House dust mite allergen levels in households and

correlation with allergic rhinitis symptoms

Yanjun Wang, M.D.,1,2 Liyan Xiong, M.B.B.S.,1 Xiaoyan Yin, M.D.,3 Jinghui Wang, M.D.,4
Quanming Zhang, M.D.,5 Zizhong Yu, M.D.,1 Guoqing Gong, M.D.,1 Yiwu Zheng, Ph.D.,6
Jianjun Chen, M.D.,1 and Weijia Kong, M.D.1,2

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ABSTRACT

Background: House dust mite (HDM) allergen is a risk factor for the development of allergic rhinitis (AR).
Objectives: To determine the levels of indoor allergens in the households of patients with AR in Wuhan city, identify the environmental risk factors for
high allergen exposure, and investigate the correlations between allergen exposure and specific immunoglobulin E levels and symptoms.
Methods: The study examined 50 patients with AR. Two dust samples were collected from the bedding of each patient, one in summer and one in winter.
Major allergens Der p 1 and Der f 1, from Dermatophagoides pteronyssinus and Dermatophagoides farinae, were measured with an enzyme-linked
immunosorbent assay. Participants completed a standardized questionnaire about their living environments, and their rhinitis symptom scores were calculated.
Specific immunoglobulin E levels against Der p and Der f were measured.
Results: The percentage of bedding samples with high HDM allergen (Der f 1 Der p 1) levels (10 g/g) was 44% in summer and 46% in winter. There
was no significant difference between the level of mite allergens in summer and winter; however, the level of Der f 1 was higher than that of Der p 1 (p
0.05). The age of the mattress and pillow was significantly correlated with allergen concentration. Indoor HDM allergen level affected the severity of nasal
itching.
Conclusions: HDMs are important indoor allergens in Wuhan. Mattresses and pillows that have been used for a long time contain high levels of allergens.
High levels of exposure to HDM allergens correlates with the severity of nasal itching.
(Am J Rhinol Allergy 28, e193e196, 2014; doi: 10.2500/ajra.2014.28.4095)

ouse dust mites (HDMs) are the most important source of indoor allergens in the world.14 Clinical reports58 from China
have shown that HDM allergens are the main cause of sensitization in
patients with perennial allergic rhinitis (AR). Li et al.9 demonstrated
that HDM sensitization in the skin-prick test is approximately 60% in
allergy patients in mainland China. A study in Guangzhou showed
that more than 88% of households live with high levels of HDM
allergens.10 However, indoor allergen levels in Chinese households
have not been determined. The influence of HDM allergen levels on
patient symptoms has not been fully investigated in China. This study
was conducted to determine HDM allergen levels in the households
of AR patients in central China, to investigate the risk factors in their
living environments, and to explore the correlations between the
exposure levels and specific immunoglobulin E (sIgE) levels and
clinical symptoms.

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Department of Otorhinolaryngology and 2Institute of Otorhinolaryngology, Union

Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China, 3Department of Otorhinolaryngology, The Second Hospital of Hebei
Medical University, China, 4Department of Otorhinolaryngology, The First Hospital of
Handan, Hebei, China, 5Departments of Otorhinolaryngology, Shenzhen Nanshan
Hospital, Shenzhen, China, and 6Research and Development, ALK, Asia Pacific
This work was supported by grants from the Research and National Promotion of Early
Detection, Standardized Diagnosis and Treatment, and Preventive Strategy for Major
Otology and Rhinologic Diseases (201202005), Wu Jieping Medical Foundation
(LC1345), Foundation of Hubei Province Key Laboratory of Molecular Imaging
(02.03.2013 64), the National Natural Science Foundation of China (30901659), and
the National Key Technology R&D Program from the Ministry of Science and Technology of China (2007BAI18B15)
Yanjun Wang and Liyan Xiong contributed equally to this work
The authors have no conflicts of interest to declare pertaining to this article
Address correspondence to Weijia Kong, M.D., Department of Otorhinolaryngology,
Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
E-mail address: entwjkong@hust.edu.cn
Copyright 2014, OceanSide Publications, Inc., U.S.A.

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MATERIALS AND METHODS

Subjects

Fifty AR patients who visited the Department of Otorhinolaryngology, Union Hospital of Tongji Medical College were recruited for this
study. The patients (who had never used nasal medications) had at
least two of the following symptoms: nasal obstruction, nasal itching,
running nose, or sneezing. These symptoms were not caused by a
cold or the flu. Each subjects sensitization to HDM was detected with
a skin-prick test. All of the subjects or their guardians signed a written
informed consent before the study, which was approved by the
medical ethics committee of Huazhong University of Science and
Technology.

Dust sample collection and extraction

Two dust samples were collected from each subjects living environment, one in summer (July to August 2011) and one in winter
(January to February 2012). All of the subjects had been living in their
homes for at least one year before dust collection and were asked not
to replace their bedding for two weeks before dust collection. Dust
was sampled by a trained technician using a hand-held vacuum
cleaner equipped with a filter trap (ALK, Hrsholm, Denmark); the
aim was to get more than 1.0 gram per sample. Dust samples were
collected from the sheets, pillowcases, pillows, quilts, and mattresses.
Samples were stored at 18C before the dust was extracted from
them as large particles using 0.125M NH4(HCO3) for 2 hours at room
temperature and gentle shaking. The extracted solution was then
filtered through a 0.22-m filter and stored at 18C until it was
analyzed.

Allergen level measurement

Allergen detection in the extracted dust samples was performed by
sandwich enzyme-linked immunosorbent assay with monoclonal antibodies against Der p 1 and Der f 1, from Dermatophagoides pteronyssinus and Dermatophagoides farinae. All of the antibodies and allergens
were from ALK. The sample results are reported as micrograms of
Der p 1/Der f 1 per gram of dust. To allow comparison, HDM

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e193

allergen levels of Der p 1 and Der f 1 were calibrated against commercial allergen standards (INDOOR Biotechnologies, Charlottesville, VA). The lower limit of enzyme-linked immunosorbent assay
measurement is 0.0060 g/g for Der p 1 and 0.0054 g/g for Der f 1.

Table 1. Concentration of allergen in winter and summer (g/g)

Questionnaire about living environment

Der p 1
Der f 1
Der p 1 Der f 1

A standardized questionnaire was administered by a trained technician on the day of the dust sample collection. The questionnaire
included 19 items: years of living in this environment; age of building;
house/flat size; which floor lived on; number of floors in building;
pets or not; what kind of pets; pets in the bedroom; use of air
conditioning (heating installation) or not; materials of pillow, quilt,
sheet, and mattress; the ages of pillow, quilt, sheet, and mattress;
frequency of changing the bedding; and time since last bedding
change.

The severity of nasal symptoms (nasal blockage, itching, rhinorrhea, and sneezing) was recorded on the day the first dust sample was
collected. A four-point scale was used to evaluate each symptom: 0
no symptom; 1 mild; 2 moderate; and 3 serious. Total scores
were calculated to measure the overall severity of the symptoms.

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Risk factors of indoor allergens

The 19 environmental factors in the questionnaire were analyzed
using multivariate linear regression analysis and stepwise method
selection. The retained risk factors for indoor allergens were age of
pillow and age of mattress (Table 2).

Correlation of HDM allergen concentrations and

serum sIgE or nasal symptoms
The correlations between indoor allergen concentrations and serum
sIgE or nasal symptoms are shown in Table 3. No significant relation-

e194

Our data suggest that HDM is an important allergen source in

central China. In both summer and winter, HDM allergen levels are
high in households. In this study, the mean Der p 1 Der f 1 levels
in summer and winter were 11.48 and 12.12 g/g, respectively. The
percentage of samples with high levels (10 g/g) of Der p 1 Der
f 1 was 44% in summer and 46% in winter; only 10% of the samples
were under 2 g/g. This is consistent with the premise that HDM
allergen levels above 10 g/g are likely to be associated with allergy
symptoms.11 Previous studies1214 reported variable levels of Der p 1
and Der f 1 in the United States and Europe, but HDM allergen
exposure was generally lower than in our investigation. Der f 1 levels
were higher than Der p 1 (p 0.01) in this study. There is no obvious
explanation for this observation, but it may be due to differences in
the two biologic species.2
Our results demonstrated that there was no significant difference
between HDM allergen levels in winter and summer, which is consistent with the report by Li et al.,9 which showed that there were no
robust changes in sensitization to Der p and Der f in a 12-month
period in four regions of China. It has been shown that the temperature in homes is controlled by residents, regardless of the season.15
An integrated measurement for one heating season can thus predict
the indoor climate for other heating seasons. In addition, the popular
use of air conditioners and heating systems makes for constant indoor
temperatures and humidity levels in this study. However, Feng et al.16
found a seasonal distribution of HDMs in regions in central China,
including Wuhan.17 HDMs reached a peak in summer and a trough in
winter (see Fig. 1).
Our results indicate that there was a significant correlation between
HDM allergen level and the age of pillows and mattresses. Previous
studies18,19 suggested that the age of a mattress was associated with
bedding dust mites. Frequent replacement of mattresses can reduce
the concentration of dust mites. Other factors such as age and size of
the building, pets, material of pillows and mattresses, cleaning frequency, etc. had no influence on indoor dust mites in this study.
In our study, the adjusted R2 for the multiple regression analyses
were 0.450 and 0.389. This means that 45% of the variation was
explained by factors considered in this study. Our data suggest that
allergic patients should be advised to use newer pillows and mattresses to lower HDM allergen levels.
The concentrations of Der p 1 Der f 1 were positively related to
nasal itching symptoms. Allergic sensitization to HDM and asthma
has been shown to be related to HDM allergens at an early age in
children.20 However, few published data show the correlation between nasal itching symptoms and HDM allergens. Moon and Choi21
found that nasal symptoms were alleviated after environment control
of mite exposure in AR patients, whereas Rijssenbeek-Nouwens et
al.22 found no change of rhinitis symptoms with environment control.
In our study, patients were only sensitized to HDM, which reduced

Statistical analysis

Fifty patients were recruited in the study, including 24 males and

26 females. The average age was 21.4 13.9 years old. A hundred
dust samples (two samples, one in summer and one in winter, for
each patient) were collected. The indoor allergen concentrations are
shown in Table 1.
The mean Der f 1 levels in summer and winter were 7.27 and 7.26
g/g, respectively. Compared with the levels of Der f 1 in summer
and winter, Der p 1 was lower (4.21 and 4.86 g/g, respectively);
however, there was no significant difference between HDM allergens
in winter and summer (p 0.05).

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DISCUSSION

Rhinitis symptom scores

Allergen levels

p
0.642
0.995
0.766

ship was found between the exposure level of indoor HDM allergens
and sIgE in serum (r 0.249, r 0.313; p 0.05) (data not shown).
There was a weak positive significant correlation between nasal itching symptom scores and concentrations of HDM allergen (r 0.302,
p 0.039).

Serum samples were obtained and stored at 18C until the sIgE
tests. The UniCAP100 automatic diagnostic system was used for sIgE
determination of Der p and Der f.

RESULTS

Winter
4.86 8.58
7.26 9.46
12.12 12.64

Plus-minus values are means standard deviation. Data for allergens are
the means of within-person medians.

sIgE detection

Excel 2007 was used for data sorting and SPSS 17.0 was used for
statistical analyses. HDM allergens from the winter and summer
beddings were compared using the 2 test. The results were expressed
as means standard deviation with 95% confidence intervals. Multivariate regression analysis was used to analyze the risk factors for
allergen content in the living environment. A Pearson correlation
coefficient was used to measure the correlation between variables.
Linear regression was used to analyze the rhinitis symptom scores
total score, and the correlation of nasal symptoms was assessed using
the stepwise screening method. A p value of less than 0.05 was
considered significant.

Summer
4.21 4.87
7.27 6.13
11.48 8.34

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Table 2. Correlation between HDM allergen (Der p 1 Der f 1) and age of pillow and mattress
Model

Not Standardized Parameters

B regression coefficient
Standard error

Constants in winter
Age of pillow
Age of mattress
Constants in summer
Age of mattress

48.268
4.129
4.565
37.978
13.295

Standardized Coefficients

0.384
0.345

0.644

1.054
2.388
2.142
1.226
5.458

0.298
0.022
0.038
0.227
0.049

37.848
1.729
2.131
24.665
2.436

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The HDM concentrations (Der p 1 Der f 1) were calculated with multivariate linear regression.
F 16.786; R2 0.450
Winter: Der p 1 Der f 1 48.268 4.129 * age of pillow 4.565 * age of mattress
F 26.701 R2 0.389
Summer: Der p 1 Der f 1 37.978 13.295 * age of mattress.
Table 3. Spearman correlation between exposure level to allergen and nasal symptoms
Nose Blockage
r
p
Der p 1
Der f 1
Der p 1 Der f 1

0.019
0.076
0.107

Itching

0.901
0.624
0.472

0.119
0.239
0.302

0.427
0.118
0.039

Rhinorrhea
r
p
0.056
0.039
0.034

RSS rhinitis symptom scores.

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0.707
0.801
0.819

Sneezing

0.088
0.227
0.203

0.558
0.138
0.172

RSS

0.014
0.222
0.251

0.927
0.148
0.088

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Figure 1. Distribution of allergen levels of HDM. Percentage of dust samples with HDM allergen concentrations less
than 2 g/g, 210 g/g, and more than 10 g/g of dust. High
levels (10 g/g) of Der f 1 were 26% and 22% in summer
and winter, respectively. Der p 1 allergen concentrations
were 16% and 14%, respectively. The percentage of samples
with high levels (10 g/g) of Der p 1 Der f 1 was 44%
in summer and 46% in winter.

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the interference from other allergens. Patients living in multistory

buildings in the urban area of Wuhan city also had low environmental variety. The symptoms of rhinitis were investigated only in summer, avoiding interference from the stimulation of nasal symptoms by
cold air in winter; this allowed us to better evaluate the correlation
between concentrations of dust mites and nasal symptoms.
Our study provided novel evidence that there was no significant
correlation between HDM allergen concentrations and levels of sIgE
in serum of AR patients. Similarly, no significant correlation was
found between the exposure levels of Der p 1/Der f 1 and the sIgE
level in the Inner Mongolia region of China.23 Furthermore, a recent
study24 reported that no effect was seen in high mite allergens and
asthmatic patients with high levels of mite-sIgE. It was also reported
that sIgE could vary between different genotypes in the same environment. Kurowski et al.25 showed that in patients with the CD14/
1359 GG and CD14/159CC genotypes, there was a positive correlation between Der p 1 sIgE and the levels of dust mites in bedding,
whereas there was no such correlation in patients with other genotypes. This suggested that specific sensitization and allergies might be

associated with polymorphisms of innate immune response genes

and modified by allergen exposure in the environment.
In conclusion, our findings provide evidence that HDM allergens
are abundant in the urban areas of Wuhan. The allergen concentrations are highly associated with the age of mattresses and pillows. The
level of exposure to dust mites is implicated in nasal itching symptoms.

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