This PRISMA-compliant systematic review synthesized evidence from 2014–2025 (92 studies from 3,371 records) on pediatric HDM allergy management, comparing environmental controls, SLIT vs. SCIT, and biologics (omalizumab, dupilumab), and evaluated the role of component-resolved diagnosis (CRD) in guiding treatment. It also mapped geographic sensitization patterns and proposed a CRD-guided, resource-stratified stepped-care framework for children ≤18 years.
Physical interventions cut Der p 1 by 45–60% short-term but failed to improve clinical outcomes (meta-analysis of 17 RCTs), with adherence <42%. SLIT had fewer systemic reactions than SCIT (OR 2.6, 95% CI 1.8–3.8), while SCIT showed better symptom remission in polysensitized children (40% vs. 25%; RR 1.60, 95% CI 1.12–2.28). Omalizumab improved FEV1 by +12.5% (p<0.01) in severe asthma but costs ~$30,000/year. CRD identified Der p 23 as a biomarker for asthma severity (OR 2.5, 95% CI 1.3–4.8) and revealed Der p 1 dominance in Asia (58.2% in southern China) vs. Der p 23 in Europe (36.7%).
- Substantial clinical heterogeneity precluded meta-analysis for most outcomes; narrative synthesis limits certainty. - Evidence from low-income regions is scarce, restricting global generalizability. - The proposed stepped-care framework is conceptual only and has not been prospectively validated; several recommendations (e.g., dupilumab for AD, EoE management) are extrapolated from general atopic disease literature rather than HDM-specific trials.
Use CRD to distinguish monosensitized from polysensitized children: favor SLIT for mild or monosensitized cases and SCIT for polysensitized patients, with biologics reserved for severe, refractory disease. Note that environmental controls alone are unlikely to improve clinical outcomes despite reducing allergen levels, so immunotherapy should not be deferred based on avoidance measures alone.
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