be the massive release of allergens when this barrier is removed. Other recommended measures include regular washing of bedding at high temperatures, removal of carpets, upholstered furniture, and curtains in the household, using air purifiers with HEPA filters, regular vacuuming, and ventilating rooms. A newly available innovative natural product for eliminating mites is ExAller, whose clinically proven effect is based on mimicking the pheromone-based communication of mites. ExAller is simply sprayed onto a sheet, attracting the mites there. Then, you only need to vacuum the mattress and wash the sheet in a washing machine at a temperature of at least 60°C.
Topical sodium cromoglicate and intranasal corticosteroids are prophylactically effective in most patients. Local or oral antihistamines can help relieve symptoms. In asthma treatment, both relief and control medications are commonly used.
The only causal treatment today is specific allergen immunotherapy, which can also delay the possible onset of asthma. It is administered either subcutaneously or, more recently, sublingually. This leads to long-term improvement of symptoms and reduces the need for symptomatic medications mentioned above.
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Source: Aggarwal P., Senthilkumaran S. Dust mite allergy. StatPearls 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560718/.
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