title: Dust mite avoidance for the primary prevention of atopic dermatitis: A systematic review and meta-analysis.
abstract: BACKGROUND
  Dust mite sensitization plays a controversial role in the development of atopic dermatitis. Despite a lack of evidence for its efficacy, dust mite avoidance is commonly recommended for the prevention and treatment of atopic dermatitis. We aimed to evaluate whether dust mite avoidance strategies reduce the risk of developing atopic dermatitis in high-risk infants compared to randomized controls.
  
  
  METHODS
  Studies were obtained by searching MEDLINE, PubMed, Scopus, The Cochrane Library, and The Global Resource of Eczema Trials databases. We included randomized, controlled trials of high-risk infants treated with a dust mite avoidance intervention and assessed for atopic dermatitis. Data were extracted independently by two reviewers using predefined criteria.
  
  
  RESULTS
  Seven randomized controlled trials met our inclusion criteria (total n = 3040). Studies were largely unblinded but otherwise of reasonable quality. Three trials utilizing a dust mite avoidance approach but not additional interventions were combined in a meta-analysis. Dust mite avoidance provided no benefit in the prevention of atopic dermatitis (relative risk (RR) = 1.08, 95% confidence interval (CI) = 0.78-1.49, I(2) = 73%).
  
  
  CONCLUSIONS
  Dust mite avoidance strategies alone or in combination with additional allergen avoidance modalities do not decrease the risk of developing atopic dermatitis and, given the current state of the evidence, should not be recommended for this purpose. The utility of dust mite avoidance for the treatment of atopic dermatitis or for the prevention and treatment of asthma or seasonal rhinoconjunctivitis are outside the scope of this review.
authors.affiliation: Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Bremmer
authors.affiliation: Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
mesh_terms: D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000009:adverse effects / Q000276:immunology; D003876:Dermatitis, Atopic / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control*; D006801:Humans; D015233:Models, Statistical; D011322:Primary Prevention / Q000379:methods*; D039981:Pyroglyphidae / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000485:Allergens; D039741:Antigens, Dermatophagoides
keywords: atopic dermatitis; dust mite; meta-analysis; prevention; randomized controlled trial; systematic review