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Health condition · Clinically reviewed

Dust mite allergy, the year-round trigger of rhinitis, asthma and eczema.

House dust mites are the most common indoor allergen in the UK - a stepped medical plan, sensible avoidance and, where needed, immunotherapy give lasting control.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSACI, NICE and peer-reviewed allergy sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK allergy practice including HDM sublingual immunotherapy (Acarizax) and biologics for severe asthma.

Key facts

Dust mite allergy at a glance.

The essentials, in plain English - what it is, what it causes and the treatments that actually change outcomes.

  • What it is

    IgE-mediated allergy to house dust mite faecal proteins - the most common indoor perennial allergen worldwide.

  • The mites

    Dermatophagoides pteronyssinus and D. farinae - microscopic, harmless to touch, feeding on skin flakes in bedding and soft furnishings.

  • The allergens

    Der p 1, Der p 2 and Der p 23 - protease enzymes in mite droppings that provoke IgE and drive airway and skin inflammation.

  • How common

    Around 10 to 20 percent of UK adults show HDM sensitisation. Very common in atopic children and adults.

  • What it causes

    Perennial allergic rhinitis, allergic conjunctivitis, atopic asthma flares and eczema flares - often overlapping.

  • Disease-modifying

    Sublingual immunotherapy (Acarizax) is the only treatment that changes the underlying allergy over years.

Why this guide matters

A perennial problem needs a perennial plan.

Dust mite disease is not seasonal and does not respond to one-off measures. The three ideas below shape everything else on this page.

  • Confirm the allergen

    Skin prick testing and specific IgE, ideally with component-resolved diagnostics, separate HDM allergy from pollen, pets and moulds.

  • Treat every day

    Intranasal steroids and asthma preventers only work with daily use over weeks. On-demand antihistamines alone rarely control perennial disease.

  • Consider immunotherapy

    For persistent symptoms despite optimised medical therapy, sublingual immunotherapy (Acarizax) offers a disease-modifying option.

How the diagnosis is made

From first symptoms to a confirmed diagnosis.

The steps a UK GP or allergy specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Allergy-focused history

    Perennial symptoms worse indoors, at night and on waking - and often worse in autumn and winter as heating traps humidity.

  2. 02

    Assessing

    Rule out seasonal triggers

    Dust mite disease is year-round. Purely spring or summer flares point to pollen; pet-linked flares point to dander.

  3. 03

    Assessing

    Impact on daily life

    Sleep, school and work impact drive the treatment ladder more than symptom counts alone.

  4. 04

    Confirming

    Skin prick testing (SPT)

    Specialist allergy clinic test using purified HDM extract - fast, safe and gives a live wheal-and-flare reading.

  5. 05

    Confirming

    Specific IgE blood test

    ImmunoCAP for HDM, with component-resolved testing (Der p 1, Der p 2, Der p 23) to confirm the true allergen and immunotherapy readiness.

  6. 06

    Confirming

    Assess coexisting airway disease

    Spirometry and FeNO where asthma is suspected - HDM is a major driver of atopic asthma.

  7. 07

    Planning

    Specialist allergy referral

    For persistent symptoms despite optimised medical therapy, or where immunotherapy is being considered.

Typical timeline: from first GP visit to a settled specialist plan in weeks to a few months.

Symptoms

What dust mite allergy actually feels like.

A perennial mix of nasal, eye, chest and skin symptoms - worst in the bedroom, worst on waking, and often overlooked as a persistent cold.

  • Perennial allergic rhinitis

    Year-round sneezing, clear rhinorrhoea, nasal blockage and an itchy nose - worst on waking and at home.

  • Allergic conjunctivitis

    Itchy, watery, gritty red eyes - often bilateral and worse indoors around soft furnishings.

  • Atopic asthma flares

    Wheeze, cough and chest tightness triggered by dusting, bed-making or overnight exposure to mite-heavy bedrooms.

  • Eczema flares

    HDM is a well-recognised trigger of atopic dermatitis - flares often mirror airway symptoms.

  • Chronic sinusitis and post-nasal drip

    Long-standing nasal inflammation drives a blocked nose, throat clearing and sinus pressure.

  • Morning symptom peak

    Bedroom exposure over 6 to 8 hours means symptoms are usually worst on waking, easing through the day outdoors.

  • Adult-onset atopic disease

    HDM allergy can present or worsen in adulthood after a house move, damp exposure or renovation.

  • Red flag - uncontrolled asthma

    Frequent reliever use, night waking or hospital attendance means the asthma plan needs urgent stepping up.

Treatment

How dust mite allergy is treated in the UK.

Sensible avoidance, daily nasal steroids and antihistamines, proper asthma control and, where symptoms persist, sublingual immunotherapy or biologics.

  • Allergen avoidance

    Allergen-proof mattress and pillow encasings, hot washing of bedding at 60 degrees weekly, HEPA vacuuming and humidity control below 50 percent. Modest but reasonable adjunct.

  • Intranasal corticosteroids

    Daily fluticasone, mometasone or budesonide - or combined Dymista - is the mainstay for perennial allergic rhinitis. Use every day, not on demand.

  • Non-sedating antihistamines

    Cetirizine, fexofenadine or loratadine daily to control sneezing, itch and eye symptoms alongside the nasal steroid.

  • Ocular antihistamine drops

    Olopatadine or ketotifen for troublesome eye itch and watering not controlled by systemic antihistamines.

  • Saline nasal rinse

    Isotonic saline douching once or twice daily - simple, cheap and clears allergen and mucus before the steroid spray.

  • Asthma preventer inhaler

    Inhaled corticosteroid, often with a long-acting beta agonist, is the backbone of atopic asthma care. Never rely on the reliever alone.

  • Sublingual immunotherapy

    Acarizax - a NICE-approved HDM SLIT tablet for persistent allergic rhinitis and mild-to-moderate HDM asthma. Three years of daily treatment, disease-modifying.

  • Biologics for severe asthma

    Omalizumab (anti-IgE) and other biologics for severe uncontrolled atopic asthma where HDM is a driver - specialist-only.

What this guide is based on

The sources behind every claim on this page.

UK and international allergy society guidance current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or allergist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • BSACI (British Society for Allergy and Clinical Immunology). Guideline for the management of allergic and non-allergic rhinitis.

  • NICE TA787. Acarizax (house dust mite allergen extract) for treating allergic rhinitis and asthma.

  • GINA (Global Initiative for Asthma). Global strategy for asthma management and prevention.

  • EAACI. Guidelines on allergen immunotherapy for house dust mite-driven respiratory allergy.

  • MHRA. Prescribing information for Acarizax and Omalizumab (Xolair).

Red flags

When dust mite allergy needs urgent attention.

Most dust mite disease is managed in primary care with specialist support. These are the situations where a specialist opinion is essential.

  • Uncontrolled asthma

    Frequent reliever use, night waking, exercise limitation or unscheduled care needs an urgent review of the asthma plan.

  • Anaphylaxis on immunotherapy

    SCIT is delivered under specialist supervision because of the rare risk of severe systemic reactions. Adrenaline and observation are on hand.

  • Oral swelling on SLIT

    Local oral itch is common in the first days of Acarizax - severe swelling, throat tightness or breathing difficulty means stop and seek urgent help.

  • New-onset wheeze in a child

    Persistent wheeze, cough or exercise limitation deserves a proper asthma assessment, not just an over-the-counter antihistamine.

  • Failure to thrive with eczema

    Severe childhood eczema and poor weight gain warrant paediatric review - allergy testing may be part of the workup.

  • Occupational exposure

    Cleaners, textile workers and warehouse staff with heavy HDM exposure and worsening asthma deserve an occupational health opinion.

  • Overlapping severe allergies

    Multiple perennial allergens, food allergy or drug allergy needs a coordinated allergy clinic plan, not piecemeal treatment.

  • Persistent nasal polyps

    Blocked nose that never responds to steroid spray, with anosmia, may reflect polyps - ENT review is warranted.

  • Suspected mould or damp

    Visible damp, mould or a musty smell at home can drive both HDM growth and separate mould allergy - environmental review helps.

Living with it

A treatable allergy, with a clear ladder.

Four things that make the biggest difference day to day - bedroom hygiene, humidity control, daily preventers and knowing when to consider immunotherapy.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for months do more than a heroic week of cleaning that does not last.

  1. 01 Bedroom

    Treat the bedroom first

    You spend a third of the day in bed - encasings, hot washing and clutter reduction earn their keep here first.

  2. 02 Humidity

    Keep it dry

    Aim for humidity below 50 percent - ventilate, dry laundry outside where possible and consider a dehumidifier in damp rooms.

  3. 03 Daily

    Take the preventers daily

    Intranasal steroids and asthma preventers only work when used every day - not just on bad days.

  4. 04 Long-term

    Consider immunotherapy

    If daily medication is not enough, or you want to change the underlying allergy, ask about sublingual immunotherapy.

Frequently asked

Everything we get asked about dust mite allergy.

Quick answers on testing, avoidance, medication and immunotherapy.

  • What is a dust mite allergy?

    An IgE-mediated allergic reaction to protease proteins in house dust mite droppings - most notably Der p 1, Der p 2 and Der p 23. It is the most common indoor perennial allergen and drives allergic rhinitis, conjunctivitis, atopic asthma and eczema flares.

  • Why are my symptoms worse in bed and on waking?

    Mattresses, pillows and bedding hold the highest concentrations of dust mites in the home. Six to eight hours of overnight exposure produces peak nasal, eye and airway symptoms first thing in the morning.

  • Do mattress encasings and hot washing actually work?

    Single measures rarely fix the problem, but a bundled approach - allergen-proof encasings, weekly bedding wash at 60 degrees, humidity control, HEPA vacuuming and clutter reduction - offers modest, worthwhile benefit alongside medical treatment.

  • Is Acarizax available on the NHS?

    Yes - NICE TA787 approves Acarizax for adults with persistent moderate-to-severe HDM allergic rhinitis despite optimised medical therapy, and for mild-to-moderate HDM-driven asthma with rhinitis. It is a daily sublingual tablet taken for three years and is disease-modifying.

  • What is the difference between SLIT and SCIT?

    Sublingual immunotherapy (SLIT) is a daily tablet dissolved under the tongue at home after the first supervised dose - Acarizax is the licensed HDM option. Subcutaneous immunotherapy (SCIT) is regular injections in a specialist allergy centre. Both retrain the immune system over three years.

  • When should I see an allergy specialist?

    When perennial symptoms are not controlled by daily intranasal steroids and antihistamines, when asthma is not controlled on preventers, when several allergens overlap, or when you want to explore immunotherapy. A specialist allergy clinic offers testing, component-resolved diagnostics and a coordinated plan.

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