Ms. Huang brought her 10-year-old son, Xiao Chong, to our pediatric specialist clinic to see a doctor. As soon as she saw me, without saying a few words about the child’s condition, tears flowed down her face, and she was very distressed. It turned out that Xiao Chong had recurrent coughs and colds since he was just over 1 year old, and the doctor diagnosed him with bronchial asthma. The family was equipped with all the inhalation devices, including the nebulizer pump and dry powder used when he was a child. The child’s asthma symptoms improved significantly after inhaling the medication. In the past two years, he stopped wheezing and only sneezed and had a runny nose frequently. The child had a severe asthma attack 2 weeks ago when the weather changed, and his asthma was so bad that he couldn’t sleep at home even after 3 emergency wheezing relief medications. I inquired about the child’s medical history and medication history, gave a detailed physical examination of Xiaochong, and found that the child’s bilateral turbinate mucosa was pale and edematous, the pulmonary ventilation function FEV1 was 80.3% of the expected value for a normal child, the excitation test (+), and the FEV1 decreased by 35.5% after inhalation of histamine 0.24 μmol. Skin prick testing for allergens: house dust mite, dust mite, and tropical mite were all strongly positive. Blood sampling: total IgE was as high as 861μg/ml, house dust mite specific IgE (d1) > 100μg/ml, grade 6; dust mite specific IgE (d2) > 100μg/ml, grade 6; tropical mite specific IgE (d201) > 100μg/ml, grade 6. Ms. Huang asked me a series of questions with this result and said with great concern, “Now that my child is older and has a heavy study load, and my family is planning to send him to study abroad, his condition is really reassuring. How can there be allergens in the house, which is always sanitized? Mites are so powerful, how can I treat them better?” 1. What are allergens? Allergic factors are generally considered to be the main cause of the occurrence of asthma. There are thousands of proven allergens that can cause allergic diseases in humans, among which rhinitis and asthma are mainly caused by inhalation allergens, including house dust mites, dust mites, tropical mites, animals, fur, fungi and pollen. Dust mites are the main allergens in China. In our pediatric outpatient clinic, 15 common inhalant allergens were tested on children over 5 years old with asthma and (or rhinitis), and the positive rate was as high as 85.8%; these children had the highest positive rate of allergy to house dust mites, 79.8%, followed by dust mites and tropical mites, 72.7% to 65.0% respectively, and the rest of the common allergens were: dog hair, cat hair, cockroaches The rest of the common allergens are: dog hair, cat hair, cockroaches, molds and pollen, etc. Dust mite is a spider-like flat louse animal, because the body length is only 0.3 mm, the general naked eye can not see, only through the microscope to see. Dust mites like to live in a warm and humid environment and feed on human skin flakes, so they grow and breed in mattresses, carpets, pillows, sofas and clothing. That is to say, where people live, there is dust mite growth, which is very difficult to avoid. 2.Why does Xiao Chong’s asthma recur? As children with respiratory allergic diseases grow older, their ability to move around on their own increases, they are exposed to inhalant allergens for a longer period of time, and their exposure to various inhalant allergens increases, so the more likely they are to be sensitized. The direct exposure and repeated stimulation of allergens can lead to abnormalities in the body’s immune response, which also leads to recurrent and uncontrollable disease. In our study, we found that recurrent rhinitis, eye, and poorly controlled asthma symptoms are risk factors for mite (including house dust mite, dust mite, and tropical mite) sensitization as age increases. In the prevention and control measures of allergic asthma and allergic rhinitis in children, avoidance of allergen exposure is an important factor to be taken into account in both pharmacological treatments. Although there are multiple means, including physical and chemical methods to reduce mite breeding and standardized ICS methods to treat patients with asthma and rhinitis, although effective, they still do not reduce symptom scores and medications to control symptoms in this group of patients. And patients whose mites have induced sensitization of the organism are at increased risk of allergy to other allergens. The evolution of a single allergen into multiple allergens not only makes it more difficult for patients to avoid allergen exposure, but also makes it easier to trigger recurrent allergic symptoms and affect the control of asthma and rhinitis. These reasons have led to the recurrence of Xiaochun’s disease. 3.Do I have to use inhaled hormones for the rest of my life? At present, inhaled surface hormone is the main drug treatment to achieve asthma control. Standardized adherence to inhaled ICS therapy can benefit most asthma patients. If asthma control can be maintained for about one year with the lowest dose of medication, the medication can be considered to be discontinued, and lifelong medication is not necessarily required. However, inhaled medication is nonspecific. Some patients with asthma or rhinitis who are severely allergic to dust mites, or patients with allergic asthma or rhinitis who still have recurrent symptoms after standard inhalation treatment, it is advisable to choose desensitization therapy for allergens, and in the process of desensitization therapy, the doctor adjusts the dose of medication according to the patient’s condition, and about 80% of these patients are able to stop medication completely. 4.Is it appropriate to choose specific desensitization treatment for small flushes? According to the Global Guidelines for the Control of Asthma (GINA) and the World Health Organization (WHO), standardized desensitization (specific immunotherapy) can be considered for children with asthma whose asthma attacks cannot be effectively controlled with inhaled medications and who clearly have unavoidable allergens (e.g. mite allergy), mainly for children over 5 years old. Xiaochong has been treated with ICS regularly for almost 6 years, and after stopping the medication he had another asthma attack, and house dust mite, dust mite and tropical mite are at very high levels in vitro and in vivo, and these mites are unavoidable allergens. If Xiaochong has been under repeated stimulation of allergens, it is more difficult to avoid asthma attacks, and desensitization therapy can be considered. The method is to inject a low dose of allergen (such as Androda) subcutaneously, then slowly increase the dose and reach the optimal fixed therapeutic dose for the patient in about four months, then slowly increase the dose and maintain the treatment with a frequency of 1 to 2 months of injections (depending on the progress of the treatment), so that the patient gradually develops a normal immune response to the allergen without allergic reactions, which is a very effective treatment for the cause of the disease. It is a very effective treatment for the cause of asthma, with about 80% of patients being able to stop the drug completely and achieve long-term stability of asthma symptoms. The disadvantages of desensitization are the high cost and the long duration of treatment, which takes at least 2 to 3 years for the whole course of treatment. For allergic asthma with clear allergens, it is advocated to be performed in the early stages of asthma, when irreversible airway damage has not yet occurred. In contrast, the FEV1 of patients in the late stage is still lower than 70% of the expected value even after standardized drug treatment, suggesting that irreversible damage may already exist at this time, and desensitization is not advocated, because the efficacy of desensitization in this state will be poor and it is easy to stimulate serious side effects. Allergic factors are important risk factors associated with the development of allergic asthma or allergic rhinitis. Therefore, for the prevention and treatment of allergic asthma or allergic rhinitis in children, avoidance of allergen exposure is an important factor to be taken into account in both pharmacological treatments, and the implementation of standardized specific desensitization therapy for asthma and rhinitis patients with mite allergy helps in early intervention of the disease and is one of the important therapeutic tools to achieve and maintain and achieve long-term control of asthma.