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Introduction Demographics Causes Clinical features Complications Diagnosis Differential diagnoses Treatment Outcome
A house dust mite is an eight-legged arachnid with a three-month life cycle of egg, larva, protonymph, tritonymph, and adult stages. The adult mite is transparent and 0.25-0.33 mm in length. The female lays 50–80 eggs during her lifetime. Each immature mite stage sheds a hard exoskeleton of chitin which is an aeroallergen, although the main allergens derive from the membrane encasing faecal pellets. The house dust mite feeds on skin scales, so increased numbers are found in association with humans with dermatoses that cause increased skin shedding.
The most common house dust mite species in temperate zones are Dermatophagoides pteronyssinus (Der p), Dermatophagoides farina (Der f) and Euroglyphus maynei (Eur m). Blomia tropicalis (Blo t) is also found in tropical climates. House dust mites are not found in the Arctic or Antarctic due to the cold temperatures, or at high altitudes where there is low humidity - the mite requires a humidity level above 75%. House dust mites avoid light so appear on exposed surfaces only at night. The highest mite numbers are found in carpeted bedrooms and living rooms, in couches and beds, especially sheepskin bedding and clothing.
House dust mites produce aeroallergens that can cause hypersensitivity particularly in atopic individuals — those with atopic dermatitis, allergic rhinitis, and allergic asthma.
House dust mites produce the most relevant airborne allergens for atopic dermatitis.
Particles containing mite allergens are undetectable in the air of undisturbed rooms, however will become airborne after disturbing contaminated surfaces such as making a bed or vacuuming carpet. Contact can also be more direct such as via pillows, soft toys, or clothing.
House dust mite allergens may be inhaled, ingested, or contacted directly to the skin or eye.
There are many potential allergens related to house dust mites, the most sensitising of which are Der p1/Der f1 (cysteine proteases) and Der p2/Der f2 (lipid-binding auto-adjuvants). Der p11 (paramyosin homologue) is a major allergen in atopic dermatitis. Polysensitisation is common in atopic dermatitis.
Dust mite particles contain proteases (proteolytic enzymes) and pathogen-associated molecular patterns (PAMPS).
In atopic dermatitis, proteases:
House dust mite aeroallergens may cause exacerbation of atopic dermatitis on exposed sites such as the face and arms. There may be particular aggravation in the morning on skin that directly contacts bedsheets overnight. There may be a seasonal association with flares in Spring and Summer months.
House dust mite hypersensitivity also exacerbates allergic rhinitis, allergic conjunctivitis, and allergic asthma.
House dust mite hypersensitivity should be considered clinically in atopic dermatitis refractory to treatment.
Investigations may include:
The effectiveness of eradication and desensitisation interventions remains uncertain and should only be considered in patients with atopic dermatitis and proven house dust mite hypersensitivity.
Guidelines for the management of house dust mite hypersensitivity in atopic dermatitis remain unclear and inconsistent due to low-quality clinical trials.
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