Transient sensitization to house-dust mites a study on the influence of mite exposure and sex

This study aimed to evaluate the prognosis of a previous positive skin test to house-dust mites (HDM) in relation to environmental exposure. A total of 115 children, 50 from Stockholm and 65 from northern Sweden, all with a previous (average 2.5 years) positive Phazet (Pharmacia AB, Uppsala, Sweden) skin prick test (SPT) to extracts of Dermatophagoides pteronyssinus (Dpt) and/or D. farinae (Df) were included. Dust samples were collected from the children's mattresses, and the total (Dpt, Df, and D. microceras [Dm]) amount of major mite allergen was measured by ELISA (50 children) and expressed as microgram allergen per gram of dust, or was measured by microscopy (65 children). The results of microscopic mite counts were transformed to approximate allergen levels as 2 μg equals 100 mites per gram of dust. Of 115 originally SPT-positive children, only 48 (48%) remained positive at re test, while the majority (58%) were SPT negative after 2 years. Among the 67 converted children, 11 were still exposed to mite allergen, but only to low concentrations (only one converted child being exposed above the suggested threshold level [TLV] of 2 μg/g), compared to 15/48 children still SPT positive who were exposed above the TLV. This shows that continued mite exposure is a major risk factor (OR = 30, CI 4.8–184) for continued positive SPT to HDM. A minor risk factor for continued sensitization was sex, boys having a higher risk than girls (OR=2.2, CI 1.0–4.8). In conclusion, a surprisingly high rate of SPT conversion occurred, mainly as a result of a favorable indoor environment with low exposure to HDM and, to a lesser degree, as a result of sex. The present results support the view that the risk level of exposure is 2 μg mite allergen per gram of dust.