Pfaar Oliver, Gerth van Wijk Roy
Center for Rhinology and Allergology Wiesbaden, Germany, An den Quellen 10, 65189 Wiesbaden, Germany ; Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Section of Allergology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
Curr Treat Options Allergy. 2015;2(1):1-9. doi: 10.1007/s40521-014-0040-y.
House dust mite (HDM) allergen exposure is the most important cause of perennial allergic rhinitis and/or asthma. Although allergen-specific immunotherapy (AIT) with HDM is well established, published studies have been characterized by substantial heterogeneity in clinical endpoints. Standardization in measuring clinical efficacy is required. Moreover, when designing an AIT trial with HDM allergens, several considerations have to be taken into account. The history of HDM allergy is less clear cut than the typical history of pollen allergy. In addition, clinical features of HDM allergy may differ from those of pollen allergy. Moreover, although not easily measurable, fluctuation in allergen exposure may cause variation in symptom severity and determine the timing of assessment of clinical effects of HDM AIT. Key points 1. A combined symptom and medication score (CSMS) is recommended as standard for the primary endpoint in future house dust mite (HDM) allergen-specific immunotherapy trials. 2. The diagnosis of HDM allergy is based on a carefully taken history in combination with sensitization to HDM allergens. 3. Eye symptoms are less prominent in patients with HDM-induced allergic rhinitis. Nasal symptoms, but not eye symptoms, should be included in the CSMS and in symptom scores as well. 4. As methods to determine allergen exposure vary and the efficacy of environmental control is a matter of debate, a practical approach consists of restraining patients from implementing HDM-reducing measures, such as removing carpets and introducing anti-mite covers, after the start of the study. 5. Efficacy evaluation in the period with the highest exposure to mites is recommended.
屋尘螨（HDM）过敏原暴露是常年性变应性鼻炎和/或哮喘的最重要病因。尽管使用HDM进行过敏原特异性免疫疗法（AIT）已得到充分确立，但已发表的研究在临床终点方面存在很大异质性。需要对临床疗效测量进行标准化。此外，在设计使用HDM过敏原的AIT试验时，必须考虑几个因素。HDM过敏的病史不如典型的花粉过敏病史明确。此外，HDM过敏的临床特征可能与花粉过敏不同。而且，尽管不易测量，但过敏原暴露的波动可能导致症状严重程度的变化，并决定HDM AIT临床效果评估的时间。要点：1. 建议将症状和药物综合评分（CSMS）作为未来屋尘螨（HDM）过敏原特异性免疫疗法试验主要终点的标准。2. HDM过敏的诊断基于详细的病史以及对HDM过敏原的致敏情况。3. HDM诱发的变应性鼻炎患者眼部症状不那么突出。CSMS和症状评分中应包括鼻部症状，但不包括眼部症状。4. 由于确定过敏原暴露的方法各不相同，且环境控制的效果存在争议，一种实际的方法是在研究开始后限制患者采取减少HDM的措施，如移除地毯和使用防螨套。5. 建议在螨虫暴露最高的时期进行疗效评估。
