Correlation between Density of House Dust Mites and Relapse Rate

of Atopic Dermatitis: A Cross Sectional Study

Gardenia Akhyar

Department of Dermatology-Venereology, Head of Allergo-Immunology Division, Dr. M. Djamil Hospital, Medical

Faculty of Andalas University, Padang, West Sumatera, Indonesia

Keywords: house dust mites, atopic dermatitis, skin prick test

Abstract: Background: Inhaled allergens especially house dust mites (HDM) greatly contribute to the occurrence of

atopic dermatitis (AD). It is supported by research conducted by Collof (1992) that measured the density of

HDM on mattresses of AD and mattresses of non atopic healthy people and the result of HDM density on

mattresses of patients with AD is higher than non atopic healthy controls. Teplitsky et al (Jerussalem, 2008)

reported that patients with AD showed a higher prevalence of mites on their skin than did healthy individuals,

which could be involved in allergic sensitization and disease exacerbation. The present study aims to

investigate the correlation between density of HDM and relapse rate of AD, confirmed with skin prick test

(SPT) of HDM. Methods: In present study 30 participants were included. Dust from each bedroom was

collected. The density of HDM was calculated while the participants were checked their sensitivity of HDM

by SPT. Establishing the diagnosis of AD based on Hanifin-Radjka criteria. Each participant was asked about

recurrence of AD in the last three months. Results: Seven (23.3%) samples had moderate density of HDM

while 23 (76.7%) had low density of HDM. From anamnesis, 10 (33.3%) participants were diagnosed with

AD and SPT showed that 50% samples were sensitive against HDM. Out of 10 AD participants, 8 (80%)

were positive with HDM allergens. All 10 participants with AD had relapse within three months. Conclusion:

Out of 10 participants with atopic dermatitis, two (20%) had moderate density of HDM in bedroom (p>0.05).

Also, from seven samples with moderate density of HDM, three (20%) were sensitive against HDM (p>0.05).

About 80% of AD showed sensitivity against HDM while all 10 AD participants had relapse within last three

months indicated that HDM allergen could induce exacerbation of disease in AD, but the correlation between

HDM density and the relapse rate could not be proven yet. This present study suggests further investigation

with larger samples size.

1 INTRODUCTION

Atopic dermatitis (AD) is a chronically relapsing skin

disease that occurs most commonly during early

infancy and childhood (Leung et al., 2012). This

disease usually begins in the early life and is often

seen in the people with the personal or family

background of asthma or swelling of the mucous

membranes. Forty five percent of children experience

the early onset in the first 6 months of their life, 60%

during their first year and 85% before the age of 5.

This disease can assist with asthma and allergic

rhinitis. This disease can cause sleep, educational,

and social disorders in patients (Leung e tal., 2012;

Norris et al., 1998).

AD is a highly pruritic inflammatory skin disease

that results from complex interactions between

genetic susceptibility genes resulting in a defective

skin barrier, defects in the innate immune system, and

heightened immunologic responses to allergens and

microbial antigens (Leung et al., 2012). Sensitization

to inhalant allergens such as house dust mite (HDM)

allergens, detectable with specific IgE tests, is very

common in adolescent and adult patients suffering

from AD (Werfel et al., 2006; Gavino et al., 2008). A

T-cell-mediated reaction is critical in the worsening

of eczema, which can be triggered by the

epicutaneous application of HDM allergens in

sensitized patients. HDM allergens penetrate the skin

where they are trapped via specific IgE on high-

affinity Fc-receptors on Langerhans cells.

Langerhans cells may subsequently present the

allergens to T lymphocytes, leading to specific T-cell

proliferation and eczema (Werfel et al., 2006; Gavino

et al., 2008; Leung et al., 2012).

To cause transdermal sensitization, HDM

Akhyar, G.

Correlation between Density of House Dust Mites and Relapse Rate of Atopic Dermatitis: A Cross Sectional Study.

DOI: 10.5220/0008155102530256

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 253-256

ISBN: 978-989-758-494-7

253

allergens must be absorbed through the skin,

processed by dendritic cells, and presented to T-

helper lymphocytes. For efficient absorption, close

and prolonged contact between the skin and HDM

allergens is probably necessary, for example, via

HDM-contaminated clothes and bedding (Plattsmills

& Chapman, 1993). Accordingly, several studies

have reported that the homes of patients with AD

contain large amounts of HDM and their antigens,

compared with controls, and that clothes and bedding

are an important source of HDM (Teplitsky, 2008).

The aim of the present study was to determine the

number of HDM and to correlate its density with

incidence of atopic dermatitis, also comparing with

skin sensitivity towards HDM by conducting skin

prick test (SPT).

2 METHODS

The study samples were 30 children and

adolescent of Al Falah and Aisyiyah

Reformatory in

Padang, with aged range 8 to 23

year old. Ethical approval was obtained and all

participants were explained about the purpose of the

study and also were informed about the procedure of

SPT and the informed consent was obtained from

each of the participant. The following data were

collected: demographic data for age, sex, personal

and family history of atopy. Diagnosis of atopic

dermatitis was established based on Hanifin-Radjka

criteria.

2.1 Dust Collecting and Counting

Dust was sucked with a vacuum cleaner. At the end

of the vacuum cleaner was installed a chiffon cloth to

catch the inhaled dust. Suction was done for 3 minutes

on each mattress in the reformatory. Dust inserted to

plastic containers. The container was labeled

according to where the dust was taken. The dust

samples were then taken to the Parasitology

Laboratory of the Faculty of Medicine, Andalas

University for examination.

Dust in a plastic container that had been labeled

was filtered using a sieve. Strained dust was put in a

petri dish that has been previously weighed to

determine the weight of an empty petri dish. Dust was

weighted and noted each weight. Weighted dust was

put into a container containing 100 ml of 5% sodium

chloride solution. The solution was put into a reaction

tube. This solution was centrifuged for 4 min at 600

rpm for separating mites from debris. A saturated

NaCl solution is added to the reaction tube until it was

full and the surface of the convex solution appears.

Then covered with cover glass (deck glass) and left

for 30 minutes. Cover glass was taken and placed on

the object glass. Samples were examined using a 40x

light magnification microscope. The number of HDM

found was calculated.

2.2 Skin Prick Testing

The medial aspect of the forearms and the upper arms

were cleaned and test sites for placing the allergens

were marked using a marker 2-3 cm away from the

wrist and ante cubital fossae. Distance between two

allergens was kept at 2 cm to avoid false positives

either due to direct contamination or due to axon

reflex. A drop of each allergen was placed on the skin

and was pricked with a lancet to introduce the

allergen. Equal pressure was applied for all the

allergens. Histamine dichloride (10 ng/ml or 0.1%)

was used as a positive control and saline as negative

control. Results were read after 20 minutes. Wheals

at the test site were compared with the wheal

produced at the positive control site. Largest diameter

of the wheal was measured using a plastic scale

provided along with the test kit. A wheal of 50% of

diameter positive control or bigger was considered as

positive. Negative control was used to rule out any

dermographism.

2.3 Statistical Analysis

Data obtained was analyzed using SPSS vr.15.0.

3 RESULTS

We conducted 30 participants which 1o of them have

met the Hanifin-Radjka criteria. Seven dust samples

had moderate density of HDM and other 23 samples

with low density of HDM. From seven samples of

moderate density of HDM, only one that have a

history of urticarial (p>0.05). 15 participants were

sensitive to HDM (positive SPT), and three of them

had moderate density of HDM (p>0.05).

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From anamnesis, we found that all 10 AD participants

had relapse in the last three months. And out of 10

AD participants, eight samples (80%) were sensitive

against HDM allergen.

4 DISCUSSION

The house dust mites are the most common

environmental allergens. Mites sensitize and induce

allergic disorders such as perennial rhinitis and

asthma in predisposed individuals. In addition, house

dust mites are important deteriorating factors in

patients with atopic dermatitis (Tupker et al., 1998).

Although definite causality has yet to be

determined, it has been alleged that HDMs play a role

in the immunopathogenesis of AD. Not only do AD

patients have elevated levels of serum IgE antibodies

specific to HDM allergens, biopsy specimens of AD

lesional skin have also been shown to be infiltrated

with T lymphocytes that recognize HDM. It has been

shown that HDM may facilitate its entry into AD skin

by enzymatically breaking down the epidermal

barrier. Mite allergens are able to activate

keratinocytes and induce them to produce and secrete

proinflammatory cytokines (Gavino et al., 2008).

Briefly, the prevalence of allergic diseases due to

household arthropods have significantly increased in

the recent last decades, because people spend most of

their time in their home environment and according

to the modern lifestyle, houses are warmer and filled

with a lot of furniture and not enough air-regulation

is provided (Ziyaei et al., 2017). In this study, we

determined the correlation between density of HDM

with the incidence of atopic dermatitis.

Out of 10 participants with atopic dermatitis, two

(20%) had moderate density of HDM in bedroom

(p>0.05). Also, from seven samples with moderate

density of HDM, three (20%) were sensitive against

HDM (p>0.05). There was no evidence to support the

first assumption, as no difference in incidence of

atopic dermatitis with HDM density that was counted

from patients’ clothes and bedding, although an

earlier study had reported there were larger numbers

of HDMs in the mattresses of patients with AD when

compared with controls.

However, all AD

Table 1. Correlation between HDM density with incidence of atopic dermatitis

HDM DENSITY

INCIDENCE OF ATOPIC DERMATITIS

P value

YES NO

HIGH

(

)

(

)

p 1.000

MODERATE

(20.0%)

(25.0%)

LOW

(80.0%)

(75.0%)

TOTAL

(

100%

)

(

100%

)

Table 2. Correlation between HDM density with sensitivity of HDM

HDM DENSITY

SKIN PRICK TEST

P value

POSITIVE NEGATIVE

HIGH

(

)

(

)

p 1.000

MODERATE

(20%)

(26.7)

LOW

(80%)

(73.3%)

TOTAL

(

100%

)

(

100%

)

Correlation between Density of House Dust Mites and Relapse Rate of Atopic Dermatitis: A Cross Sectional Study

255

participant had relapse within three months while

80% of them positive to SPT indicates that HDM

allergen might induce the recurrence of disease.

5 CONCLUSION

Even though recent evidence supports a role for HDM

in atopic dermatitis, the correlation of its density with

prevalence of occurrence of atopic dermatitis still

needs further research with bigger sample size.

ACKNOWLEDGMENT

This research is not sponsored and there is no

conflict of interests.

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