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Immunotherapy for House Dust Mite Sensitivity: Where Are the Knowledge Gaps?

  • IMMUNOTHERAPY AND IMMUNOMODULATORS (L COX, SECTION EDITOR)
  • Published:
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Abstract

House dust mites (HDMs) are found in the environments where human habitation exists. Their density is dependent on environmental relative humidity; therefore, higher populations are present in areas of the world with higher humidity levels, e.g., coastal areas and tropics. To date, 24 HDM allergens have been identified. Many of these represent digestive enzymes since HDM feces are the major source of allergen exposure. IgE- medicated sensitization to HDM allergens is an important factor in the pathogenesis of allergic diseases since it is the most common aeroallergen detected by skin testing or in vitro IgE assays. Sensitization to HDM allergens often occurs early in life and appears to play an important role in the progression from allergic rhinitis to asthma (the so-called Allergic March) in children. HDM sensitization is also associated with asthma across all age groups. Efforts to control environmental exposure to HDM allergens have often proven to be unsuccessful. While medications can improve symptoms, only immunotherapy currently provides disease-modifying effects in allergic rhinitis and asthma. Several systemic reviews and meta-analysis indicate that both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are effective in the treatment of allergic rhinitis and asthma for HDM sensitivity. In this report, we review recent studies and the evidence for the use of HDM SCIT and SLIT. Fundamental gaps in knowledge are identified which could lead to improved approaches to HDM allergy.

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Abbreviations

CI:

Confidence interval

Der p 1, Der p 2, Der p 23:

House dust mite Dermatophagoides pteronyssinus allergens

Der f 1, Der f 2:

House dust mite Dermatophagoides farinae allergens

HDM:

House dust mites

IgA2, IgG4:

Immunoglobulin, A2 and G4

IL-10:

Interleukin-10

NNT:

Number needed to treat

RR:

Relative risk ratio

SCIT:

Subcutaneous immunotherapy

SLIT:

Sublingual immunotherapy

SMD:

Standardized mean difference

TGF-beta:

Transforming growth factor beta

TH1, TH2:

T helper cells, type 1 and 2

Tregs:

T regulatory Cells

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

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Conflict of Interest

Robert Bush is an Associate Editor of the Journal of Allergy and Clinical Immunology. He also serves as a Section Editor for Current Allergy and Asthma Reports and Current Opinions in Allergy and Clinical Immunology. Mark Biagtan and Ravi Viswanathan report no disclosures.

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

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  1. Section of Allergy, Immunology, Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Wisconsin-Madison, K6/910 CSC #9988, 600 Highland Ave., Madison, WI, 53792, USA

    Mark Biagtan, Ravi Viswanathan & Robert K. Bush

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  1. Mark Biagtan
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Correspondence to Robert K. Bush.

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This article is part of the Topical Collection on Immunotherapy and Immunomodulators

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Biagtan, M., Viswanathan, R. & Bush, R.K. Immunotherapy for House Dust Mite Sensitivity: Where Are the Knowledge Gaps?. Curr Allergy Asthma Rep 14, 482 (2014). https://doi.org/10.1007/s11882-014-0482-0

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