House dust mites belong to the most potent indoor allergen sources worldwide and are associated with allergic manifestations in the respiratory tract and the skin. Here we studied the importance of the high molecular weight allergen, Der p 11, in HDM allergy. Sequence analysis showed that Der p 11 has high homology to paramyosins from mites, ticks and other invertebrates. A synthetic gene coding for Der p 11 was expressed in Escherichia coli and rDer p 11 purified to homogeneity as folded, alpha helical protein as determined by circular dichroism spectroscopy. Using antibodies raised against rDer p 11 and immunogold electron microscopy, the allergen was localized in the muscle beneath the skin of mite bodies but not in faeces. IgE reactivity of rDer p 11 was tested with sera from HDM allergic patients from Europe and Africa in RAST-based dot-blot assays. Interestingly, we found that Der p 11 is a major allergen for patients suffering from atopic dermatitis (AD), whereas it is only a minor allergen for patients suffering from respiratory forms of HDM allergy. Thus, rDer p 11 might be a useful serological marker allergen for the identification of a subgroup of HDM allergic patients suffering from HDM-associated AD.Journal of Investigative Dermatology accepted article preview online, 07 July 2014; doi:10.1038/jid.2014.271.