Introduction: Amongst allergic asthmatics, high
allergen exposure increases
asthma severity. However, there is no consensus on the role of mite
allergen avoidance in the management of
asthma, and various guidelines differ in their recommendations. Areas covered: Several systematic reviews/meta-analyses on mite avoidance in the management of
asthma have been published, and their findings have been used for a call to provide a recommendation in British guidelines that dust-mite control measures should not be recommended. However, there are several problems with such analysis (such as combining studies in adults and children), and we question whether these are appropriate tools to evaluate available evidence about mite
allergen avoidance, and whether it is correct to rely disproportionately on the results of meta-analyses/systematic reviews to inform clinical practice in this area. Recent evidence in children suggests that mite-impermeable bed encasings reduce emergency hospital attendance with severe
asthma exacerbations. Expert opinion: The practical questions include how to achieve a sufficient real-life reduction
allergen exposure, and how to identify patients who will benefit from effective intervention. The intervention should start early in the natural history of
asthma, and consideration for choosing patients should include using the titre of
allergen-specific
IgE antibodies or the size of skin test wheal as an
indicator.