D2.139 - Atypical Presentation of House Dust Mite–Induced Atopic Asthma in an Adolescent Girl: A Case Report from a Remote Region of Kyrgyzstan

BackgroundAsthma in adolescents may present with atypical symptoms, leading to delayed diagnosis, particularly in low-resource or remote regions. Syncope and palpitations are rare initial manifestations of asthma and often prompt cardiologic and neurologic evaluations before allergic causes are considered.

Case PresentationA 15-year-old girl from a remote region of Kyrgyzstan presented with recurrent episodes of palpitations, shortness of breath, and transient loss of consciousness. Symptoms occurred exclusively during household cleaning, especially while vacuuming. Each episode began with palpitations, followed by acute dyspnea and syncope. The symptoms first appeared in early autumn 2025. The patient and her family sought allergology consultation in November 2025.

The patient had no previous history of allergic diseases and denied a family history of atopy. She was born from the first pregnancy and delivery. Initial assessment by a local pediatrician resulted in referrals to a cardiologist and neurologist. Electrocardiography was normal, and no abnormalities were identified on cardiologic or neurologic examination.

On examination, the patient was alert and cooperative, appropriate for pubertal age. Body weight was 52 kg, height 160 cm. Blood pressure was 100/60 mmHg, heart rate 62 beats per minute. Skin examination revealed no rashes. Lung auscultation was normal, without wheezing. Other systemic examinations were unremarkable.

Laboratory testing revealed mild anemia. Total serum IgE was markedly elevated (1000 IU/mL). Molecular allergy diagnostics showed significant sensitization to house dust mite allergens Der p 1 and Der p 23. Spirometry demonstrated obstructive ventilatory impairment consistent with bronchial asthma. Fractional exhaled nitric oxide (FeNO) levels were elevated, indicating eosinophilic airway inflammation typical of atopic asthma.

Diagnosis and ManagementThe patient was diagnosed with moderate persistent atopic bronchial asthma with severe house dust mite sensitization. Treatment with inhaled corticosteroid and long-acting β₂-agonist combination therapy, along with environmental control measures, was initiated.

ConclusionThis case illustrates an unusual presentation of atopic asthma with syncope triggered by indoor allergen exposure. It emphasizes the importance of considering allergic asthma in adolescents with unexplained syncope and highlights the diagnostic value of molecular allergology and FeNO, especially in underserved regions.