Human papillomavirus (HPV) is a common type of sexually transmitted disease (STD) that can be passed on through skin-to-skin exposure...
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Atopic dermatitis tends to be the first step in the subsequent development of allergic conditions such as allergic rhinitis and allergic asthma- this is known as the 'Atopic March'. Managing atopic dermatitis is key in halting and managing the later atopic conditions. Atopic dermatitis can be associated with allergy triggers, including airborne and food protein allergens. One of the key common airborne allergens triggering atopic dermatitis is house dust mites.Â
One with atopic dermatitis has baseline leaky or ineffective skin layer barrier, leading to susceptibility of airborne proteins, allergens, bacteria, and irritants to enter the skin layer and interact with immune cells in the body. Over time and with repeated exposure of the allergens to the internal immune cells, one can be sensitised towards the protein triggers and progressively develop an inflammatory allergic response in the form of atopic dermatitis.
Singapore is a tropical country known for its high humidity and density of house dust mites. We would like to share further insights on the role of house dust mites as a key airborne allergen in atopic dermatitis.
Atopic dermatitis is one of the most common recurring inflammatory skin conditions that is seen, affecting up to 20% of the paediatric group and about 8% of the adults globally. While allergy or predisposition to allergy (also known as atopy) can also affect the respiratory system, causing allergic rhinitis, asthma, skin presentation remains one of the key concerns that affects a person's wellbeing and quality of life. Uncontrolled atopic dermatitis is associated with poorer quality of life, reduced work performance, increased absentees from work, and can even be associated with mood disorders such as anxiety and depression.
While the actual cause of atopic dermatitis can be multifaceted and remains much to be elucidated, able to identify common triggers of symptom exacerbation can potentially beneficial to overall management of the skin condition.
As its name suggests, our home environment contains various species of mites- hence the name house dust mites! House dust mites are commonly found in tropical and subtropical countries.
The mite species that are found ubiquitous in tropical/ locally consists of Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis. In farm, or storage places, other house dust mite species include Glycyphagus domesticus, Lepidoglyphus destructor, Tyrophagus putrescentior and Ascarus siro.
The dust mite’s life cycle starts from egg, turning into larva and adult over a course of 3 months. They are difficult to visualise with naked eyes as they are usually minute with a translucent body length of only 0.25-0.3mm. They thrive under humid weather, low (dimmed) light, feeds on skin scales, dander, food crumbs, fungus, yeast, bacteria and takes in the water vapour from the surrounding environment.
Dust mites themselves can trigger allergic response in human. Besides, their dead body and excrement (faeces/dropping) can also induce allergy.
Dust mite allergy can present itself as Respiratory allergic symptoms:
| Allergic Rhinitis | Snuffly watery nose, blocked nose, watery and itchy eyes, cough, hay fever |
| Allergic Asthma | Wheezing, shortness of breath, cough |
Skin allergic symptoms:
| Atopic dermatitis/Eczema | Itching, red inflamed skin patch |
| Hives | Itching, wheals that comes and goes |
House dust mites are known to play a role in atopic dermatitis. They are able to weaken and breakdown the skin barrier layer in people with atopic dermatitis. Following the disruption of the skin barrier, allergens (either from dust mite or even other protein particles) are able to enter the skin layer triggering a cascade of immune inflammatory response, leading to persistent inflammation of the skin- this manifests clinically as atopic dermatitis –with itch, discomfort, eczematous red broken patches of the affected skin.
House dust mite allergies are usually picked up from a strong history of exacerbation of allergic symptoms following exposure to dust mite environment. A history of other atopic diseases or family history of atopy also points towards atopic dermatitis and possible underlying airborne allergies, such as dust mite allergies.
The diagnosis can be safely confirmed with a skin prick test or laboratory RAST blood tests.
You may wish to speak to your health care provider if there is a concern of house dust mite allergy.
There are conflicting research study results, though some medical evidence has shown that children who grew up in environment that is less exposed to house dust mites are less likely to develop allergy against house dust mites. This suggested that measures to reduce or avoid dust mite particles can be beneficial in avoiding development of house dust mite allergy.
Lifestyle advice is mainly to reduce exposure to house dust mites:
Although lifestyle management of dust mite allergies potentially benefits the overall control of atopic dermatitis, it is often less practical in real life. The backbone management of atopic dermatitis still involves good skin care with regular moisturiser to maintain a good physical skin barrier and topical corticosteroid to control the surface skin inflammation. In more severe, uncontrolled atopic dermatitis conditions, one may consider second-line treatment such as phototherapy or immunosuppressant medications.
Immunotherapy against dust mite particles has been gaining popularity for the treatment of allergy in recent years. Allergen-specific immunotherapy is useful in the treatment and prevention of future sensitisation and progression of allergic respiratory disease (from allergic rhinitis to allergic asthma).
Studies have shown that when immunotherapy is used on those with respiratory allergy symptoms who also have concurrent atopic dermatitis, the skin condition may improve during the treatment, suggesting a possible benefit of immunotherapy in those with atopic dermatitis and dust mite allergies. While clinical data is not fully conclusive on its efficacy, immunotherapy can be considered for selective atopic dermatitis patients who are proven with house dust mite sensitisation and a history of exacerbation following exposure to dust mites.
Struggling with recurring eczema or allergy symptoms at home? Let Dr Ben Medical help you identify the triggers and find the right treatment approach for your skin. Book your consultation today.
References:
Human papillomavirus (HPV) is a common type of sexually transmitted disease (STD) that can be passed on through skin-to-skin exposure...
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