Pigeon mite: An underdiagnosed cause of papular urticaria

Dermanyssus gallinae, known as bird mite, generally lives on nestlings' featherless skin. Humans are accidentally infected, and itchy dermatitis is induced when the mites are unable to use birds' blood. The diagnosis is difficult due to the very small size and rapid movement of the mites, which make them hard to spot.A 14-year-old male and his mother were referred to the allergy clinic complaining of a 2-week generalized itchy cutaneous papular lesion, unresponsive to antihista-mines, with the feeling of an insect moving on the surface of the skin. Due to the history of recently hatched pigeons nesting on their balcony and finding very small bugs, diagnosed as D. gallinae, they were instructed to clean the pigeon's nest as the source of these parasites, which successfully solved the problem.Bird mite infestation should be considered in the differential diagnosis of recurrent pruritus and urticaria, refractory to conventional treatments. Physicians should be aware of this mite infestation in approach to any patient with papular urticaria.