Update on House Dust Mite Allergen Avoidance Measures for Asthma

Chiara Zuiani,Adnan Custovic

doi:10.1007/s11882-020-00948-y

Abstract

Purpose of ReviewTo critically review the evidence in favor or against the use of house dust mite (HDM) allergen avoidance measures in patients with asthma.Recent FindingsSystematic 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.SummaryUntil 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.

Highlights

Sensitization to house dust mite (HDM) is one of the most common causes of respiratory allergy in the world [1] and has been consistently found to be one of the strongest associates of asthma in children, adolescent, and adults [2,3,4,5]
The US NHLBI Asthma Guideline (2007) provides the opposite recommendations on the use of HDM avoidance in the management of the disease compared to the Global Initiative for Asthma (GINA), the British guideline on the management of asthma (BTS/SIGN), or the UK National Institute of Clinical Excellence (NICE) guideline on asthma [9,10,11,12]
A very important recent RCT in children tested the hypothesis that reduction in mite allergen exposure may reduce the risk of severe asthma exacerbations

Summary

Introduction

Sensitization to house dust mite (HDM) is one of the most common causes of respiratory allergy in the world [1] and has been consistently found to be one of the strongest associates of asthma in children, adolescent, and adults [2,3,4,5]. Asthma symptoms in children and adults sensitized to HDM tend to correlate with mite allergen levels at home [6, 7]. High domestic exposure to mite allergens in asthmatic patients with HDM sensitization triggers bronchospasm and increases bronchial hyper-reactivity, whereas cessation of exposure may relieve symptoms [8]. We have recently reviewed this topic, outlining the potential reasons for such discrepancies [13]. We provide an update on this subject, review the recent evidence

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Findings

Conclusions

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