Article

Patients' perceptions and experience of house dust mite allergy in a European survey

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The 'General Public and House Dust Mite Allergy European Survey' was a quantitative survey completed by a total of 4,016 respondents in four European countries. The aims of the survey were to assess: the awareness of respiratory allergies, the prevalence of diagnosed house dust mite (HDM) allergy, the perception of HDM allergy and the knowledge of management and treatment strategies for this condition. The results of the survey show a significant mismatch between the level of awareness of the symptoms of HDM allergy (57 %), the proportion of participants with symptoms of HDM allergy (57 %) and the actual proportion that were diagnosed with HDM allergy (15 %). Additionally, in both participants with or without diagnosed HDM allergy there was confusion between dust and HDMs as the source of allergen and the majority of those surveyed believed that hygiene measures are the only methods of controlling HDM allergy. This survey highlights the Europe-wide need for increased public education regarding HDM allergy, the causes of allergic disease, the potential for disease progression, and the types of treatment available. Addressing these gaps in knowledge may improve allergy care and benefit those whose daily functioning and quality of life are severely impacted by this treatable condition.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... The symptoms of HDM-induced allergy can have a significant negative impact on a patient's quality of life (QoL) [12]. Although the harmful symptoms related to HDM-induced respiratory allergy are usually always present to some extent, their intensity varies over time as domestic HDM populations and allergen levels fall or rise as a function of weather-related factors or other changes in the indoor living environment [13,14]. ...
... Although the harmful symptoms related to HDM-induced respiratory allergy are usually always present to some extent, their intensity varies over time as domestic HDM populations and allergen levels fall or rise as a function of weather-related factors or other changes in the indoor living environment [13,14]. The pernicious nature of persistent, HDM-induced allergy has given rise to the perception among patients [12] that it is not a "real" disease. For example, sufferers may believe that pollen allergy is more severe than HDM allergy-even though this is contradicted by literature data on clinical profiles and treatments [10,15] and simply because pollen only allergic patients are free of symptoms between two seasons and know what being "normal" means. ...
... For example, sufferers may believe that pollen allergy is more severe than HDM allergy-even though this is contradicted by literature data on clinical profiles and treatments [10,15] and simply because pollen only allergic patients are free of symptoms between two seasons and know what being "normal" means. Even people with physician-diagnosed HDM allergy may consider that dust (rather than the HDMs in dust) is the trigger for their allergic symptoms [12]. ...
Article
Full-text available
House dust mite (HDM) allergens constitute the leading trigger for the symptoms of persistent respiratory allergies (such as allergic rhinitis and asthma). However, the fluctuating, pernicious nature of the symptoms has given rise to a perception that HDM-induced respiratory allergy is not a “real” disease.Methods In order to assess the self-reported disease profile and behaviour of adult patients with a self-reported history of severe, poorly controlled, physician-diagnosed HDM respiratory allergy, we performed an observational, international, multicentre survey in three European countries (France, Italy and Spain). Participants were included in the survey if they passed a short Internet-based screening questionnaire. Following completion of a detailed post-inclusion questionnaire, 28 fortnightly telephone interviews were used to gather extensive data on the participants’ symptom prevalence and intensity, medical consultations, disease burden, quality of life, and medication use from late May 2012 to early July 2013.ResultsTwenty-two thousand nine hundred ninety five individuals completed the Internet screening questionnaire and 339 respondents (67 % female) met all the inclusion criteria. 313 of the 339 (92 %) completed the post-inclusion questionnaire (n = 114 in Italy, 92 in France and 107 in Spain). The median time since the first symptoms of HDM allergy was over 13 years in all three countries. The response rate for the fortnightly interviews averaged 75 % (range: 29 to 97 %). The reported fortnightly prevalence of nasal and ocular symptoms peaked in the autumn (September to November) and spring (March to May). These peaks in prevalence coincided with increased reports of symptom worsening and higher physician consultation rates. In participants not allergic to pollen, the autumn and spring peaks were accompanied by a third peak in late December 2012. Very few participants reported that their symptoms had never improved (4 %) or never worsened (11 %) during the survey period.Conclusions In a survey in France, Italy and Spain, patients with severe HDM-induced respiratory allergies experienced a complex set of changing, troublesome symptoms throughout the year, with peaks in spring, autumn and (to a lesser extent) mid-winter.
... Categories of evidence are based on Shekelle et al, 43 adapted by Cox et al. 44 level of awareness of the symptoms of HDM allergy (57%), the proportion of participants with potential symptoms of HDM allergy (57%), and the actual proportion of participants diagnosed with HDM allergy (15%). 76 Many patients in this study felt that HDM allergy was "something you must accept and live with". 76 Similarly, an earlier study of 726 Danish patients with asthma and/or rhinitis found that 75% were allergic, and asthma was undiagnosed and untreated in 50% of all those with asthma and undertreated according to GINA guidelines in 76%. ...
... 76 Many patients in this study felt that HDM allergy was "something you must accept and live with". 76 Similarly, an earlier study of 726 Danish patients with asthma and/or rhinitis found that 75% were allergic, and asthma was undiagnosed and untreated in 50% of all those with asthma and undertreated according to GINA guidelines in 76%. Rhinitis was undiagnosed in 32% of the patients, and 83% with moderate to severe rhinitis were undertreated. ...
Article
Full-text available
Although house dust mite (HDM) allergy is a major cause of respiratory allergic disease, specific diagnosis and effective treatment both present unresolved challenges. Guidelines for the treatment of allergic rhinitis and asthma are well supported in the literature, but specific evidence on the efficacy of pharmacotherapy treatment for known HDM-allergic patients is weaker. The standard diagnostic techniques-skin prick test and specific IgE testing-can be confounded by cross-reactivity. However, component-resolved diagnosis using purified and recombinant allergens can improve the accuracy of specific IgE testing, but availability is limited. Treatment options for HDM allergy are limited and include HDM avoidance, which is widely recommended as a strategy, although evidence for its efficacy is variable. Clinical efficacy of pharmacotherapy is well documented; however, symptom relief does not extend beyond the end of treatment. Finally, allergen immunotherapy has a poor but improving evidence base (notably on sublingual tablets) and its benefits last after treatment ends. This review identifies needs for deeper physician knowledge on the extent and impact of HDM allergy in respiratory disease, as well as further development and improved access to molecular allergy diagnosis. Furthermore, there is a need for the development of better-designed clinical trials to explore the utility of allergen-specific approaches, and uptake of data into guidance for physicians on more effective diagnosis and therapy of HDM respiratory allergy in practice.
... Regulatory bodies and patient associations are placing ever-greater emphasis on patient-reported outcomes such as QoL. The symptoms of HDM-induced allergy are known to have a significant negative impact on QoL [13]. ...
Article
Full-text available
Background: House dust mite (HDM) allergens constitute the most frequent cause of persistent allergic rhinitis and asthma. The symptoms vary throughout the year but typically peak in spring, autumn and (to a lesser extent) mid-winter. Methods: We performed a 13-month, observational, multicentre survey of adult patients with a self-reported history of moderate-to-severe, poorly controlled, physician-diagnosed HDM respiratory allergy in three European countries (France, Italy and Spain). After screening and inclusion, 28 detailed, fortnightly telephone interviews were used to gather extensive data on the participants' symptom prevalence and intensity, medical consultations, disease burden and medication use from late May 2012 to early July 2013. This report focuses on the disease burden. Results: Of the 22,995 screened participants, 313 met the inclusion criteria and completed the post-inclusion questionnaire (n = 114 in Italy, 92 in France and 107 in Spain). The median time since the first symptoms of HDM allergy was ≥ 13 years in each country. A relevant minority of the participants suffered from symptoms of HDM allergy every day or almost every day of the year (14% in Italy, 46% in France and 37% in Spain). According to the fortnightly telephone interviews, the most frequently impacted disease burden variables were sleep, daytime tiredness and irritability, with the highest values in spring 2012, autumn 2012 and spring 2013 (mirroring symptom intensities). Professional activities were more affected than social activities. The burden data were heterogeneous: around a quarter of participants were strongly or very strongly affected but most of the remaining participants were only rarely bothered or not bothered. Conclusions: In a 13-month, fortnightly survey of patients in France, Italy and Spain with a self-reported history of moderate-to-severe, poorly controlled, HDM-induced allergic rhinitis and asthma, we found that a relevant minority of participants regularly reported a severe or very severe impact of their allergy on tiredness, sleep and professional activities (including time off work). The disease burden peaked in autumn and late spring.
... 3,5 Subgroup analyses for perennial allergens, such as HDM, provided controversial and inconclusive results regarding several important issues: standardization of allergen extracts, heterogeneity of allergen dose, duration and schedules of treatment, selection of patients, etc. 5,14,16 We chose perennial allergy and polysensitization as the most common in patients with respiratory allergy in Serbia 17 as well as in Europe. 18 HDM is the dominant inhalant allergen in our region followed by grass and weed pollens. 17 Most AR patients are polysensitized, however, polysensitized patients are not necessarily clinically polyallergic. ...
Article
Full-text available
Sublingual allergen immunotherapy (SLIT) is considered to be safer and more convenient than subcutaneus immunotherapy. SLIT trials with house dust mites involving patients with allergic rhinitis (AR) and asthma reported discordant results. The aim of the study was to investigate the clinical efficacy and safety of SLIT with Dermatophagoides pteronyssinus (D.pt) extract produced in Serbia and patient's satisfaction through open-label trial. Adult patients with allergic rhinitis were randomized into two groups: one received drugs and SLIT, while other received only drugs. Symptom score (SS), medication score (MS) and cumulative score (CS), skin prick tests (SPT) and serum level of D. pt specific IgE were assessed. One year after, the patients were re-evaluated. In total, 61 patients were enrolled in the study, but 52 of them were analyzed at the end of the year. CS (29.3%, p<0.001) and MS (54.3%, p<0.05) reduced significantly in the SLIT group. There was a significant improvement of MS and CS in the SLIT compared to control group (p<0.001 and p<0.05 respectively). There was no significant improvement of SS as well as specific slgE. Patients in the SLIT group were more satisfied with treatment (p<0.001). The incidence of mild adverse reaction was 38.4%. Specific lgG was not done. One year SLIT with D.pt extract was clinically efficient treatment in AR patients.
Article
Objective: To identify house dust mite (HDM) sensitivity by skin prick test in children with allergic rhinitis, allergic wheezing and eczema. Methods: In this prospective study, children with persistent or recurrent allergic symptoms of rhinitis, wheezing and eczema were enrolled to undergo skin prick testing. Sensitivity was checked for three mites: Dermatophagoide farinae, Dermatophagoide pteronyssinus, and Blomia tropicalis. Results: Total 92 children underwent skin prick test; 49 (53.2 %) showed significant positivity to one or more dust mite. In the HDM sensitized group, a positive family history of allergic disorders was present in 32 children (65.3 %). In the HDM sensitized group, 18 (36.7 %) children had allergic rhinitis. The youngest child in this group was 12-mo-old. Ten (55.55 %) children were less than 24 mo of age. Significant sensitization to mites was detected in 7 (14.28 %) children with eczema. All children were below 24 mo of age. In children with a tendency to wheeze frequently without any evidence of infections or other systemic disease, 24 (48.9 %) had sensitization to HDM. The youngest child was 15 mo of age. Ten (41.6 %) children were below 24 mo of age. Sensitivity to Blomia tropicalis was detected in 6 (12.24 %) children. Significantly more number of children were sensitive to D. pteronyssinus as compared to D. farinae (65.31 % vs. 46.94 %; p = 0.034). Conclusions: Children in Mumbai show early sensitization to HDM. D. pteronyssinus is the commonest offending allergen in the index study.
Article
Full-text available
The effect of exposure to allergens not causing sensitisation in atopic asthmatic subjects has not previously been studied. A study was undertaken to assess the degree of asthma severity (measured by spirometry, airway reactivity and exhaled nitric oxide) in atopic asthmatic patients not sensitised to the domestic allergen to which they were exposed. Dust samples were collected from the living room carpet and mattress in the homes of 248 subjects and dust mite, cat and dog allergen concentrations were measured. Spirometry, non-specific bronchial reactivity (BR), and exhaled nitric oxide (eNO) were ascertained. Patients' sensitisation status was assessed by skin prick testing. Adult atopic asthmatics not sensitised to mite but exposed to high levels of mite allergen had significantly more severe BR than subjects not exposed to high levels of mite (PD(20), geometric mean (GM) 0.21 mg (95% CI 0.09 to 0.47) v 0.86 mg (95% CI 0.44 to 1.67), mean ratio difference 4.1 (95% CI 1.5 to 11.4), p=0.008). Subjects not sensitised but exposed to high levels of dog allergen also had significantly more severe BR than subjects not exposed (PD20 GM 0.16 v 0.52 mg, mean ratio difference 3.3 (95% CI 1.2 to 9.2), p=0.01). The differences in BR between these groups were still significant after adjusting for confounding factors. This effect of greater airway reactivity was not seen in subjects exposed but not sensitised to cat allergens. Atopic asthmatic subjects who are exposed to high levels of dust mite or dog allergens but not sensitised to these allergens have evidence of increased airway reactivity.
Article
Full-text available
In 2004 the World Allergy Organization's Specialty and Training Council conducted a survey of World Allergy Organization (WAO) member societies to obtain information about the status of the specialty of allergy worldwide. Responses were received from 33 countries, representing a population of 1.39 billion people, of whom it was estimated that 22% may suffer from some form of allergic disease. Allergy was reported by 23 respondents to be a certified or accredited specialty in their country, and the number of certified allergists per head of population ranged from 1:25 million to 1:16,000. Allergists were ranked as the fifth most likely clinicians to see cases of allergic asthma, third most likely to see allergic rhinitis, and fourth most likely to see eczema or sinusitis. Nine countries only reported that children with allergic diseases would be seen by a pediatrician with appropriate training. The survey results highlight a pressing need for the development of allergy services worldwide.
Article
A self administered screening questionnaire was sent to 15,000 households randomly selected from a nationwide panel of approximately 200,000 households. This questionnaire was used to select a balanced sample of 1450 persons with ≥7 days of nasal/ocular symptoms in the previous 12 months. These persons received a second questionnaire that contained detailed questions regarding symptoms, triggers, patient attitudes, and medical treatment. Of the 1065 people who responded to the second questionnaire, 481 were identified as having self-reported seasonal or perennial allergic rhinitis. Our major findings regarding the attitudes toward their disease expressed by these 481 respondents are as follows. Although 53% of our study population regarded their symptoms as mild, 47% reported onset before age 17, suggesting that many have become accustomed to their symptoms. The level of allergen avoidance was generally low; only 38% took any allergen avoidance measures in the home. The level of self-medication was high; 92% reported self-medication with prescription and nonprescription drugs. Finally, 26% believed that their symptoms were “well controlled” or “completely controlled,” and 52% believed that effective treatments were available. Our findings suggest the need for a greater effort on the part of health care providers to identify patients with allergic rhinitis and to educate them about their disease.
Article
The primary objective of this study is to retrospectively describe the treatment regimens (initiation, maintenance, dosage and duration) in sublingual immunotherapy (SLIT) with house dust mite (HDM) extracts in routine practice in France. The secondary objectives include a description of the respiratory allergies that led to treatment and an evaluation of the treatment's efficacy and safety, patient satisfaction and compliance (as assessed by the physician) and patient management practices. Randomly-selected allergy specialists each included ten patients over the age of five with a respiratory allergy and proven sensitization to HDM (positive skin test and/or specific IgE >0.7 kUI) and in whom SLIT had been initiated in 2002 or 2005. The participants were monitored for at least two years. A total of 139 physicians participated in the study and contributed data from 1,289 patients (57% of whom were under the age of 18). More than 70% of the patients suffered from moderate-to-severe allergic rhinitis and 50% also suffered from asthma. More than 60% of the patients were polysensitized. A shift to shorter SLIT protocols was observed over time. Longer protocols tended to be used in children. Compliance was deemed good or very good in 84% of the patients. Treatment was deemed effective or very effective in 82% of the patients. Symptoms of rhinitis and/or asthma improved in 66% and 63% of the patients respectively, with a concomitant reduction in symptomatic medication intake. The majority of the patients were satisfied with their treatment, which was well tolerated. The results of this large, retrospective, observational study confirm the efficacy and tolerability of HDM SLIT in routine French practice in a real-world setting.
Article
The epidemiology of specific sensitization to inhalant allergens remains unknown in patients at tertiary rhinology clinics. We used skin prick testing (SPT) to assess sensitization to major aeroallergens in order to evaluate the prevalence of specific rhinologic diseases, the frequency of polysensitization and the relationship between nasal symptoms, nasal endoscopy parameters, diagnosis and sensitization. A retrospective review of medical records was conducted at the ENT Department of the Catholic University Hospital in Leuven, Belgium. The study analyzed the medical data of patients with rhinologic symptoms suspected of having allergies. The study included 1326 patients with a mean age of 35 +/- 18 years (range: 3-88 years); 52.8% were males. Rhinitis without nasal abnormalities (42.1%), chronic rhinosinusitis without nasal polyps (16.5%) and nasal abnormalities (16.1%) were the most prevalent findings. About 31.6% of patients were sensitive to at least one allergen, and the most common aeroallergens were dermatophagoides pteronyssinus (62.1%) and grass pollen (53.2%). Polysensitization was found in 54.2%. The most prevalent clinical symptoms in allergic rhinitis patients were nasal obstruction, clear/watery nasal discharge, sneezing, postnasal drip and headache. Clear nasal discharge, sneezing, and itchy nose and eyes (p < 0.05 for all) were significantly higher in sensitized patients. In contrast, postnasal drip, headache and purulent nasal discharge were also observed in non-sensitized patients (p < 0.05 for all). At a rhinology clinic at a university ENT clinic, 31.6% of the patients had positive SPT results, mainly to house dust mites and grass pollen. Among sensitized patients, 54.2% were polysensitized.
Article
It is suggested that polysensitized patients might not benefit from specific allergic rhinitis immunotherapy as much as monosensitized patients, although further research on this subject is needed. To compare the efficacy of sublingual immunotherapy (SLIT) with standardized house dust mite extract in monosensitized and polysensitized patients with allergic rhinitis. Patients who were sensitized to house dust mites and treated with SLIT for house dust mites for at least 1 year between November 2007 and March 2010 were studied. The monoallergen sensitized group was defined as patients who were sensitized to Dermatophagoides pteronyssinus and/or Dermatophagoides farinae (n = 70). The polyallergen sensitized group was defined as patients who were simultaneously sensitized to house dust mites and other allergens (n = 64). A standardized extract of house dust mites was used for immunotherapy. Antiallergic medication and the total nasal symptom score (TNSS), including rhinorrhea, sneezing, nasal obstruction, and itchy nose, were evaluated before and 1 year after SLIT. This study enrolled 134 patients. The TNSS improved significantly after SLIT in both groups, whereas the change in the TNSS did not differ significantly between the groups. The antiallergic medication scores also decreased significantly in both groups, but there was no significant difference between the groups. In polysensitized allergic rhinitis patients, SLIT for D pteronyssinus and/or D farinae produced improvements in both nasal symptoms and rescue medication scores comparable to those in monosensitized patients, regardless of other positive allergens. SLIT for D pteronyssinus and/or D farinae should be considered in polysensitized allergic rhinitis patients.
Article
To describe the sensitization profile of respiratory allergies in France, identifying factors influencing the prescription of allergen immunotherapy (AIT) [Transversal phase (T)], and assess treatment efficacy, tolerability, compliance and satisfaction [Longitudinal phase (L)]. French allergists (600) and pneumo-allergists (600) were offered participation and asked to recruit the first 20 new patients with allergic rhinitis (AR) and/or asthma, consulting for a first time allergy check-up with skin prick-test (T), and 5 patients sensitized to pollens (skin test and/or specific IgE) for whom SLIT with pollens was prescribed (L). In the T phase, 2,714 patients were recruited by 169 specialists, mostly allergists (76.5%). The majority (98%) suffered from AR, alone (57.7%) or with asthma (40.3%) and 80.3% suffered from moderate-to-severe rhinitis, mostly persistent (65.8%). Asthma, when present, was mostly intermittent (63.7%) or mild persistent (20.1%). Sensitization to house dust mites was the most common (64.5%), followed by grass pollens (61.5%), tree pollens (41.6%) and cat danders (30.5%). Poly-sensitization was seen in 73.6% of patients. AIT, mostly sublingual, was recommended in 55.6% of the patients, mostly (78.1%) because of insufficient control with symptomatic treatments. The overall impact of symptoms on QOL, positive skin test to grass pollens, ocular pruritus and/or nasal obstruction and moderate-to-severe rhinitis were significant predictors of SLIT prescription. Poly-sensitization or concomitant asthma were not seen as deterrents. Most patients consulting a specialist for allergy testing suffer from moderate-to-severe rhinitis. Treatment in current practice includes immunotherapy in half of the patients, and follows ARIA recommendations.
Article
Both rhinitis (ARIA) and asthma (GINA) guidelines recommend allergen-specific immunotherapy (SIT) tailored to the specific levels of severity of each disease. Real world studies evaluating congruence between these recommendations and prescribing practice in the single patient with comorbidity are lacking. An observational polycentric study was carried out in 518 patients recruited from 34 allergy centers throughout Italy. A questionnaire was administered to each consecutive patient over a span of four months. Taking into account guideline recommendations for both diseases, concomitant in the same patient, three subsets resulted: patients not eligible for SIT (11%); patients eligible for SIT for one disease only (60%); patients eligible for SIT for both diseases (29%). SIT was prescribed in 257 (49.6%) subjects. The level of SIT prescription was about 50% in all three groups. Consistent with the ARIA guidelines, a correlation between the prescription of SIT and the severity of rhinitis was documented (r=0.87; p=0.001). An association with asthma severity was found (p=0.02), but the trend was inconsistent with the GINA recommendations. Young age was the most important factor for SIT prescription both in the eligible for one disease and in the eligible for both diseases subset. The tendency towards worsening of symptoms was a factor for SIT in the eligible for one disease subset. In mite allergic patients with rhinitis and asthma comorbidity, the severity of rhinitis and the young age are the most important factors driving the SIT prescription. The congruence of SIT prescription was better for the ARIA than GINA guidelines.
Article
Specific immunotherapy (SIT) duration for respiratory allergy is currently based on individual decisions. To evaluate the differences in clinical efficacy of SIT as a result of the duration between the current recommended limits (3-5 years). A 5-year prospective, controlled clinical trial of SIT blind until the first year and randomization to a 3-year (IT3) or 5-year (IT5) course was conducted. Of the 239 patients with respiratory allergy caused by D pteronyssinus initially included, 142 completed 3 years of SIT with good compliance. Twenty-seven controls were included at the third year. Efficacy of SIT after 3 (T3) and 5 (T5) years was assessed by using clinical scores, visual analog scales (VASs), rhinitis (RQLQ) and asthma (AQLQ) quality of life questionnaires, skin tests, and serum immunoglobulins. At T3, significant reductions were observed in rhinitis (44% in IT3 and 50% in IT5; P < .001), asthma (80.9 % in IT3 and 70.9% in IT5; P < .001) scores, VAS (P < .001 in both), RQLQ (P < .001 in both) and AQLQ (P < .001 in both). At T5, the clinical benefit was maintained in both groups, and IT5 patients presented additional decreases (19%; P = .019) in rhinitis scores. At Tf, specific IgG(4) measurements were lower in IT3 (P = .03) without detecting differences in IT5. An increase in asthma score of 133% was the only difference observed in controls. Clinical improvement is obtained with 3 years of D pteronyssinus SIT. Two additional years of SIT add clinical benefit in rhinitis only.
Article
Allergic rhinitis (AR) has been found to impact the daily activities of allergic patients. This includes the effects on sleep and chronic fatigue. The effect of AR on sexual function has not been well studied. The purpose of this study was to assess the impact of AR on sexual function, sleep, and fatigue. The Rhinosinusitis Disability Index (RSDI) is a quality of life (QOL), validated outcomes tool that assesses how AR affects QOL. Specific questions address the adverse consequence on sexual function, sleep, and fatigue. Four subsets of patient with AR who completed the RSDI were evaluated for the specific questions as well as the physical, emotional, functional, and total scores. The scores were compared with a cohort of normal subjects, patients with a diffuse group of rhinologic disorders, and patients scheduled for septal surgery (non-AR patients). Patients with AR had significantly higher (worse) sexual and sleep RSDI scores than the non-AR patients and normal subjects. Although the AR subjects also had significantly higher fatigue RSDI scores than the normal subjects, there was no significant difference between the AR and non-AR patients' fatigue scores. Non-AR patients had significantly higher sexual, sleep, and fatigue RSDI scores than the normal subjects. AR has a significant negative impact on sexual function and can result in sleep disturbances and fatigue as measured by the RSDI.
Article
Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma. To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children. Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education. Der p 1 house dust mite allergen concentration of 2.0 microg/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 microg/g and OR 2.55 95% CI 1.13, 5.73 for 10.0 microg/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22). Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.
Article
Patient and physician perceptions of the effectiveness of treatment, symptoms, and the impact of allergic rhinitis (AR) were assessed in an international prospective, cross-sectional survey. We present the results from Spain. Out of 88 patients recruited by primary care physicians and specialists, 77 (87.5%) had AR confirmed by symptoms and skin prick testing, measurement of specific immunoglobulin E, or nasal allergen challenge. Physicians and patients recorded the presence, severity, and impact of symptoms at the time of consultation, as well as symptoms that were frequently, but not currently, present. The Mini Rhinoconjunctivitis Quality of Life Questionnaire (miniRQLQ) was used to assess health-related quality of life (HRQOL). Most patients had moderate or severe disease (67.0%), which was assessed in terms of severity and persistence of symptoms, and comorbid conditions such as asthma and anxiety. Nasal and ocular symptoms were reported by 83% of patients, either currently or frequently, and 36.4% of patients reported that these symptoms were moderate or severe. More than half of the patients (59.1%) were using 2 or more medicines to manage theirAR, and 73.7% of patients taking a nonsedating antihistamine plus an intranasal corticosteroid had moderate or severe disease. Most patients (83.1%) reported some impact from the symptoms of AR on daily activities. The mean (SD) miniRQLQ score was 2.4 (1.4) in patients with mild disease, 2.6 (1.2) in patients with moderate disease, and 3.3 (2.3) in patients with severe disease. AR is a significant health problem in Spain because of its high symptom burden and impact on HRQOL.
Article
Nonspecific airway hyperresponsiveness is a fundamental characteristic of patients with asthma and can be influenced by several stimuli. In nine patients with asthma and an isolated allergy to house dust mite, the variation of natural exposure to the house dust mite allergen Der p I and the corresponding changes in nonspecific airway hyperresponsiveness were followed up for 1 year. The concentration of Der p I in floor dust from living rooms and bedrooms (as a measure of exposure) reached maximum levels in late summer and the beginning of autumn (August to October), whereas the lowest levels were found during the months of March to May (delta Der p I = +2.31 micrograms/gm and -1.33 micrograms/gm respectively, both compared with the year average). Airway hyperresponsiveness (as measured by the provocative concentration of histamine causing a 20% fall in forced expiratory volume in 1 second [PC20] threshold) also showed a seasonal variation, with most severe hyperresponsiveness during the months of August to November, almost the same period in which the exposure to house dust mite allergens reached maximal levels (delta PC20 histamine = -1.47 mg/ml in November vs +1.79 mg/ml in March, both compared with the year average). Our results support the view that seasonal changes of exposure to environmental allergens such as house dust mite allergens will have an effect on the level of airway hyperresponsiveness in patients with allergic asthma.
Article
Our knowledge about the age-related growth of pulmonary function is incomplete. The purpose of this study was to describe the relation of various factors to the growth of pulmonary function in children and adolescents. A population sample comprising 408 children and adolescents (7-17 yr of age at enrollment) was reexamined after a 6-yr interval. Case history was obtained by interview and questionnaire. Pulmonary function, skin prick test reactivity to common allergens, and airway responsiveness (AR) were measured using standard techniques; airway hyperresponsiveness (AHR) was defined as a concentration of histamine causing a 20% decline in FEV1 < 8 mg/ml. The cross-sectional analyses of data from the two surveys showed that the presence of asthma (p < 0.02), atopy to house dust mite (HDM) (p = 0.03), and increasing degree of AR (p < 0.002) were associated with a lower level of FEV1 %pred. The longitudinal analysis revealed that asthma (p = 0.0001) and a lower level of FEV1 (p < 0.0001) at enrollment were associated with a lower level of FEV1 at follow-up. Further, an increase in the degree of AR (p = 0. 0001), new asthma (p = 0.0002), and new atopy to HDM (p = 0.03) also predicted a lower level of FEV1 at the end of the observation period. Confining the analysis to subjects without asthma and without evidence of AHR (n = 271) showed that both persistent (p = 0.04) and new (p = 0.03) atopy to HDM predicted a lower level of FEV1 at follow-up; compared with subjects with a negative skin reaction to HDM, those subjects who were sensitized to HDM had on average a 5%pred lower level of FEV1. The growth of FEV1 in children and adolescents appears to be impaired not only by symptomatic asthma but also by an increase in the degree of AR and atopy to HDM; sensitization to HDM appears to have a negative impact on the age-related growth in FEV1 even in nonasthmatic subjects without evidence of AHR.
Article
To review epidemiologic correlations between asthma and atopic dermatitis (AD), identify common features in disease pathophysiology, and review steps involved in the development of asthma therapy guidelines to assess the appropriateness of a similar process and approach for AD. A 7-member panel representing specialists in dermatology, allergy, asthma, immunology, and pediatrics from around the United States convened to review the current literature and evolving data on AD. Participants presented reviews to the panel on the epidemiology of asthma and AD, the genetic predisposition to allergic disease, the current understanding of the immunopathophysiology of AD, interrelationships between the pathologic pathways of asthma and AD, evolving treatment concepts and options in AD, and the applicability of the asthma treatment model and how it may be adapted for guideline development for AD. Commentary and criticism were recorded for use in document preparation. There are clear epidemiologic parallels in asthma and AD. Importantly, AD frequently is the first manifestation of an atopic diathesis, which occurs in genetically predisposed individuals and also includes asthma and allergic rhinitis. Up to 80% of children with AD will eventually develop allergic rhinitis or asthma later in childhood. This classic "atopic triad" has numerous pathophysiologic elements in common, including cyclic nucleotide regulatory abnormalities, immune cell alterations, and inflammatory mediators and allergic triggers. New therapeutic options that target underlying immune mechanisms are available, and their place among treatments for AD is becoming established. Guidelines of care have been developed for asthma. The panel noted that the National Institutes of Health/National Heart, Lung, and Blood Institute guidelines for diagnosis and management of asthma, first issued in 1991, had a tremendous positive impact on many aspects of asthma treatment. It not only created a heightened awareness that asthma is a disease of chronic inflammation, but it also provided unified approaches for therapy and opened new areas of basic science and clinical research. In addition, the guidelines spurred interactions among physicians of various specialties and stimulated a great quantity of research in asthma therapy. It is anticipated that AD therapy guidelines would have similar positive outcomes. The panel concluded that, on the basis of current information and evolving therapeutic options, a clear rationale exists to support AD guideline development. The many parallels between AD and asthma suggest that processes and approaches used for the asthma therapy guidelines would be appropriate for AD.
Article
We undertook this study to test the possible correlation between serum concentration of total and specific IgE antibodies and asthma severity in asthmatic children sensitized to the house dust mite Dermatophagoides pteronyssinus. The study included 157 asthmatic children aged 5-15 years (8 +/- 3 years). Clinical diagnosis was based on personal and family history, physical examination, pulmonary function testing and skin tests. Asthma severity was determined according to GINA guidelines. In vitro tests included serum concentration of total and specific IgE. All asthmatic children had elevated serum concentration of total IgE. The children with elevated serum concentration of total IgE also showed an increased serum concentration of specific IgE. Asthma of higher higher severity was present in patients with total IgE concentration >288.0 kIU/L (AUC = 0.736) and specific IgE to Dermatophagoides pteronyssinus >44.1 kIUA/L (AUC = 0.843). Intermittent asthma was present in 76.9% of children with specific IgE concentration <44.1 kIUA/L. The positive predictive value suggested with 79.2% probability that a child with a concentration of specific IgE to Dermatophagoides pteronyssinus >44.1 kIUA/L would have a more severe form of asthma. Asthmatic children with higher asthma severity have a higher serum concentration of both total IgE (>288.0 kIU/L) and specific IgE to Dermatophagoides pteronyssinus (>44.1 kIUA/L), respectively.
Article
The major allergen in house dust comes from mites. Chemical, physical and combined methods of reducing mite allergen levels are intended to reduce asthma symptoms in people who are sensitive to house dust mites. To assess the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma. PubMed and The Cochrane Library (last searches Nov 2007), reference lists. Randomised trials of mite control measures vs placebo or no treatment in people with asthma known to be sensitive to house dust mites. Two authors applied the trial inclusion criteria and evaluated the data. Trial authors were contacted to clarify information. Fifty-four trials (3002 patients) were included. Thirty-six trials assessed physical methods (26 mattress encasings), 10 chemical methods, and 8 a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning (1565 patients), the standardised mean difference was 0.00 (95% confidence interval (CI) -0.10 to 0.10). There were no statistically significant differences either in number of patients improved (relative risk 1.01, 95% CI 0.80 to 1.27), asthma symptom scores (standardised mean difference -0.04, 95% CI -0.15 to 0.07), or in medication usage (standardised mean difference -0.06, 95% CI -0.18 to 0.07). Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended. It is doubtful whether further studies, similar to the ones in our review, are worthwhile. If other types of studies are considered, they should be methodologically rigorous and use other methods than those used so far, with careful monitoring of mite exposure and relevant clinical outcomes.
Article
There is uncertainty about the nature of the relationship between mite allergen exposure during infancy and the expression of allergic diseases in childhood. We sought to explore the relationships between repeated measurements of mite allergen exposure during the first 5 years of life and clinical allergic disease outcomes at age 5 years. In a birth cohort of 516 at-risk children, 13 bed dust samples were collected between birth and 5 years of age and analyzed for mite allergen. At age 5 years, the presence of mite atopy was assessed based on skin prick test results, and clinical assessments for asthma, eczema, and wheeze were conducted. The association of allergen exposure with each clinical outcome was examined by means of logistic regression, with adjustments for potential confounders. The lowest and highest mite exposure quintiles, expressed as mean allergen concentration averaged over 0 to 5 years, were associated with a lower prevalence of mite atopy and of asthma compared with intermediate levels of exposure. These relationships, when determined by using average allergen concentration over 0 to 18 months, were weaker. This study demonstrates a nonlinear relationship between mite allergen exposure and clinical outcomes in this generally high mite allergen environment.