Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Jan 19;1(1):CD008426.
doi: 10.1002/14651858.CD008426.pub2.

House dust mite reduction and avoidance measures for treating eczema

Helen Nankervis  1 , Emma V Pynn, Robert J Boyle, Lesley Rushton, Hywel C Williams, Deanne M Hewson, Thomas Platts-Mills
Affiliations
Meta-Analysis

House dust mite reduction and avoidance measures for treating eczema

Helen Nankervis et al. Cochrane Database Syst Rev. .

Abstract

Background: Eczema is an inflammatory skin disease that tends to involve skin creases, such as the folds of the elbows or knees; it is an intensely itchy skin condition, which can relapse and remit over time. As many as a third of people with eczema who have a positive test for allergy to house dust mite have reported worsening of eczema or respiratory symptoms when exposed to dust.

Objectives: To assess the effects of all house dust mite reduction and avoidance measures for the treatment of eczema.

Search methods: We searched the following databases up to 14 August 2014: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 8), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), and the GREAT database. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant studies. We handsearched abstracts from international eczema and allergy meetings.

Selection criteria: Randomised controlled trials (RCTs) of any of the house dust mite reduction and avoidance measures for the treatment of eczema, which included participants of any age diagnosed by a clinician with eczema as defined by the World Allergy Organization. We included all non-pharmacological and pharmacological interventions that sought to reduce or avoid exposure to house dust mite and their allergenic faeces. The comparators were any active treatment, no treatment, placebo, or standard care only.

Data collection and analysis: Two authors independently checked the titles and abstracts identified, and there were no disagreements. We contacted authors of included studies for additional information. We assessed the risk of bias using Cochrane methodology.

Main results: We included seven studies of 324 adults and children with eczema. Overall, the included studies had a high risk of bias. Four of the seven trials tested interventions with multiple components, and three tested a single intervention. Two of the seven trials included only children, four included children and adults, and one included only adults. Interventions to reduce or avoid exposure to house dust mite included covers for mattresses and bedding, increased or high-quality vacuuming of carpets and mattresses, and sprays that kill house dust mites.Four studies assessed our first primary outcome of 'Clinician-assessed eczema severity using a named scale'. Of these, one study (n = 20) did not show any significant short-term benefit from allergen impermeable polyurethane mattress encasings and acaricide spray versus allergen permeable cotton mattress encasings and placebo acaricide spray. One study (n = 60) found a modest statistically significant benefit in the Six Area, Six Sign Atopic Dermatitis (SASSAD) scale over six months (mean difference of 4.2 (95% confidence interval 1.7 to 6.7), P = 0.008) in favour of a mite impermeable bedding system combined with benzyltannate spray and high-filtration vacuuming versus mite permeable cotton encasings, water with a trace of alcohol spray, and a low-filtration vacuum cleaner. The third study (n = 41) did not compare the change in severity of eczema between the two treatment groups. The fourth study (n = 86) reported no evidence of a difference between the treatment groups.With regard to the secondary outcomes 'Participant- or caregiver-assessed global eczema severity score' and the 'Amount and frequency of topical treatment required', one study (n = 20) assessed these outcomes with similar results being reported for these outcomes in both groups. Four studies (n = 159) assessed 'Sensitivity to house dust mite allergen using a marker'; there was no clear evidence of a difference in sensitivity levels reported between treatments in any of the four trials.None of the seven included studies assessed our second primary outcome 'Participant- or caregiver-assessed eczema-related quality of life using a named instrument' or the secondary outcome of 'Adverse effects'.We were unable to combine any of our results because of variability in the interventions and paucity of data.

Authors' conclusions: We were unable to determine clear implications to inform clinical practice from the very low-quality evidence currently available. The modest treatment responses reported were in people with atopic eczema, specifically with sensitivity to one or more aeroallergens. Thus, their use in the eczema population as a whole is unknown. High-quality long-term trials of single, easy-to-administer house dust mite reduction or avoidance measures are worth pursuing.

PubMed Disclaimer

Conflict of interest statement

Helen Nankervis: nothing to declare. Emma V Pynn: nothing to declare. Robert J Boyle: "I am a co‐investigator on a new trial of temperature controlled laminar airflow for treating atopic eczema http://www.hra.nhs.uk/news/research‐summaries/temperature‐controlled‐laminar‐airflow‐in‐severe‐paediatric‐eczema/. This is an allergen avoidance study taking place at Imperial College, in children and adolescents with severe eczema." Lesley Rushton: nothing to declare. Hywel C Williams: nothing to declare. Deanne M Hewson: nothing to declare. Thomas Platts‐Mills: nothing to declare.

Figures

1
1
Acute atopic eczema in a child. Copyright © 1991 Professor Hywel Williams: reproduced with permission
2
2
A house dust mite. Copyright © 2013 Professor Thomas Platts‐Millls: reproduced with permission
3
3
Study flow diagram
4
4
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008426

References

References to studies included in this review

Colloff 1989 {published data only}
    1. Colloff MJ, Lever RS, McSharry CM. A controlled trial of house dust mite eradication using natamycin in homes of patients with atopic dermatitis: effect on clinical status and mite populations. British Journal of Dermatology 1989;121(2):199‐208. [MEDLINE: ] - PubMed
Endo 1997 {published data only}
    1. Endo K, Fukuzumi T, Adachi J, Kojima M, Aoki T, Yoshida M, et al. Effect of vacuum cleaning of room floors and bed clothes of patients on house dust mite counts and clinical scores of atopic dermatitis. A double blind control trial (Japanese). Arerugi ‐ Japanese Journal of Allergology 1997;46(10):1013‐24. [MEDLINE: ] - PubMed
Gutgesell 2001 {published data only}
    1. Gutgesell C, Heise S, Seubert S, Seubert A, Domhof S, Brunner E, et al. Double‐blind placebo‐controlled house dust mite control measures in adult patients with dermatitis. British Journal of Dermatology 2001;145(1):70‐4. [MEDLINE: ] - PubMed
Oosting 2002 {published data only}
    1. Gutgesell C. Atopic dermatitis and the clinical effect of house dust mite avoidance. Journal of Allergy & Clinical Immunology 2003;111(1):203‐4. [MEDLINE: ] - PubMed
    1. Oosting AJ, Bruin‐Weller MS, Bruijnzeel‐Koomen CAFM. Author reply. Journal of Allergy & Clinical Immunology 2003;111(1):203‐4.
    1. Oosting AJ, Bruin‐Weller MS, Terreehorst I, Tempels‐Pavlica Z, Aalberse RC, Monchy JG, et al. Effect of mattress encasings on atopic dermatitis outcome measures in a double‐blind, placebo‐controlled study: the Dutch mite avoidance study. Journal of Allergy & Clinical Immunology 2002;110(3):500‐6. [MEDLINE: ] - PubMed
Ricci 2000 {published data only}
    1. Ricci G, Patrizi A, Specchia F, Menna L, Bottau P, D'Angelo V, et al. Effect of house dust mite avoidance measures in children with atopic dermatitis. British Journal of Dermatology 2000;143(2):379‐84. [MEDLINE: ] - PubMed
    1. Ricci G, Patrizi A, Specchia F, Menna L, Bottau P, D'Angelo V, et al. Mite allergen (Der p1) levels in houses of children with atopic dermatitis: the relationship with allergometric tests. British Journal of Dermatology 1999;140(4):651‐5. [MEDLINE: ] - PubMed
Tan 1996 {published data only}
    1. Friedmann PS, Tan BB. Mite elimination ‐ clinical effect on eczema. Allergy 1998;53(Suppl 48):97‐100. [MEDLINE: ] - PubMed
    1. Tan BB, Weald D, Strickland I, Friedmann PS. Double‐blind controlled trial of effect of housedust‐mite allergen avoidance on atopic dermatitis. Lancet 1996;347(8993):15‐8. [MEDLINE: ] - PubMed
Terreehorst 2005 {published data only}
    1. Terreehorst I, Duivenvoorden HJ, Tempels‐Pavlica Z, Oosting AJ, Monchy JG, Bruijnzeel‐Koomen CA, et al. The effect of encasings on quality of life in adult house dust mite allergic patients with rhinitis, asthma and/or atopic dermatitis. Allergy 2005;60(7):888‐93. [MEDLINE: ] - PubMed
    1. Terreehorst I, Hak E, Oosting AJ, Tempels‐Pavlica Z, Monchy JG, Bruijnzeel‐Koomen CA, et al. Evaluation if impermeable covers for bedding in patients with allergic rhinitis. New England Journal of Medicine 2003;349(3):237‐46. [MEDLINE: ] - PubMed

References to studies excluded from this review

Adham 2011 {published data only}
    1. Adham TM, Tawfik SA, Abdo NM. House dust mites in pediatric atopic dermatitis. Saudi Medical Journal 2011;37(2):177‐82. [MEDLINE: ] - PubMed
Corver 2006 {published data only}
    1. Corver K, Kerkhof M, Brussee JE, Brunekreef B, Strien RT, Vos AP, et al. House dust mite allergen reduction and allergy at 4yr: Follow up of the PIAMA‐study. Pediatric Allergy & Immunology 2006;17(5):329‐36. [MEDLINE: ] - PubMed
D'Souza 1973 {published data only}
    1. D'Souza MF, Pepys J, Wells ID, Tai E, Palmer F, Overell BG, et al. Hyposensitisation with Dermatophagoides pteronyssinus in house dust allergy: a controlled study of clinical and immunological effects. Clinical Allergy 1973;3(2):177‐93. [MEDLINE: ] - PubMed
Holm 2001 {published and unpublished data}
    1. Holm L, Bengtsson A, Hage‐Hamsten M, Ohman S, Scheynius A. Effectiveness of occlusive bedding in the treatment of atopic dermatitis ‐ a placebo‐controlled trial of 12 months' duration. Allergy 2001;56(2):152‐8. [MEDLINE: ] - PubMed
Kim 2005 {published data only}
    1. Kim B, Kim C. Effect of mattress and pillow encasings on children with atopic dermatitis. Journal of Allergy & Clinical Immunology 2005;115(2 Suppl):S101.
Norris 1987 {published data only}
    1. Norris PG. Does house dust mite aggravate atopic eczema?. British Journal of Dermatology 1987;117(Suppl 32):14.
Sanda 1992 {published data only}
    1. Sanda T, Yasue T, Oohashi M, Yasue A. Effectiveness of house dust mite allergen avoidance through clean room therapy in patients with atopic dermatitis. Journal of Allergy & Clinical Immunology 1992;89(3):653‐7. [MEDLINE: ] - PubMed
Weber‐Chrysochoou 2007 {published data only}
    1. Weber‐Chrysochoou C, Crisafulli D, Almqvist C, Li Q, Kemp AS, Britton WJ, et al. IL‐5 T‐cell responses to house dust mite are associated with the development of allergen‐specific IgE resonses and asthma in the first 5 years of life. Journal of Allergy & Clinical Immunology 2007;120(2):286‐92. [MEDLINE: ] - PubMed

Additional references

AAD 2003
    1. AAD Expert Work Group. Guidelines for the care of atopic dermatitis: technical report. 2003.
Arlian 2001
    1. Arilan LG, Platts‐Mills TA. The biology of dust mites and the remediation of mite allergens in allergic disease. Journal of Allergy & Clinical Immunology 2001;107(3 Suppl):S406‐13. [MEDLINE: ] - PubMed
Bath‐Hextall 2008
    1. Bath‐Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD005203.pub2] - DOI - PMC - PubMed
Baum 2002
    1. Baum WF, Schneyer U, Lantzsch AM, Kloditz E. Delay of growth and development in children with bronchial asthma, atopic dermatitis and allergic rhinitis. Experimental & Clinical Endocrinology & Diabetes 2002;110(2):53‐9. [MEDLINE: ] - PubMed
Beck 2000
    1. Beck L, Leung DY. Allergen sensitization through the skin induces systemic allergic responses. Journal of Allergy & Clinical Immunology 2000;106(5):S258‐63. [MEDLINE: ] - PubMed
Birnie 2008
    1. Birnie AJ, Bath‐Hextall FJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD003871.pub2] - DOI - PubMed
Bjorksten 2001
    1. Bjorksten B, Sepp E, Julge K, Voor T, Mikelsaar M. Allergy development and the intestinal microflora during the first year of life. Journal of Allergy & Clinical Immunology 2001;108(4):516‐20. [MEDLINE: ] - PubMed
Boyle 2008
    1. Boyle RJ, Bath‐Hextall FJ, Leonardi‐Bee J, Murrell DF, Tang MLK. Probiotics for treating eczema. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD006135.pub2] - DOI - PubMed
Brauer 2007
    1. Brauer M, Hoek G, Smit HA, Jongste JC, Gerritsen J, Postma DS, et al. Air pollution and development of asthma, allergy and infections in a birth cohort. European Respiratory Journal 2007;29(5):879‐88. [MEDLINE: ] - PubMed
Charman 2000a
    1. Charman C, Williams H. Outcome measures of disease severity in atopic eczema. Archives of Dermatology 2000;136(6):763‐9. [MEDLINE: ] - PubMed
Charman 2000b
    1. Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. British Journal of Dermatology 2000;142(5):931‐6. [MEDLINE: ] - PubMed
Curtiss 2007
    1. Curtiss FR. Atopic march to a dead end or does the theory really have legs?. Journal of Managed Care Pharmacy 2007; Vol. 13, issue 9:810‐1. [MEDLINE: ] - PMC - PubMed
Ellis 2002
    1. Ellis CN, Drake LA, Prendergast MM, Abramovits W, Boguniewicz M, Daniel CR, et al. Cost of atopic dermatitis and eczema in the United States. Journal of the American Academy of Dermatology 2002;46(3):361‐70. [MEDLINE: ] - PubMed
Emerson 1998
    1. Emerson RM, Williams HC, Allen BR. Severity distribution of atopic dermatitis in the community and its relationship to secondary referral. British Journal of Dermatology 1998;139(1):73‐6. [MEDLINE: ] - PubMed
Emerson 2001
    1. Emerson RM, Williams HC, Allen BR. What is the cost of atopic dermatitis in preschool children?. British Journal of Dermatology 2001;144(3):514‐22. - PubMed
Flohr 2004
    1. Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis?. Journal of Allergy & Clinical Immunology 2004;114(1):150‐8. [MEDLINE: ] - PubMed
Friedmann 1999
    1. Friedmann PS. Dust mite avoidance in atopic dermatitis. Clinical & Experimental Dermatology 1999;24(6):433‐7. [MEDLINE: ] - PubMed
Gotzsche 2008
    1. Gotzsche PC, Johansen HK. House dust mite control measures for asthma. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD001187.pub3] - DOI - PMC - PubMed
Hallai 2009
    1. Hallai N, Gawkrodger DJ. Patch testing to aeroallergens, especially house dust mite, is often positive in atopics with eczema of the hands and face. Journal of the European Academy of Dermatology & Venereology 2009; Vol. 23, issue 6:728‐30. [MEDLINE: ] - PubMed
Hanifin 1980
    1. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Dermato‐Venereologica 1980;60(Suppl 92):44‐7.
Hanifin 2004
    1. Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ, et al. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association "Administrative Regulations for Evidence‐Based Clinical Practice Guidelines". Journal of the American Academy of Dermatology 2004;50(3):391‐404. [MEDLINE: ] - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hoare 2000
    1. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technology Assessment 2000;4(37):1‐191. [MEDLINE: ] - PMC - PubMed
Johansson 2001
    1. Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel‐Koomen C, Dreborg S, Haahtela T, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56(9):813‐24. [MEDLINE: ] - PubMed
Johansson 2004
    1. Johansson SG, Bieber T, Dahl R, Friedmann P, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. Journal of Allergy & Clinical Immunology 2004;113(5):832‐6. [MEDLINE: ] - PubMed
Kemp 2003
    1. Kemp AS. Cost of illness of atopic dermatitis in children: a societal perspective. Pharmacoeconomics 2003;21(2):105‐13. [MEDLINE: ] - PubMed
Koren 1993
    1. Koren LGH. Long term efficacy of acarides against house dust mites (Dermatophagoides pteronyssinus) in a semi‐natural test system. Proceedings of the First International Conference on Urban Pests. 1993:367‐71.
Langan 2006
    1. Langan SM, Williams HC. What causes worsening of eczema? A systematic review. British Journal of Dermatology 2006;155(3):504‐14. [MEDLINE: ] - PubMed
Mancini 2008
    1. Mancini AJ, Kaulback K, Chamlin SL. The socioeconomic impact of atopic dermatitis in the United States: A systematic review. Pediatric Dermatology 2008;25(1):1‐6. [MEDLINE: ] - PubMed
McHenry 1995
    1. McHenry PM, Williams HC, Bingham EA. Management of atopic eczema. Joint Workshop of the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London. BMJ 1995;310(6983):843‐7. [MEDLINE: ] - PMC - PubMed
Meltzer 2008
    1. Meltzer LJ, Moore M. Sleep disturbances in parents of children and adolescents with chronic illnesses: prevalence, causes and consequences. Journal of Pediatric Psychology 2008;33(3):279‐91. [MEDLINE: ] - PubMed
Mitchell 1982
    1. Mitchell EB, Crow J, Chapman MD, Jouhal SS, Pope FM, Platts‐Mills TA. Basophils in allergen‐induced patch test sites in atopic dermatitis. Lancet 1982;1(8264):127‐30. [MEDLINE: ] - PubMed
Muller 2009
    1. Muller S, Marenholz I, Lee YA, Sengler C, Zitnik SE, Griffioen RW, et al. Association of Filaggrin loss‐of‐function‐mutations with atopic dermatitis and asthma in the early treatment of the atopic child (ETAC) population. Pediatric Allergy & Immunology 2009;20(4):358‐61. [MEDLINE: ] - PubMed
NICE 2007
    1. National Collaborating Centre for Women's and Children's Health (UK). Atopic Eczema in Children: Management of Atopic Eczema in Children from Birth up to the Age of 12 Years. Vol. NICE Clinical Guidelines, No. 57, London: RCOG Press, 2007 Dec. [www.ncbi.nlm.nih.gov/books/NBK49365/] - PubMed
Nurmatov 2012
    1. Nurmatov U, Schayck CP, Hurwitz B, Sheikh A. House dust mite avoidance measures for perennial allergic rhinitis: an updated Cochrane systematic review. Allergy 2012;67(2):158–65. [MEDLINE: ] - PubMed
Penard ‐Mornard 2005
    1. Penard‐Morand C, Charpin D, Raherison C, Kopferschmitt C, Caillaud D, Lavaud F, et al. Long‐term exposure to background air pollution related to respiratory and allergic health in schoolchildren. Clinical & Experimental Allergy 2005;35(10):1279‐87. [MEDLINE: ] - PubMed
Platts‐Mills 1983
    1. Platts‐Mills TA, Mitchell EB, Rowntree S, Chapman MD, Wilkins SR. The role of dust mite allergens in atopic dermatitis. Clinical & Experimental Dermatology 1983;8(3):233‐47. [MEDLINE: ] - PubMed
Platts‐Mills 2008
    1. Platts‐Mills TA. Allergen avoidance in the treatment of asthma: problems with the meta‐analysis. Journal of Allergy & Clinical Immunology 2008;122(4):694‐6. [MEDLINE: ] - PubMed
Review Manager 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
SIGN 2011
    1. Scottish Intercollegiate Guidelines Network (SIGN). Management of atopic eczema in primary care. A national clinical guideline, SIGN publication no. 125, March 2011. http://sign.ac.uk/pdf/sign125.pdf (accessed 14 August 2014).
Su 1997
    1. Su JC, Kemp AS, Varigos GA, Nolan TM. Atopic eczema: Its impact on the family and financial cost. Archives of Disease in Childhood 1997;76(2):159‐62. [MEDLINE: ] - PMC - PubMed
Tuft 1949
    1. Tuft L. Importance of inhalant allergens in atopic dermatitis. Journal of investigative Dermatology 1949;12(4):211‐9. [MEDLINE: ] - PubMed
Van Bever 2002
    1. Bever HP. Early events in atopy. European Journal of Pediatrics 2002;161(10):542‐6. [MEDLINE: ] - PubMed
van den Oord 2009
    1. Oord R, Sheikh A. Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: Systematic review and meta‐analysis. BMJ 2009;339:b2433. [MEDLINE: ] - PMC - PubMed
van Reijsen 1992
    1. Reijsen FC, Bruijnzeel‐Koomen CA, Kaltoff FS, Maggi E, Romagnani S, Westland JK, et al. Skin‐derived aeroallergen‐specific T‐cell clones of Th2 phenotype in patients with atopic dermatitis. Journal of Allergy & Clinical Immunology 1992;90(2):184‐93. [MEDLINE: ] - PubMed
Verboom 2002
    1. Verboom P, Hakkaart‐Van L, Sturkenboom M, Zeeuw R, Menke H, Rutten F. The cost of atopic dermatitis in the Netherlands: An international comparison. British Journal of Dermatology 2002;147(4):716‐24. [MEDLINE: ] - PubMed
Williams 1994
    1. Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ, et al. The U.K Working Party's diagnostic criteria for atopic dermatitis. British Journal of Dermatology 1994;131(3):383‐96. [MEDLINE: ] - PubMed
Williams 1999
    1. Williams HC, Robertson C, Stewart A, Ait‐Khaled N, Anabwani G, Anderson R, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the international study of asthma and allergies in childhood. Journal of Allergy & Clinical Immunology 1999;103(1 Pt 1):125‐38. [MEDLINE: ] - PubMed
Williams 2006
    1. Williams H, Flohr C. How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. Journal of Allergy & Clinical Immunology 2006;118(1):209‐13. [MEDLINE: ] - PubMed

Publication types

MeSH terms