Indoor Allergy Research Articles

Component-Resolved Diagnosis of American Cockroach (Periplaneta americana) Allergy in Patients From Different Geographical Areas

Background: Manifestation of respiratory allergy to American cockroach (Periplaneta americana) is prominent in the subtropical and tropical areas. However, co-existing perennial indoor inhalant allergies frequently compromise clinical diagnosis of cockroach allergy, and the analysis of sensitization pattern is limited by the lack of Periplaneta allergens widely available for component-resolved diagnostics (CRD).Objective: To evaluate a collection of previously described recombinant Periplaneta allergens for CRD in cockroach allergy.Methods: A panel of nine recombinant Periplaneta allergens (Per a 1–5, 7–10) was generated, purified, and subjected to physicochemical characterization by applying circular dichroism (CD) spectroscopy, dynamic light scattering (DLS), amino acid (AA) analysis, and mass spectrometry (MS). Patients (n = 117) from India, Korea, Venezuela, and Iran, reporting perennial respiratory indoor allergies with IgE sensitization to cockroach (P. americana and/or Blattella germanica), were included. The sensitization profile was monitored by the experimental ImmunoCAP testing.Results: ImmunoCAP testing confirmed IgE sensitization to Periplaneta and/or Blattella extract in 98 of 117 patients (r = 0.95). Five out of 117 patients were sensitized to only one of the two cockroach species. Within the whole study group, the prevalence of sensitization to individual allergens varied from 4% (Per a 2) to 50% (Per a 9), with the highest IgE values to Per a 9. Patients from four countries displayed different sensitization profiles at which Per a 3 and Per a 9 were identified as major allergens in India and Korea. Periplaneta-derived lipocalin and myosin light chain were characterized as new minor allergens, designated as Per a 4 and Per a 8. Periplaneta extract showed higher diagnostic sensitivity than all individual components combined, suggesting the existence of allergens yet to be discovered.Conclusion: Utilization of a panel of purified Periplaneta allergens revealed highly heterogeneous sensitization patterns and allowed the classification of lipocalin and myosin light chain from Periplaneta as new minor allergens.

Update to asthma guidelines covers ICS, LAMAs, indoor allergy mitigation, more

In December 2020, the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee released a focused update to its 2007 asthma guidelines. The update covers only select topics, such as intermittent use of inhaled corticosteroids (ICS), the role of long-acting muscarinic antagonists (LAMAs), indoor allergy mitigation, use of immunotherapy, bronchial thermoplasty, and fractional exhaled nitric oxide (FeNO) testing.

Outdoor Allergies are Associated with Increased Oral Corticosteroid Use in Children with Allergic Asthma in New York City: A Single-Center Retrospective Study

Sensitization and exposure to environmental allergens is well known to be related to asthma morbidity; however, individual populations may vary with respect to specific risk factors associated with exacerbations. Among children with asthma in our urban community practices, we sought to better characterize children with the allergic asthma phenotype to identify allergic predictors of poor asthma outcomes. This is a single-center retrospective chart review using electronic health records of 264 children (3 to 21 years) with asthma in New York City, with outpatient encounters at NYPH-Weill Cornell Medicine from January 2015 to April 2019. Descriptive statistics were used to define allergic (N = 213) and nonallergic (N = 54) groups. Logistic regression models were used to assess the association between allergy status and asthma severity. Among children with allergic asthma, 48.4% had both indoor and outdoor allergies. Subjects with indoor and outdoor allergies had increased odds (ORunadj 3.65; 95% CI 1.36-9.76, p=0.010) of having persistent asthma, compared to having indoor allergies alone. Compared to the non-allergic group, subjects with outdoor allergies had increased odds (ORunadj 7.29; 95% CI 1.44-37.01, p=0.017) of asthma exacerbations requiring oral steroids. There were no associations between the degree of sensitization and asthma exacerbations, severity or control. In this cohort, outdoor allergies is an important risk factor for asthma exacerbations over degree of sensitization, or presence of indoor allergies. In addition to avoidance measures, this higher risk subset of patients may benefit from aggressive medication regimens including consideration of targeted allergen immunotherapy, to improve asthma outcomes.

Children With Poorly Controlled Asthma: Randomized Controlled Trial of a Home-Based Environmental Control Intervention

To determine the efficacy of a home-based environmental control (EC) intervention, based on biomarkers for allergen sensitization and secondhand smoke (SHS) exposure, in reducing asthma emergency department (ED) visits among inner-city children with persistent asthma.Children (mean age: 6.3 years) with physician-diagnosed persistent asthma (n = 222) were recruited from an asthma ED visit from August 2013 to February 2016. Subjects had had ≥2 ED asthma visits or >1 hospitalization in the past 12 months and were residents in the Baltimore metropolitan area. Children in foster care and other significant nonasthma respiratory conditions were excluded.In this prospective randomized controlled trial, children in the intervention or attention control group were stratified by age. All children had serological immunoglobulin E testing to common environmental allergens and salivary cotinine measurements for SHS exposure. Caregivers completed surveys about the child’s indoor exposure to mice, cockroaches, cats, and dogs at the baseline, 6-month, and 12-month time points. The intervention group had a medical follow-up visit in the ED within 7 days of enrollment, 2 home nurse visits for asthma follow-up, a targeted EC educational and remediation program based on the child’s sensitizations, and motivational interviews with caregivers of children with a positive salivary cotinine result to encourage a ban on home smoking. The control group had 3 home nurse visits, basic EC education without remediation, and a smoking cessation referral.Most (204 out of 222) completed the study at 1 year. Subjects were 65% boys, 94% African American, and 94% Medicaid insured. Approximately 75% had moderate to severe asthma with >1 asthma ED visit in the previous 3 months. Eighty-three percenthad positive serological allergy test results, and 56% had positive salivary cotinine results. The asthma medication ratio of controller to total controller or rescue canisters used, cotinine levels, mouse or cockroach exposure, symptom-free nights, and caregiver worry about medication side effects were no different between groups. Children who resided in homes with no SHS exposure and who were in the control group, atopic children, younger children, and children with an asthma medication ratio >0.5 were more likely have a repeat ED visit. For children with positive SHS exposure, time to first repeat ED visit did not differ by group. For children with no SHS exposure and after adjusting for age, allergic sensitization, and medication fills, the control subjects (70%) were more likely than intervention subjects (45%) to have a repeat ED visit. Overall, baseline increased controller and rescue medication fills were the only factors associated with increased risk for repeat ED visits for all subjects.Home-based, targeted EC intervention was not more effective in reducing repeat asthma ED visits in children with persistent asthma and SHS exposure compared with controls.This study further illustrates that achieving good asthma control truly requires a consistent, multipronged approach. Indoor allergies and SHS are problematic factors in asthma management, and smoking and/or indoor allergen interventions in other studies have reported mixed success in improving asthma outcomes. The type or number of interventions in this study may have been inadequate and/or did not account for all other caregiver or social challenges. Not considering the baseline and asthma medical management during the study is a significant limitation. Also, this study included mostly inner-city, minority subjects with very poorly controlled asthma, so possibly, these interventions could have different outcomes in other populations.

Clinical and laboratory evaluation of patients afflicted with allergic asthma under immunotherapy

<p align="justify"><strong>Background</strong>: Allergy may be defined as a constellation of signs and symptoms in which the altered immunologic reaction between foreign substance (allergens) and antibodies resulting in pathologic reactions referred as allergic reactions.</p><p align="justify">Allergic asthma is well known type 1- allergic reaction Up to 30% of general population suffers from various form of this malady during normal life span .</p><p align="justify"><strong>Objective:</strong> To evaluate the effects of immunotherapy on groups of Iraqi people afflicted with allergic asthma through some clinical and laboratories tests</p><p align="justify"><strong>Methods: </strong>A cross sectional study was carried out on Iraqi patients ( males and famales) in AL-Zahraa Consultant Center for Allergy and Asthma in Baghdad - Karkh, between Nov. 2013 - Apr. 2014 .The study included 60 asthmatic patients ( 6 - 45 years old) whom had allergy to house mites antigens " through skin test ",in addition to 20 apparently healthy persons as control group.A subcutaneous immunotherapy was given for 3 months, starting from diluted doses which were increased gradually. Clinical assessment was done depending on scoring of signs and symptoms, in addition to the medical history , clinical investigation, skin test, and pulmonary function test .<strong></strong></p><p align="justify"><strong>Results:</strong> Study showed that asthma still affected all age group but tend to be higher in age group 31-45 years with male to female ratio 2:1. Family history to allergic disease play a major role 60% with increase prevalence of reactivity for indoor allergy (House Mites and Moulds).</p><p align="justify">66.7% had positive skin reaction to House Mites which includes D1 ,D2 and D1+D2. The dust found to be one of main aggravating factors. Medical condition had shown significant improvement after three months of giving immunotherapy.<strong></strong></p><p align="justify"><strong>Conclusion:</strong> Immunotherapy need to be considered as one of alternative treatment of allergic asthma decreasing the side effects and cost of different drugs used by these patients when given regularly to them, also detection of prevalent allergens in our local atmosphere and their concentration with detection of their seasonal distribution in different parts of our country is required.</p>

Mapping Mimotopes for House Dust Mite Allergen Der f 7 Using a Specific Monoclonal Antibody.

The dust mite Dermatophagoides farinae is a common worldwide cause of indoor allergies induced by its proteins, including the mid-tier allergen Der f 7. To identify conformational epitopes in Der f 7 using mimotope mapping and computational modelling. Here, we used standard hybridoma technology to generate 3 new monoclonal antibodies against Der f 7 and performed mimotope mapping by probing a random peptide phage display library. Computational tools, including Minox and the DiscoTope-2.0 Server were used to assess the structure and potential position of antigenic residues within Der f 7. Thirteen mimotopes sharing the common sequence --XX[LST]P[-E][LI]MLPLR[-S]- were identified. Further, computationally-predicted conformational epitopes were found at residues 1-7, 10, 27, 76-81, 92, and 130-133 of Der f 7, and the key amino acids for these epitopes were deduced to be 2P, 3I, 10E, 27E, 78E, 79E, 81I, 130S, and 132E based on the common mimotope sequence. We identified Der f 7 peptide mimotopes that may model binding sites for blocking antibodies. These may guide the development of immunotherapy for individuals with hypersensitivity to Der f 7.

Mimotope identification of dust mite allergen Der f 5 using phage‑displayed random peptide libraries.

Mimotope mapping enables the characterization of allergen epitopes for the development of diagnostic and therapeutic approaches. In the present study, a phage display peptide library was used for mimotope mapping based on the binding of antibodies against the recombinant group5 allergen from the house dust mite Dermatophagoidesfarinae (Der f 5), an arthropod that causes indoor allergies worldwide. When three monoclonal anti‑Der f 5 antibodies were used for biopanning, seven mimotopes were identified. Their common subsequence was '‑‑‑[‑A][‑T]W[‑S]H[HSFW][LM][PSKR] [TLV][AST]‑[DP][‑L]‑'. When analyzed in combination with predicted discontinous epitopes, amino acids P2, K3, K4, H5, F11, F13, L14, R72, T77, L79, R84, T39, F40, P44, T45 and K46 were identified as key residues in conformational epitopes of Der f 5. Therefore, the seven mimotopes or modification of the key amino acids may facilitate the development of blocking antibodies or epitope‑specific immunotherapies for mite allergy.

Indoor Allergens and Allergic Respiratory Disease.

The purpose of this review is to evaluate the most recent findings on indoor allergens and their impact on allergic diseases. Indoor allergens are present inside buildings (home, work environment, school), and given the chronic nature of the exposures, indoor allergies tend to be associated with the development of asthma. The most common indoor allergens are derived from dust mites, cockroaches, mammals (including wild rodents and pets), and fungi. The advent of molecular biology and proteomics has led to the identification, cloning, and expression of new indoor allergens, which have facilitated research to elucidate their role in allergic diseases. This review is an update on new allergens and their molecular features, together with the most recent reports on their avoidance for allergy prevention and their use for diagnosis and treatment. Research progress on indoor allergens will result in the development of new diagnostic tools and design of coherent strategies for immunotherapy.

Thioredoxin from the Indianmeal Moth Plodia interpunctella: Cloning and Test of the Allergenic Potential in Mice

Background/ObjectiveThe Indianmeal moth Plodia interpunctella is a highly prevalent food pest in human dwellings, and has been shown to contain a number of allergens. So far, only one of these, the arginine kinase (Plo i 1) has been identified.ObjectiveThe aim of this study was to identify further allergens and characterise these in comparison to Plo i 1.MethodA cDNA library from whole adult P. interpunctella was screened with the serum of a patient with indoor allergy and IgE to moths, and thioredoxin was identified as an IgE-binding protein. Recombinant thioredoxin was generated in E. coli, and tested together with Plo i 1 and whole moth extracts in IgE immunoblots against a large panel of indoor allergic patients' sera. BALB/c mice were immunised with recombinant thioredoxin and Plo i 1, and antibody production, mediator release from RBL cells, T-cell proliferation and cytokine production were measured.ResultFor the first time a thioredoxin from an animal species was identified as allergen. About 8% of the sera from patients with IgE against moth extracts reacted with recombinant P. interpunctella thioredoxin, compared to 25% reacting with recombinant Plo i 1. In immunised BALB/c mice, the recombinant allergens both induced classical Th2-biased immune responses such as induction IgE and IgG1 antibodies, upregulation of IL-5 and IL-4 and basophil degranulation.ConclusionThioredoxin from moths like Plo i 1 acts like a classical Type I allergen as do the thioredoxins from wheat or corn. This clearly supports the pan-allergen nature of thioredoxin. The designation Plo i 2 is suggested for the new P. interpunctella allergen.

Parental attitudes toward new dosage forms of desloratadine in an online survey: results from four European countries

ABSTRACTBackground: Allergic disease affects an estimated 50% of children worldwide and causes considerable impairment in academic performance and daily activities. Pediatric formulations for allergy treatment are often highly sugared or contain ingredients to improve palatability, appearance, and patient acceptance/adherence. These excipients, however, are associated with dental caries, gastrointestinal intolerance, and dermatologic reactions.Objective: To assess the appeal of new sugar-free/dye-free syrup and orodispersible formulations of the second-generation antihistamine desloratadine to parents of children with allergy in four European countries.Design: In an online survey of households with children aged ≤12 years with allergies in France, Italy, the Netherlands, and Spain, respondents were asked to consider one of two desloratadine product concepts: a sugar-free, dye-free oral solution or an orodispersible tablet.Participants: Eligible households had to have at least one child aged ≤12 years with symptomatic seasonal, pet, or indoor allergies or hives for ≥1 week/year. Respondents had to be the decision makers regarding their child's allergy medication and to be likely to treat symptoms with prescription medication some of the time.Results: There were 627 eligible households. Most (88%) parents in Spain were likely to ask their physician about and to consider trying sugar-free, dye-free desloratadine syrup, followed by 76% of those in France, 68% in Italy, and 56% in the Netherlands. About three-quarters of parents in France, Spain, and Italy and more than half of those in the Netherlands were likely to ask their physician about and to consider trying the orodispersible formulation.Limitations: There is no control group for comparisons between the study's online responses and those that would have resulted from another survey methodology. Further, response biases do exist across countries based on cultural norms.Conclusion: Survey respondents were generally receptive to the new sugar-free, dye-free syrup and orodispersible tablet formulations of the second-generation antihistamine desloratadine. At least half of parents surveyed indicated their willingness to try the new products.

Anti-Bullying Week: Being different, belonging together

November is set to be a busy month, with Anti-Bullying Week, Indoor Allergy Week and Universal Children’s Day all occurring. There has also been research carried out on whether using a Nintendo Wii can help tackle obesity, whether watching sex on the television will affect teens getting pregnant, and finally Channel 4 are looking for overweight and underweight children to take part in their new series.

Patient Perceptions of Allergic Rhinitis and Quality of Life: Findings From a Survey Conducted in Europe and the United States

Background Allergic rhinitis (AR) is a common, costly, and troublesome condition, impairing patients' quality of life (QoL), cognitive function, and productivity. Patients with AR report disturbed sleep, fatigue, irritability, and a range of practical problems. However, there is a relative lack of data on how patients with AR perceive their QoL.Objective To better understand how patients perceive AR and their attitudes toward this condition (including QoL) and its treatment options.Methods An online and telephone survey of 3635 people identified as having outdoor and indoor allergies, urticaria, and/or pet allergies was performed in 6 countries.Results The survey confirmed that patients with allergies perceive their symptoms as causing significant disruptions to their daily lives. Respondents were affected for a considerable part of each day, with the most severe symptoms occurring in the morning. The most important desired effect of medication was the restoration of normal breathing, and the most highly rated attributes of the "ideal" AR drug were efficacy, safety, and freedom from undesirable side effects.Conclusions The information gathered from allergy sufferers who participated in this survey sheds light on the degree to which people with allergies are affected by their disease and the limitations imposed by associated symptoms.

Dust-mite avoidance measures in patients on immunotherapy

The compliance of dust-mite (DM) allergic patients receiving immunotherapy (IT) with environmental avoidance measures has not been reported. To investigate patient practices, a questionnaire was distributed to patients receiving IT for indoor allergens. Ninety-three of 200 patients (46%) with indoor allergies completed the questionnaire. Of the 93 patients, 69% were allergic to DMs, 45% were allergic to pets, 17% were allergic to mold, and 3% were allergic to cockroaches. Of 64 patients allergic to DMs, 53% reported use of mattress covers, 61% reported use of pillow covers, 81% reduced moisture in their homes, 83% washed their bed linens in water that was >130 degrees F, 77% vacuumed or dusted weekly, and 21% replaced carpets with polished flooring. Fifty-two percent of patients who did not use covers and 49% who did not replace their carpets cited cost as the most common reason. Education about the use of DM covers was reported by 97% of patients allergic to DMs, predominantly by physicians. In conclusion, many patients on IT for DM allergy do not use avoidance measures for decreasing allergen exposure. Cost appears to influence compliance with several measures including protective mattress and pillow covers. It may be unreasonable to require most patients to use such avoidance measures before being candidates for IT.

The Efficacy of Medic-Air™ in Patients with Dust Mite Allergy

RATIONALE: Environmental control is highly recommended to patients with Indoor allergy. We studied the clinical value of a new devise, Medic-Air™ (Sharp Co.), designed for neutralizing indoor allergens.

Indoor allergies and strategies to reduce the allergen load

This week is Indoor Allergy Week. Simple steps to reduce allergens in the home can help your patients.

気管食道科領域における環境とアレルギー 気道領域における室内アレルギー

気管食道科領域における環境とアレルギー 気道領域における室内アレルギー

Predictors of short-term clinical response to acute asthma care in adults.

We assessed the effects of potential patient risk factors on short-term clinical response to acute asthma care among adults who often require emergency department (ED) visits and hospitalizations to manage their asthma. Prospective cohort study that included adult patients treated for acute asthma, which was conducted in a US public hospital ED between March 1997 and August 1999, with a 2- to 3-week follow-up. Three hundred and nine patients completed the study. We identified patient risk factors that predicted lower peak expiratory flow rate (PEFR) change over 2-3 weeks following acute asthma care. Potential risk factors were ozone exposure, indoor allergy and exposure, smoking, upper respiratory infection in the last month, lower asthma knowledge, and medication non-adherence. Univariate analyses indicated that lower asthma knowledge significantly and positively correlated with lower PEFR change (r = 0.15, P = 0.01). Multivariate analysis that controlled for patient case-mix indicated that indoor allergy and exposure [b = 32.76, 95% confidence interval (CI) = 3.98-61.53, P = 0.03] significantly predicted lower PEFR change. There was no change in the multivariate analysis when the absence of treatment with corticosteroids during the 2-3 weeks before follow-up was added as a potential patient risk factor. The study suggests that interventions are needed to target the patient risk factors, indoor allergen exposure, and poor asthma knowledge, to promote short-term clinical response to acute asthma care in adults, especially among economically disadvantaged inner-city residents.

Characteristic features of cockroach hypersensitivity in Turkish asthmatic patients

Exposure to cockroach has been reported to cause asthma in many parts of the world. Although house-dust-mite is known to be the most important indoor allergen in Turkey, there are few data on the prevalence of allergy to cockroaches. Therefore, we evaluated the prevalence of cockroach sensitivity in asthmatic Turkish patients to see whether it is also an important source of asthma in addition to house-dust mites. A total of 206 patients demonstrating the characteristic features of asthma were included in the study. Sixty-three percent of the patients were considered atopic, and 37% were found to be nonatopic by skin prick tests. Mite allergens were the most common cause of indoor allergy (50%), while cockroach sensitivity was detected in 25.7% of all the asthmatics. Among all cockroach-sensitive patients, 70% were also positive for mites. A female predominance was observed in cockroach-sensitive patients, as 44% of atopic women and 34% of atopic men had positive skin tests with cockroach allergen. The average duration of asthma was 7.1+/-5.6 years in cockroach-sensitive asthmatics, and there was no difference between groups in average duration of asthma (P>0.05). Mild, moderate, and severe asthmatics constituted 73.6%, 20.7%, and 5.7% of the cockroach-sensitive patients, respectively. These data indicate that cockroach is also an important source of domestic infestation in Turkey. Thus, it seems reasonable to suggest the need for cockroach allergen in the routine battery of inhalant skin tests in this geographic location. However, possible cross-reactivity with mites has to be taken into consideration during the clinical evaluation of subjects with cockroach sensitivity, especially in our patient population with such high rates of house-dust-mite allergy.

Indoor allergies: The battle on the home front

Indoor allergies: The battle on the home front