From the Guidelines
Dust mite allergy on the skin typically presents as atopic dermatitis (eczema), characterized by red, itchy, inflamed patches of skin that may be dry, scaly, or weeping. The presentation of dust mite allergy on the skin can be identified by several key characteristics, including:
- Red, itchy, and inflamed patches of skin
- Dry, scaly, or weeping skin
- Common locations include the face, neck, inside of elbows, behind knees, and hands
- Symptoms often worsen at night and during exposure to dust mite-rich environments like bedding This condition is caused by an IgE-mediated immune response to dust mite proteins, which triggers the release of histamine and inflammatory mediators, leading to skin inflammation and itching 1.
Environmental Control Measures
To manage dust mite allergy, environmental control measures are essential, including:
- Using allergen-proof mattress and pillow covers
- Washing bedding weekly in hot water
- Reducing indoor humidity below 50%
- Regular vacuuming with HEPA filters These measures can help reduce exposure to dust mite allergens and alleviate symptoms 1.
Treatment Options
Treatment for dust mite allergy on the skin may include:
- Topical corticosteroids, such as hydrocortisone 1% or triamcinolone 0.1%, applied twice daily for 1-2 weeks during flares
- Calcineurin inhibitors, such as tacrolimus 0.03-0.1% or pimecrolimus 1%, for sensitive areas
- Antihistamines, such as cetirizine 10mg daily or diphenhydramine 25mg at bedtime, to control itching
- Moisturizers to maintain skin barrier function For severe cases, immunotherapy may be considered 1.
From the Research
Presentation of Dust Mite Allergy of Skin
- The presentation of dust mite allergy on the skin can be observed in the form of eczema, which is an inflammatory skin disease characterized by intense itchiness and involvement of skin creases, such as the folds of the elbows or knees 2.
- Eczema can relapse and remit over time, and as many as a third of people with eczema who have a positive test for allergy to house dust mite have reported worsening of eczema or respiratory symptoms when exposed to dust 2.
- Skin tests to house dust mite have higher diagnostic value for symptomatic allergy than specific IgE or total IgE, and are applicable in most patients with asthma and chronic obstructive pulmonary disease (COPD) 3.
- The best cutoff level for a positive skin test was 0.7 when the histamine wheal size was accounted for by division, -6 mm when subtraction was used, and 7 mm for absolute wheal size, and these cutoff levels proved equally applicable in various subgroups of patients with asthma and COPD 3.
- Treatment options for house dust mite allergy include avoidance, pharmacotherapy, and allergen immunotherapy, but evidence for their efficacy is variable, and there is a need for further development and improved access to molecular allergy diagnosis 4.
- Allergen immunotherapy has a poor but improving evidence base, and its benefits last after treatment ends, making it a potential treatment option for house dust mite allergy 4.