DUST MITE ALLERGY

What is house dust and what are dust mites?

House dust is a mixture of inert and allergenic substances. It may contain fabric fibers, bacteria, molds, fungus spores, food particles, human dander, bits of plant and insect parts and animal dander. Of these, mold spores, animal dander and hair and dust mites seem to be important allergens. The inert debris, while not causing allergic symptoms, can nonetheless produce irritation. Dust mites belong to the family of 8-legged creatures called Arachnids. There are two common species in this area, Dermatophagoides fariniae and Dermatophagoides pteronyssinus. This family also includes spiders, chiggers, and ticks. Dust mites which can only be seen with a microscope are hardy creatures that thrive in warm, humid places. They prefer temperatures at or above 70 degrees F. with relative humidity at 75-80%. Mites die when the humidity falls below 40-50% and are rarely found in very dry climates. As many as 18,000 dust mites can live in one gram of dust, but the usual population is about 500 mites per gram (about the weight of a paper clip). Each mite produces about 10-20 waste particles each day and lives for 30 days. Egg-laying females can add 25-30 new mites to the population. Mites eat particles of skin and dander and thrive in bedding, carpeting, upholstering, clothing, closets, and automobile seats- all likely to contain skin particles. Dust mites dont bite, cannot spread diseases and never live on people, only in the environment. They are harmful only to people who become allergic to them. While usual household insecticides have no effect on dust mites, a product is now available to kill mites and help remove them from carpeting. It is a boric acid compound and kills mite by dehydrating them.

Figure1. Scanning electron Micrograph of House Dust Mite

Is a dust allergy a sign of a dirty house?

No, a dirty house can make a house-dust allergy problem worse, but in all likelihood, normal housekeeping procedures may not be enough to relieve dust mite allergy symptoms.

What are the effects of dust mite allergy?

People allergic to dust mites react to proteins in the bodies and digestive waste (feces) of the mites. These tiny particles float in the air for about thirty minutes any time the air is disturbed from vacuuming, dusting, making beds or walking on the carpet. When allergic people inhale these particles, they suffer symptoms. Allergy to dust mites may produce symptoms of sneezing, runny or stuffy nose, and watery, itchy eyes. These symptoms, often called allergic rhinitis, are similar to those produced by seasonal allergy to pollen or hay fever. Many people allergic to dust mites may also have allergies to other things as well. House dust mites can also trigger allergic asthma, a noncontagious condition of the lungs characterized by episodic narrowing of the bronchial airways. This constriction brings on the wheezing, coughing, and shortness of breath characteristic of an asthma attack. Allergy is a very important trigger of asthma symptoms in many patients. Because house dust mites are so widespread, allergic symptoms from dust mite exposure do not usually vary from season to season although they may fluctuate with the relative humidity. Allergy to dust mite, in fact, may be the most common cause of allergic rhinitis occurring the year round.

Are dust mite allergies seasonal?

In the U.S. mite populations appear to peak in July and August with allergen levels remaining high through December. Allergen levels are lowest in April and May. The levels are lower in winter in areas where the air is cold and dry, but in Florida, the climate is warm much of the year and humid most of the time. Humidity seems to be a major factor in the growth of dust mites, especially when the relative humidity is greater than 60%.

How is dust mite allergy detected?

Dust mite allergy is easy to diagnose. After a careful history and relevant physical examination, allergy tests can be done using extracts from the two major dust mites. Results of this type of testing are available in 15 minutes of skin tests application. Positive skin tests mean that the patient is allergic to the house dust mite. Occasionally, when skin testing is impossible, a less sensitive allergy blood test is used.

How is dust mite allergy treated?

There is no permanent cure for any of the diseases associated with allergy, nor is there any permanent cure for the allergy itself. There are four ways to deal with the symptoms of dust mite allergy. First when symptoms are mild and not particularly troublesome, they may be ignored.

Avoidance
The most straightforward treatment of dust mite allergy is to avoid or minimize ones exposure to the allergen. Complete avoidance is not possible, but a carefully implemented and maintained anti-dust program in the home should reduce symptoms significantly. Our recommended dust mite avoidance measures are listed on the next page of this handout. This program should be given a trial of 4-6 weeks before the full effects are evaluated as to their success or failure.

Medications
Another aspect of treatment includes use of mediations recommended or prescribed by the physician. These generally act in one of three ways: (1) to block the release of the chemical mediators or allergy symptoms; (2) to reduce the inflammation caused by these mediators; and (3) to block the effects of histamine, one of the major mediators of nasal allergy symptoms. 1. Corticosteroids counteract the inflammation caused by release of mediators, as well as that caused by other non-allergic factors. Sometimes corticosteroids are injected or taken orally, but usually on a short term bases for more severe symptoms. Injected or oral steroids may produce several side effects when used for long periods or used repeatedly. In asthma or rhinitis, steroids are much safer when used topically by inhaling it into the lungs or spraying it on the mucous membranes or the nose. 2. Antihistamines are the most commonly used treatment for allergic symptoms. There are many different antihistamines, and there are wide variations in how individual patients respond to them. For this reason, there are many preparations available over the counter and by prescription. Generally, they work well, and produce only minor side effects, if any. Several newer brands available by prescription do not cause drowsiness (Allegra and Clarinex). Other medications used in treating allergy symptoms include sympathomimetic and anticholinergic drugs. Decongestant nose sprays and oral decongestants are in the sympathomimetic drug group. Temporary use of decongestant nose sprays is useful when nasal congestion is unbearable, but these over the counter drugs should not be used for more than two to three days at a time without a physicians order, because they can produce a rebound effect. In other words, symptoms are at first relieved, but eventually become worse because of the medication itself. Oral decongestants do not produce this effect, but should be used only under a physicians supervision in patients with high blood pressure. Often, an antihistamine is combined with a decongestant.

Allergy Shots (immunotherapy, or desensitization)

One or more of the above medications, accompanied by an anti-dust program will usually control most symptoms. If not, allergen injections (allergy shots) may provide additional relief over the long run. The treatment program consists of injections of a diluted extract, administered frequently in increasing doses until a maintenance dose is reached. Then, the interval between injections increased so that the same dose is given but with longer intervals in between. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms provoked by allergen exposure, and sometimes can actually make skin test reactions disappear. As resistance develops, symptoms should improve, but the improvement from immunotherapy will take several months to occur. Desensitization is not a substitute for dust mite control measures.

Summary of Instructions For Your Dust Mite Avoidance Program (full text on next page)
1. Washable polyester pillows. Wash in hot water every 2-3 weeks, dry completely. Ideal water temperature should be at 130 degrees. You can adjust the thermostat on the water heater unless you have small children in the house. 2. Dust proof covers for the pillows, mattress and box springs. Must be air tight. 3. Use washable sheets, pillowcases, spreads, blankets, etc. Wash in hot water. 4. Washable scatter rugs are preferable to wall-to-wall carpets. If carpet removal is not feasible then carpets can be treated with boron compounds (available through allergy supply companies). 5. To extent possible, remove other dust sources including books, upholstered furniture. Use washable curtains. Keep blinds and ceiling fans dusted. You may also use a dust mask for these chores available at most hardware stores. 6. Use washable stuffed toys, or toys that do not collect dust. 7. Keep door to bedroom and closet door shut. 8. Keep air condition and heating system clean. An electrostatic filter may help. 9. Keep humidity under 60% if possible. A hygrometer to measure relative humidity is available at Radio Shack. If humidity is persistently high (70% or more) a dehumidifier may be needed (available at Sears, Home Depot or through allergy supply companies).

Additional instructions for your dust mite avoidance program

The Patients Bedroom 1. Get washable, polyester pillows, and take the patients pillow along when traveling. Avoid feather and foam rubber pillows, as they will not be the same after they are washed. Wash the pillow in very hot water every two or three weeks to kill the dust mites and to rid the pillow of these allergen particles. Warm or cold water washing does not kill the dust mites, even with detergents and bleach. Be sure to dry the pillows well or they might mildew. Alternately,

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you may encase your pillows with special dust proof covers available through allergy suppliers. All mattresses and box springs in the room should have special dust proof covers, which encase the mattress on the top and bottom and the four sides. The correct type of cover is the kind that you slip the mattress into and close with a zipper. These covers are generally made of plastic or a special impervious material, and they are available from department stores or allergy medical suppliers. When you change the bed, check for leaks or cracks and seal them with tape. For comfort you may put a washable quilted top mattress cover on top of the plastic one. Wash pillowcases, sheets, and other bed linens in hot water. Do not use bed linens, mattress covers, blankets, and spreads that are not washable. Wash all bedspreads, blankets and cloth mattress covers at least monthly in hot water. Dust mites can live on or in carpets. When it wears out, it is preferable to replace wall-to-wall carpeting with tile, linoleum, or wood flooring. Use small washable are rugs where needed. Remove as many other sources of dust from the bedroom as possible. This includes bookshelves and books. As many things as possible in the room should be washable. Upholstered furniture is not a good idea. Washable curtains are better than dry-cleaning heavy drapes. Blinds are hard to keep dusted. Along with ceiling fans, they should be thoroughly cleaned monthly. Washable stuffed toys should be used, since dust mites could collect in a favorite teddy bear. Alternatively, remove the stuffing from an older toy and replace it with washable stuffing. Collections of stuffed toys should be relocated from the bedroom to another room or to the closet. The door to the bedroom and the closet door should be kept closed as much as possible. The bedroom closet should be used only for clothing in current use. Holes or other opening about pipes, and in the floor and walls should be sealed permanently. Clean the room thoroughly with a cloth or a mop dampened with water. Dry dusting will only scatter dust particles around. Repeat this weekly to keep dust under control. The patient should be out of the house when this is done.

Revised 10/4/2012