Dust mite allergy

Dust mite allergy, also known as house dust allergy, is a sensitization and allergic reaction to the droppings of house dust mites. The allergy is common[1][2] and can trigger allergic reactions such as asthma, eczema or itching. The mite's gut contains potent digestive enzymes (notably peptidase 1) that persist in their feces and are major inducers of allergic reactions such as wheezing. The mite's exoskeleton can also contribute to allergic reactions. Unlike scabies mites or skin follicle mites, house dust mites do not burrow under the skin and are not parasitic.[3]

Dust mite allergy
Other namesHouse dust allergy
SpecialtyAllergist, immunologist
SymptomsSymptoms
ComplicationsBronchial asthma, allergic asthma, allergic rhinitis
Usual onsetEarly childhood
CausesMite droppings
PreventionAvoid dust mites or cutting down mite numbers
TreatmentAllergen immunotherapy
MedicationAllergy shots (SCIT), HDM-SLIT tablet (SLIT)
A scanning electron micrograph of a female dust mite

The symptoms can be avoided or alleviated by a number of measures. In general, cutting down mite numbers may reduce these reactions while others say efforts to remove these mites from the environment have not been found to be effective.[4] Immunotherapy may be useful in those affected.[4] Subcutaneous injections have better evidence than under the tongue dosing.[5] Topical steroids as nasal spray or inhalation may be used.[6]

House dust mites (Dermatophagoides pteronyssinus) aggregate.

Severe dust mite infestation in the home has been linked to atopic dermatitis, and epidermal barrier damage has been documented.[7]

Symptoms

Dust mite allergy symptoms include:

  • Cough
  • Facial pressure and pain
  • Itchy, red or watery eyes
  • Itchy nose, roof of the mouth or throat
  • Nasal congestion
  • Postnasal drip
  • Runny nose, sneezing
  • Swollen, blue-colored skin under the eyes

If the dust mite allergy contributes to asthma:

  • Audible whistling or wheezing sound when exhaling
  • Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu
  • Chest tightness or pain
  • Difficulty breathing
  • Trouble sleeping caused by shortness of breath, coughing or wheezing[8][4][9]

Cross-reactivity to shellfish allergy

Tropomyosin, a minor allergen in dust mites, is also responsible for shellfish allergy.[10][11] Exposure to inhaled tropomyosins from dust mites is thought to be the primary sensitizer for shellfish allergy, an example of inhalant-to-food cross-reactivity.[12] Epidemiological surveys have confirmed correlation between shellfish and dust mite sensitizations.[13] An additional confirmation was seen in Orthodox Jews with no history of shellfish consumption, in that skin tests confirming dust mite allergy were also positive for shellfish tropomyosin.[10][13] In addition to tropomyosin, the proteins arginine kinase and hemocyanin seem to have a role in cross-reactivity to dust mites.[14]

Prevention

House dust mites are present indoors wherever humans live.[15] Positive tests for dust mite allergies are extremely common among people with asthma. Dust mites are microscopic arachnids whose primary food is dead human skin cells, but they do not live on living people.[16] They and their feces and other allergens that they produce are major constituents of house dust, but because they are so heavy they are not suspended for long in the air. They are generally found on the floor and other surfaces, until disturbed (by walking, for example).[15] It could take somewhere between twenty minutes and two hours for dust mites to settle back down out of the air.

Dust mites are a nesting species that prefer a dark, warm, and humid climate. They flourish in mattresses, bedding, upholstered furniture, and carpets.[17] Their feces include enzymes that are released upon contact with a moist surface, which can happen when a person inhales, and these enzymes can kill cells within the human body.[18] House dust mites did not become a problem until humans began to use textiles, such as western style blankets and clothing.[19]

Furniture

Furniture with wooden or leather surfaces reduces the dust mite population.[20]

Bed linen
Dust mite-proof encasements to mattress, pillow, and duvet prevent chronic contact with allergens.[6][20]

Hot tumble drying a bed linen for 1 hour will kill 99% of mites therein.[21]

Weekly changing the bed linen reduces the risk of exposure to dust mites.[6]

Cotton covers not covered with complete mattress covers are very likely to become colonized by bacteria and molds; they must be cleaned periodically (at least every second to third month). Here, the dust mites are beneficial as they return cotton to its original state after it has degraded by contact with bare skin.[22]

Dust mite eggs are freeze tolerant (−70 °C for 30 minutes); hatching can normally be prevented by exposure of fabrics to:[23]

  • Direct sunlight for 3 hours or
  • Dry or wet heat of at least 60 °C (140 °F) for a minimum of 30 minutes.

Dust mites drown in water.[21]

Good properties of anti-mite fabrics have been identified as being:[24]

  • Thread count greater than 246.
  • Pore size of between 2 and 10 micrometres. This will prevent dust mite faecal pellets that can be small as 10 µm.[25]
  • Allergen impenetrability >99%.
  • Dust leakage of less than 4%.
  • Breathability between 2 and 6 cm3 s−1 cm−2.

Indoor climate

Allergy patients are advised to keep the relative humidity below 50%, if possible. Very few mites can survive if the humidity is less than 45% (at 22 °C (72 °F)). However, they can survive if the humidity is high just for an hour and a half per day, for example due to moisture released to the air when cooking food.[21]

Treatment

Allergen immunotherapy

Allergen immunotherapy (AIT, also known as desensitization or hypo-sensitization) is a treatment involved in administering the doses of allergens to accustom the body to substances that are generally harmless (pollen, house dust mites), thereby inducing specific long-term tolerance.[26] Allergen immunotherapy is the only treatment that alters the disease mechanism.[27]

Immunotherapy can be administered orally (as sublingual tablets[28] or sublingual drops), or by injections under the skin (subcutaneous).[29] Subcutaneous immunotherapy is the most common form and has the largest body of evidence supporting its effectiveness.[30]

Subcutaneous immunotherapy

Subcutaneous Immunotherapy (SCIT) also known as Allergy Shots are series of shots/injections of the allergen given into the fat under the skin that have progressively larger amounts of allergen.[29] These shots can be given to children as young as 5 years old.[31]

Sublingual immunotherapy (SLIT)

HDM-SLIT tablet, House Dust Mites (Dermatophagoides farinae and Dermatophagoides pteronyssinus) Allergen Extract (Trade-names: ODACTRA, ACARIZAX & MITICURE), is the only FDA approved allergen extract for the immunotherapic treatment of adolescents (12–17 years)[32] and adults (18–65 years).[33][34][35] It significantly treats house dust mite (HDM)-induced allergic rhinitis,[36] with or without conjunctivitis.[35] It has been approved in Japan, Russia, South-East Asia, Turkey, the Middle East,[37] New Zealand and 14 European countries.[35][38]

Further reading

References
  1. Alderman, Lesley (2011-03-04). "Who Should Worry About Dust Mites (and Who Shouldn't)". The New York Times. ISSN 0362-4331. Retrieved 2020-07-23.
  2. "Dust Mite Allergy" (PDF). NHS.
  3. Ogg, Barb. "Managing House Dust Mites" (PDF). Extension, Institute of Agriculture and Natural Resources, University of Nebraska–Lincoln. Retrieved 24 January 2019.
  4. Biagtan, M; Viswanathan, R; Bush, RK (December 2014). "Immunotherapy for house dust mite sensitivity: where are the knowledge gaps?". Current Allergy and Asthma Reports. 14 (12): 482. doi:10.1007/s11882-014-0482-0. PMC 5034865. PMID 25354663.
  5. Eifan, AO; Calderon, MA; Durham, SR (November 2013). "Allergen immunotherapy for house dust mite: clinical efficacy and immunological mechanisms in allergic rhinitis and asthma". Expert Opinion on Biological Therapy. 13 (11): 1543–56. doi:10.1517/14712598.2013.844226. PMID 24099116.
  6. Carrard, A; Pichler, C (April 2012). "[House dust mite allergy]". Therapeutische Umschau. 69 (4): 249–52. doi:10.1024/0040-5930/a000281. PMID 22477664.
  7. Cork, Michael J; Robinson, Darren A; Vasilopoulos, Yiannis; Ferguson, Adam; Moustafa, Manar; MacGowan, Alice; Duff, Gordon W; Ward, Simon J; Tazi-Ahnini, Rachid (2006). "New perspectives on epidermal barrier dysfunction in atopic dermatitis: Gene–environment interactions". Journal of Allergy and Clinical Immunology. 118 (1): 3–21, quiz 22–3. doi:10.1016/j.jaci.2006.04.042. PMID 16815133.
  8. "Dust mite allergy – Symptoms and causes". Mayo Clinic. Retrieved 2020-07-23.
  9. Lee, Young Ji; Han, Soo Jung; Lee, Hun; Kim, Jin Sun; Seo, Kyoung Yul (2016). "Development of Allergic Conjunctivitis Induced by House Dust Mite Extract FromDermatophagoides pteronyssinus". Investigative Ophthalmology & Visual Science. 57 (4): 1773–81. doi:10.1167/iovs.15-17340. ISSN 1552-5783. PMID 27074380.
  10. Lopata AL, Kleine-Tebbe J, Kamath SD (November 2016). "Allergens and molecular diagnostics of shellfish allergy: Part 22 of the Series Molecular Allergology". Allergo J Int. 25 (7): 210–18. doi:10.1007/s40629-016-0124-2. PMC 5306157. PMID 28239537.
  11. Prester L (August 2016). "Seafood Allergy, Toxicity, and Intolerance: A Review". J Am Coll Nutr. 35 (3): 271–83. doi:10.1080/07315724.2015.1014120. PMID 26252073. S2CID 1154235.
  12. Wong L, Tham EH, Lee BW (June 2019). "An update on shellfish allergy". Curr Opin Allergy Clin Immunol. 19 (3): 236–42. doi:10.1097/ACI.0000000000000532. PMID 30893087.
  13. Wong L, Huang CH, Lee BW (March 2016). "Shellfish and House Dust Mite Allergies: Is the Link Tropomyosin?". Allergy Asthma Immunol Res. 8 (2): 101–6. doi:10.4168/aair.2016.8.2.101. PMC 4713872. PMID 26739402.
  14. Gelis S, Rueda M, Valero A, Fernández EA, Moran M, Fernández-Caldas E (July 2020). "Shellfish Allergy: Unmet Needs in Diagnosis and Treatment". J Investig Allergol Clin Immunol. 30 (6): 409–20. doi:10.18176/jiaci.0565. PMID 32694101.
  15. "Dust Mites". American Lung Association. Retrieved 2022-12-23.
  16. Australia, Healthdirect (2021-09-16). "Dust mites". www.healthdirect.gov.au. Retrieved 2022-12-23.
  17. Perryman, Oliver (December 14, 2020). "How to Get Rid of Dust Floating in the Air using a Air Purifier?". Dehumidifier Critic. Archived from the original on May 17, 2021. Retrieved May 17, 2021.
  18. Abadi, Sara (August 2009). "Hygiene Habits". AOL Health. AOL. Archived from the original on January 28, 2010. Retrieved May 17, 2021.
  19. Colloff, Matthew J (2009). Dust Mites. Dordrecht: Springer Science+Business Media. doi:10.1007/978-90-481-2224-0. ISBN 978-90-481-2224-0. OCLC 664094692.
  20. "Dust mite-proof pillow cover: MedlinePlus Medical Encyclopedia Image". MedlinePlus. 2019-03-07. Retrieved 2019-03-14.
  21. Portnoy J, Miller JD, Williams PB, Chew GL, Miller J, et al. (December 2013). "Environmental assessment and exposure control of dust mites: a practice parameter". Annals of Allergy, Asthma & Immunology. 111 (6): 465–507. doi:10.1016/j.anai.2013.09.018. ISSN 1081-1206. PMC 5156485. PMID 24267359.
  22. Pitten FA, Kalveram CM, Krüger U, Müller G, Kramer A (September 2000). "Reduktion der Besiedlung neuwertiger Matratzen mit Bakterien, Schimmelpilzen und Hausstaubmilben durch Matratzenganzbezüge" [Reduction of colonization of new mattresses with bacteria, moulds and house dust mites by complete mattress covers]. Der Hautarzt. 51 (9): 655–60. doi:10.1007/s001050051190. PMID 11057391.
  23. Mahakittikun, V; Boitano, JJ; Ninsanit, P; Wangapai, T; Ralukruedej, K (December 2011). "Effects of high and low temperatures on development time and mortality of house dust mite eggs". Experimental & Applied Acarology. 55 (4): 339–47. doi:10.1007/s10493-011-9480-2. PMID 21751035.
  24. "Best Fabrics to Exclude Dust Mites". HouseDustMite.com. Retrieved 24 January 2019.
  25. "House dust mite excrements/ faeces HDM excrements". Citeq Biologics. 1 October 2018.
  26. Van Overtvelt L, Batard T, Fadel R, Moingeon P (December 2006). "Mécanismes immunologiques de l'immunothérapie sublinguale spécifique des allergènes". Revue Française d'Allergologie et d'Immunologie Clinique. 46 (8): 713–720. doi:10.1016/j.allerg.2006.10.006.
  27. Creticos P. "Subcutaneous immunotherapy for allergic disease: Indications and efficacy". UpToDate.
  28. MD, Anna R. Wolfson (2021-02-10). "Can dust mite allergy be treated with a pill?". Harvard Health. Retrieved 2022-04-28.
  29. Dust mite allergies: Allergen-specific immunotherapy (desensitization) in the treatment of allergies. Institute for Quality and Efficiency in Health Care (IQWiG). 2020-04-23.
  30. Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S (January 2007). "Allergen injection immunotherapy for seasonal allergic rhinitis". The Cochrane Database of Systematic Reviews (1): CD001936. doi:10.1002/14651858.CD001936.pub2. PMC 7017974. PMID 17253469.
  31. "Allergy Shots (for Parents) – Nemours KidsHealth". kidshealth.org. Retrieved 2022-04-28.
  32. "ACARIZAX 12 SQ-HDM – Summary of Product Characteristics (SmPC) – (emc)". www.medicines.org.uk. Retrieved 2022-04-28.
  33. Commissioner, Office of the (2020-03-24). "FDA approves Odactra for house dust mite allergies". FDA. Retrieved 2022-04-28.
  34. Research, Center for Biologics Evaluation and (2022-02-07). "ODACTRA". FDA.
  35. Abello, A. L. K. (2017-08-21). "ALK to accelerate launches of ODACTRA™ in the USA / ACARIZAX® in Canada". GlobeNewswire News Room. Retrieved 2022-04-28.
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  37. "ALK partners with Abbott to sell Acarizax in South-East Asia". www.thepharmaletter.com. Retrieved 2022-04-28.
  38. ALK. "ALK Announces FDA Approval for its House Dust Mite Sublingual Allergy Immunotherapy Tablet (ACARIZAX® in Europe)". www.prnewswire.com. Retrieved 2022-04-28.
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