Comment

Given the strong circumstantial evidence to suggest that house dust mite allergens may play a part in atopic eczema, it is a pity that so few studies on house dust mite avoidance have been performed. Those that have been done tend to be small and it is difficult to generalise in the absence of more pragmatic studies. In none of the studies was the method of randomisation and concealment reported, and no ITT analyses were performed (although dropouts were quite low).

Further studies that separate the different interventions for reducing house dust mite are needed. It is important that such trials are as pragmatic as possible to determine which groups respond best, which interventions are the most cost-effective, and whether the laborious interventions are sustainable in less motivated people.

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