House Dust Mite-Induced Allergic Rhinitis: Is Prevention an Option?

  • Salina Husain
  • Farah Dayana Zahedi
  • Sakinah Mohamad
  • Baharudin AbdullahEmail author
Allergy Prevention (DY Wang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Allergy Prevention


Purpose of review

The aim of this paper is to review and summarise the current knowledge of prevention of house dust mite (HDM)-induced allergic rhinitis (AR).

Recent findings

AR can be either classified as seasonal/intermittent (for example hay fever occurring summer and autumn) or perennial/persistent (occurring throughout the year). The commonest trigger for seasonal AR is pollen whereas HDMs are the key allergic trigger for perennial AR. HDMs are a recognised indoor allergen that is crucial in the development of AR, asthma, and atopic dermatitis.


Preventive strategies have gained acceptance for the management scheme in the treatment of patients with AR. Specifically, preventive measures include allergen avoidance, environmental control, and immunotherapy. The primary goal of medical treatment is to reduce the burden of disease, improve quality of life and to prevent the development of the sequelae of AR such as bronchial asthma. Prevention is a viable option and key component in HDM-AR management. As urbanisation and lifestyle changes lead to the increase of HDM-AR, there should be a more concerted effort towards prevention.


Allergic rhinitis Asthma House dust mites Prevention 



Allergic rhinitis


House dust mites


House dust mite-induced allergic rhinitis


Subcutaneous immunotherapy


Sublingual immunotherapy


Allergen immunotherapy


Allergic Rhinitis and its Impacts on Asthma


Global Initiative for Asthma


Immunoglobulin E


T helper cell type 2


Compliance with Ethical Standards

Conflict of Interest

Salina Husain declares that she has no conflict of interest. Farah Dayana Zahedi declares that she has no conflict of interest. Sakinah Mohamad declares that she has no conflict of interest. Baharudin Abdullah declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Gupta R, Sheikh A, Strachan DP, Anderson HR. Burden of allergic disease in the UK: secondary analyses of national databases. Clin Exp Allergy. 2004;34(4):520–6.CrossRefGoogle Scholar
  2. 2.
    Pallasaho P, Rönmark E, Haahtela T, Sovijärvi AR, Lundbäck B. Degree and clinical relevance of sensitization to common allergens among adults: a population study in Helsinki. Finland Clin Exp Allergy. 2006;36(4):503–9.CrossRefGoogle Scholar
  3. 3.
    Papadopoulos NG, Agache I, Bavbek S, Bilo BM, Braido F, Cardona V, et al. Research needs in allergy: an EAACI position paper, in collaboration with EFA. Clin Transl Allergy. 2012;2(1):21. Scholar
  4. 4.
    •• Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950–8. This article reviews the international guidelines on allergic rhinitis.CrossRefGoogle Scholar
  5. 5.
    Mesidor M, Benedetti A, El-Zein M, Menzies D, Parent ME, Rousseau MC. Asthma phenotypes based on health services use for allergic diseases in a province-wide birth cohort. Ann Allergy Immunol. 2019;122(1):50–57.e2. Scholar
  6. 6.
    Terreehorst I, Oosting AJ, Tempels-Pavlica Z, De Monchy JG, Bruijnzeel-Koomen CA, Hak E, et al. Prevalence and severity of allergic rhinitis in house dust mite-allergic patients with bronchial asthma or atopic dermatitis. Clin Exp Allergy. 2002;32(8):1160–5.CrossRefGoogle Scholar
  7. 7.
    • Sheikh A, Hurwitz B, Nurmatov U, van Schayck CP. House dust mite avoidance measures for perennial allergic rhinitis. Cochrane Database Syst Rev. 2010;7(7):CD001563. This article is an excellent metanalysis on preventive measures for house dust mite-induced allergic rhinitis.Google Scholar
  8. 8.
    • Calderon MA, Kleine-Tebbe J, Linneberg A, De Blay F. Hernandez Fernandez de Rojas D, Virchow JC, et al. House dust mite respiratory allergy: an overview of current therapeutic strategies. J Allergy Clin Immunol Pract. 2015;3(6):843–55. A nice article on the overview of house dust mite allergy therapeutic strategies.CrossRefGoogle Scholar
  9. 9.
    Park KH, Lee J, Lee JY, Lee SC, Sim DW, Shin JU, et al. Sensitization to various minor house dust mite allergens is greater in patients with atopic dermatitis than in those with respiratory allergic disease. Clin Exp Allergy. 2018;48(8):1050–8. Scholar
  10. 10.
    Tham EH, Lee AJ, Bever HV. Aeroallergen sensitization and allergic disease phenotypes in Asia. Asian Pac J Allergy Immunol. 2016;34(3):181–9.Google Scholar
  11. 11.
    Paramesh H. Air pollution and allergic airway diseases: social determinants and sustainability in the control and prevention. Indian J Pediatr. 2018;85(4):284–94. Scholar
  12. 12.
    Patella V, Florio G, Magliacane D, Giuliano A, Crivellaro MA, Di Bartolomeo D, et al. Urban air pollution and climate change: “the Decalogue: Allergy Safe Tree” for allergic and respiratory diseases care. Clin Mol Allergy. 2018;16:20. eCollection 2018.CrossRefGoogle Scholar
  13. 13.
    • Bozek A, Ignasiak B, Filipowska B, Jarzab J. House dust mite sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with allergic rhinitis. Clin Exp Allergy. 2012;43(2):242–8. A good article on sublingual immunotherapy clinical trial.CrossRefGoogle Scholar
  14. 14.
    Linneberg A, Dam Petersen K, Hahn-Pedersen J, Hammerby E, Serup-Hansen N, Boxall N. Burden of allergic respiratory disease: a systematic review. Clin Mol Allergy. 2016;14:12 eCollection 2016.Google Scholar
  15. 15.
    Bousquet J, Neukirch F, Bousquet PJ, Gehano P, Klossek JM, Le Gal M, et al. Severity and impairment of allergic rhinitis in patients consulting in primary care. J Allergy Clin Immunol. 2006;117(1):158–62.CrossRefGoogle Scholar
  16. 16.
    Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015;46(3):622–39. Scholar
  17. 17.
    Calderon MA, Linneberg A, Kleine-Tebbe J, De Blay F. Hernandez Fernandez de Rojas D, Virchow JC, et al. Respiratory allergy caused by house dust mites: what do we really know? J Allergy Clin Immunol. 2015;136(1):38–48. Scholar
  18. 18.
    Wahn U, Lau S, Bergmann R, Kulig M, Forster J, Bergmann K, et al. Indoor allergen exposure is a risk factor for sensitization during the first three years of life. J Allergy Clin Immunol. 1997;99(6):763–9.CrossRefGoogle Scholar
  19. 19.
    Schram-Bijkerk D, Doekes G, Boeve M, Douwes J, Riedler J, Ublagger E, et al. Nonlinear relations between house dust mite allergen levels and mite sensitization in farm and nonfarm children. Allergy. 2006;61(5):640–7.CrossRefGoogle Scholar
  20. 20.
    Torrent M, Sunyer J, Munoz L, Cullinan P, Iturriaga MV, Figueroa C, et al. Early-life domestic aeroallergen exposure and IgE sensitization at age 4 years. J Allergy Clin Immunol. 2006;118(3):742–8.CrossRefGoogle Scholar
  21. 21.
    Cullinan P, MacNeil SJ, Harris JM, Moffat S, White C, Mills P, et al. Early allergen exposure, skin prick responses, and atopic wheeze at age 5 in English children: a cohort study. Thorax. 2004;59(10):855–61.CrossRefGoogle Scholar
  22. 22.
    Colloff MJ Dust mites: CSIRO Publishing, Collingwood, Australia & Springer, Dordrecht, The Netherlands, 2009.Google Scholar
  23. 23.
    Wang JY. The innate immune response in house dust mite-induced allergic inflammation. Allergy, Asthma Immunol Res. 2013;5(2):68–74. Scholar
  24. 24.
    Jacquet A. Innate immune responses in house dust mite allergy. ISRN Allergy. 2013;2013:735031. Scholar
  25. 25.
    Thomas WR. Hierarchy and molecular properties of house dust mite allergens. Allergol Int. 2015;64(4):304–11. Scholar
  26. 26.
    Thomas WR, Smith W. Towards defining the full spectrum of important house dust mite allergen. Clin Exp Allergy. 1999;29(12):1583–7.CrossRefGoogle Scholar
  27. 27.
    Takai T, Ikeda S. Barrier dysfunction caused by environmental proteases in the pathogenesis of allergic diseases. Allergol Int. 2011;60(1):25–35. Scholar
  28. 28.
    Pawankar R, Mori S, Ozu C, Kimura S. Overview on the pathomechanisms of allergic rhinitis. Asia Pac Allergy. 2011;1(3):157–67. Scholar
  29. 29.
    Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection and diagnosis. J Allergy Clin Immunol. 2001;108(1):S2–8.CrossRefGoogle Scholar
  30. 30.
    Baiz N, Macchiaverni P, Tulic MK, Rekima A, Annesi-Maesano I, Verhasselt V, et al. Early oral exposure to house dust mite allergen through breast milk: a potential risk factor for sensitization and respiratory allergies in children. J Allergy Clin Immunol. 2017;139(1):369–72. e10. Scholar
  31. 31.
    Lau S, Falkenhornst G, Weber A, Werthmann I, Lind P, Buettner-Goetz P, et al. High mite-allergen exposure increases the risk of sensitization in atopic children and young adults. J Allergy Clin Immunol. 1989;84(5):718–25.CrossRefGoogle Scholar
  32. 32.
    Simpson A, Simpson B, Custovic A, Cain G, Craven M, Woodcock A. Household characteristic and mite allergen levels in Manchester. UK Clin Exp Allergy. 2002;32(10):1413–9.CrossRefGoogle Scholar
  33. 33.
    Zock JP, Heinrich J, Jarvis D, Verlato G, Norback D, Plana E, et al. Distribution and determinants of house dust mite allergens in Europe: The European Community Respiratory Health Survey II. J Allergy Clin Immunol. 2006;118(3):682–90.CrossRefGoogle Scholar
  34. 34.
    Dold S, Wjst M, von Mutius E, Reitmeir P, Stiepel E. Genetic risk for asthma, allergic rhinitis, and atopic dermatitis. Arch Dis Child. 1992;67(8):1018–22.CrossRefGoogle Scholar
  35. 35.
    • Portelli MA, Hodge E, Sayers I. Genetic risk factors for the development of allergic disease identified by genome-wide association. Clin Exp Allergy. 2015;45(1):21–31. An excellent article on genetic risk factors for allergic disease.CrossRefGoogle Scholar
  36. 36.
    Tang XF, Tang HY, Sun LD, Xiao FL, Zhang Z, Li Y, et al. Genetic Variant rs4983958 at 14q11.2 is associated with allergic rhinitis in a Chinese Han population. J Investig Allergol Clin Immunol. 2012;22(1):55–62.Google Scholar
  37. 37.
    Andiappan AK, Wang DY, Anantharaman R, Suri BK, Lee BT, Rotzsche O, et al. Replication of genome-wide association study loci for allergic rhinitis and house dust mite sensitization in an Asian population of ethnic Chinese in Singapore. J Allergy Clin Immunol. 2013;131(5):1431–3. e8. Scholar
  38. 38.
    Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259–60.CrossRefGoogle Scholar
  39. 39.
    Wang DY. Risk factors of allergic rhinitis: genetic or environmental? Ther Clin Risk Manag. 2005;1(2):115–23.CrossRefGoogle Scholar
  40. 40.
    Smit LA, Heederik D, Doekes G, Blom C, Van Zweden I, Wouters IM. Exposure-response analysis of allergy and respiratory symptoms in endotoxin-exposed adults. Eur Respir J. 2008;31(6):1241–8. Scholar
  41. 41.
    Radon K, Windstetter D, Eckart J, Dressel H, Leitritz L, Reichert J, et al. Farming exposure in childhood, exposure to markers of infections and the development of atopy in rural subjects. Clin Exp Allergy. 2004;34(8):1178–83.CrossRefGoogle Scholar
  42. 42.
    Church MK, Maurer M, Simons FE, Bindslev-Jensen C, van Cauwenberge P, Bousquet J, et al. Risk of first-generation H (1)-antihistamines: a GA(2)LEN position paper. Allergy. 2010;65(4):459–66. Scholar
  43. 43.
    Vuurman EF, van Veggel LM, Uiterwijk MM, Leutner D, O’Hanlon JF. Seasonal allergic rhinitis and antihistamine effect on children’s learning. Ann Allergy. 1993;71(2):121–6.Google Scholar
  44. 44.
    Lejeune M, Lefebvre PP, Delvenne P, El-Shazly AE. Nasal sodium cromoglycate (Lomusol) modulates the early phase reaction of mild to moderate persistent allergic rhinitis in patients mono-sensitized to house dust mite: a preliminary study. Int Immunopharmacol. 2015;26(1):272–6. Scholar
  45. 45.
    van Adelsberg J, Philip G, LaForce CF, Weinstein SF, Menten J, Malice MP, et al. Randomized controlled trial evaluating the clinical benefit of montelukast for treating spring seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2003;90(2):214–22.CrossRefGoogle Scholar
  46. 46.
    Goh BS, Ismail MI, Husain S. Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids: a randomised, double-blind, placebo-controlled study. J Laryngol Otol. 2014;128(3):242–8. Scholar
  47. 47.
    Meltzer EO, Malmstrom K, Lu S, Prenner BM, Wei LX, Weinstein SF, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol. 2000;105(5):917–22.CrossRefGoogle Scholar
  48. 48.
    Pullerits T, Praks L, Ristioja V, Lötvall J. Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 2002;109(6):949–55.CrossRefGoogle Scholar
  49. 49.
    Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ. 1998;317(7173):1624–9.CrossRefGoogle Scholar
  50. 50.
    Aneeza WH, Husain S, Rahman RA, van Dort D, Abdullah A, Gendeh BS. Efficacy of mometasone furoate and fluticasone furoate on persistent allergic rhinoconjunctivitis. Allergy Rhinol (Providence). 2013;4(3):e120–6. Scholar
  51. 51.
    Pauwels R. Mode of action of corticosteroids in asthma and rhinitis. Clin Allergy. 1986;16(4):281–8.CrossRefGoogle Scholar
  52. 52.
    Bascom R, Wachs M, Naclerio RM, Pipkorn U, Galli SJ, Lichtenstein LM. Basophil influx occurs after nasal antigen challenge: effects of topical corticosteroid pretreatment. J Allergy Clin Immunol. 1988;8(3):580–9.CrossRefGoogle Scholar
  53. 53.
    Holm AF, Fokkens WJ. Topical corticosteroids in allergic rhinitis; effects on nasal inflammatory cells and nasal mucosa. Clin Exp Allergy. 2001;31(4):529–35.CrossRefGoogle Scholar
  54. 54.
    LaForce C. Use of nasal steroids in managing allergic rhinitis. J Allergy Clin Immunol. 1999;103(3):S388–94.CrossRefGoogle Scholar
  55. 55.
    Skoner DP, Rachelefsky GS, Meltzer EO, Chervinsky P, Morris RM, Seltzer JM, et al. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Pediatrics. 2000;105(2):E23.CrossRefGoogle Scholar
  56. 56.
    Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol. 1998;81(5):478–518.CrossRefGoogle Scholar
  57. 57.
    Fireman P. Therapeutic approaches to allergic rhinitis: treating the child. J Allergy Clin Immunol. 2000;105(6):S616–21.CrossRefGoogle Scholar
  58. 58.
    Barnes PJ. Therapeutic strategies for allergic diseases. Nature. 1999;402(6760):B31–8.CrossRefGoogle Scholar
  59. 59.
    Bousquet J, van Cauwenberge P, Ait Khaled N, Bachert C, Baena Cagnani CE, Bouchard J, et al. Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN). Allergy. 2006;61(9):1086–96.CrossRefGoogle Scholar
  60. 60.
    Berger WE. Allergic rhinitis in children: diagnosis and management strategies. Pediatr Drugs. 2004;6(4):233–50.CrossRefGoogle Scholar
  61. 61.
    Meltzer EO. Treatment options for the child with allergic rhinitis. Clin Pediatr (Phila). 1998;37(1):1–10.CrossRefGoogle Scholar
  62. 62.
    •• Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J. 2014;7(1):6. A World Allergy Organization position paper on sublingual immunotherapy.CrossRefGoogle Scholar
  63. 63.
    Thompson AK, Juniper E, Meltzer EO. Quality of life in patients with allergic rhinitis. Ann Allergy Asthma Immunol. 2000;85(5):338–47.CrossRefGoogle Scholar
  64. 64.
    Sausen VO, Marks KE, Sausen KP, Self TH. Management of allergic rhinitis. J Pediatr Pharmacol Ther. 2005;10(3):159–73. Scholar
  65. 65.
    Liao W, Hu Q, Shen LL, Hu Y, Tao HF, Li HF, et al. Sublingual immunotherapy for asthmatic children sensitized to house dust mite: a meta-analysis. Medicine (Baltimore). 2015;94(24):e701. Scholar
  66. 66.
    Aboshady OA, Elghanam KM. Sublingual immunotherapy in allergic rhinitis: efficacy, safety, adherence and guidelines. Clin Exp Otorhinolaryngol. 2014;7(4):241–9. Scholar
  67. 67.
    Canonica GW, Passalacqua G. Sublingual immunotherapy in the treatment of adult allergic rhinitis patients. Allergy. 2006;61(S81):20–3.CrossRefGoogle Scholar
  68. 68.
    •• Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, et al. Environmental assessment and exposure control of dust mites: a practice parameter. Ann Allergy Asthma Immunol. 2013;111(6):465–507. A very good article on practice parameter for house dust mite-induced allergic rhinitis prevention.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Salina Husain
    • 1
  • Farah Dayana Zahedi
    • 1
  • Sakinah Mohamad
    • 2
  • Baharudin Abdullah
    • 2
    Email author
  1. 1.Department of Otorhinolaryngology- Head & Neck SurgeryUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
  2. 2.Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical SciencesUniversiti Sains MalaysiaKubang KerianMalaysia

Personalised recommendations