Diagnosis of house dust mite allergy in asthmatic children: what constitutes a positive history?

Standardized questions were put to the parents of 530 children, referred consecutively for evaluation of asthma, to determine which features in the history were associated with house-dust mite allergy. Bronchial challenge tests performed on 19 of the children confirmed that there is a highly significant association between a positive skin prick test and a positive bronchial challenge test to Dermatophagoides farinae mite antigen. One hundred and eighteen (23%) of the children had positive prick tests to the mite. There is a highly significant association between a positive prick test to mite and a history that the subject's respiratory symptoms become worse when there is exposure to domestic activity that stirs up house dust (vacuuming, dusting, sweeping, making the bed, or shaking out blankets) or that the symptoms improve when out of doors. Seasonal variation and other features in the history are of little value in distinguishing mite-sensitive from mite-insensitive asthmatics. Although the 4% whose only positive prick test reaction was to mite had significant worsening of asthma during the colder months compared with the remainder, most mite-positive subjects had multiple allergies and had no characteristic seasonal pattern. The presence of a positive prick test to mite was not associated with aggravation of asthma either at night in bed or in the morning on awakening. A history similar to that of mite-sensitive subjects was elicited in those with a positive prick test to house dust. A positive history of house dust or house-dust mite allergy in asthmatics is one in which respiratory symptoms become worse during domestic activity that stirs up house dust or improve when outdoors.