Mite Allergy Research Articles

Clinical and laboratory profiles of pediatric asthma patients with house dust mite (HDM)–specific subcutaneous immunotherapy: A single center, cross sectional study

Introduction: House dust mite (HDM) allergy has been reported as an actual cause of asthma in children. Subcutaneous immunotherapy (SCIT) is a recommended treatment for HDM allergy patients. However, there were limited data about the characteristic of pediatric patients with HDM-SCIT, particularly in Indonesia. This study was aimed to evaluate the characteristic of pediatric patients with allergic asthma.
 Methods: Study participants were pediatric patients confirmed with HDM allergy from Skin Prick Test (SPT) in the pediatric allergy-immunology outpatient clinic in Saiful Anwar Hospital Malang, Indonesia. Patients who were treated with HDM-SCIT in the early build-up phase of treatment were included in this study. Demographic and clinical characteristics of the patients were recorded. Peripheral blood samples were drawn to evaluate the total eosinophil count (TEC), total basophil count (TBC), neutrophil-lymphocyte ratio (NLR), specific IgE (sIgE) and total IgE (t-IgE) level. Clinical diagnosis of asthma was classified according to the Global Initiative for Asthma (GINA) criteria. The evaluation of asthma control was assessed by the Asthma Control Test (ACT) score. 
 Results: Thirty-two patients were enrolled in this study, including 14 male and 18 female. The mean age of children was 6.92 ± 2.60 years old. There were 21 subjects with uncontrolled asthma and 11 subjects with partially controlled asthma. Demographic characteristics including age, sex, nutritional status and family history were not significantly different between uncontrolled and partially controlled asthma groups (p> 0.05). TEC, TBC, NLR, and tIgE were not different significantly among groups (p> 0.05). This study showed that the mean of sIgE serum level was higher in uncontrolled asthma compared to partially controlled asthma group (p= 0.022). Moreover, it was a negative significant correlation between sIgE serum level and ACT score (p= 0.002, r= -0.532). 
 Conclusion: Higher sIgE levels were correlated with poor asthma control in HDM-SCIT patients.

Sustained Eosinophilic Cholangitis Due to a Mite Allergy Mimicking Sclerosing Cholangitis.

Eosinophilic cholangiopathy (EC) presents with thickening and stenosis of the bile duct wall that is histologically characterized by eosinophil infiltration. The diagnosis is often difficult. We herein report a patient who had been followed up with a diagnosis of primary sclerosing cholangitis but had a final diagnosis of EC based on eosinophilia, histological findings of bile duct and liver biopsy specimens, and a review of a previous surgical specimen of the gallbladder. Antigen tests, isolation from her house, and accidental re-exposure to the antigen revealed that the causative antigen was the mite Dermatophagoides pteronyssinus.

Sublingual immunotherapy for pediatric patients with mite allergies.

Sublingual immunotherapy (SLIT) has been increasingly used instead of subcutaneous immunotherapy. SLIT was initially approved for use among adults; however, it has become more widely accepted for children. Few studies have evaluated the effectiveness of SLIT in the treatment of dust mite allergies among children, including adverse effects. This study aimed to investigate the effectiveness of SLIT in children with dust mite allergies, as well as its adverse effects, at a pediatric general outpatient clinic.I analyzed the data of 181 patients aged 4 to 12 years who tested positive for mite antigen-specific immunoglobulin E, exhibited nasal and/or eye symptoms, and received Miticure. Symptoms were evaluated using the Japanese rhino-conjunctivitis quality of life (QOL) questionnaire no. 1. Wilcoxon tests were used to compare the pretreatment and post-treatment symptom scores. Adverse events were tallied, and Kaplan–Meier curves and Wilcoxon tests were used to assess the proportion of dropouts.The mean QOL score at the baseline was 2.17 (standard deviation [SD] 1.45). After 1 week, the mean symptom QOL score was 1.63 (SD 1.32); the lowest mean score was found in week 41 (0.48, SD 0.63). A significant decline in the occurrence of all symptoms, including sneezing, nasal discharge, nasal congestion, itchy eyes, and teary eyes, was observed. Adverse effects were observed in 76 (42.0%) patients; the most common adverse effect was itchy mouth.SLIT improves symptoms with minimal adverse effects in pediatric patients.

Validation of a commercial allergen microarray platform for specific immunoglobulin E detection of respiratory and plant food allergens

BackgroundAs the use of multiplex-specific immunoglobulin E (sIgE) detection methods becomes increasingly widespread, proper comparative validation assessments of emerging new platforms are vital. ObjectiveTo evaluate the clinical and technical performance of a newly introduced microarray platform, Allergy Explorer (ALEX) (MacroArray Diagnostics), in the diagnosis of pollen (cypress, grass, olive), dust mite (Dermatophagoides pteronyssinus), mold (Alternaria alternata), fruit (apple, peach), and nut (walnut, hazelnut and peanut) allergies and to compare it with those of the ImmunoCAP Immuno Solid-phase Allergen Chip (ISAC) 112 microarray and the ImmunoCAP singleplex method (ThermoFisher Scientific). MethodsWe enrolled 153 patients with allergy and 16 controls without atopy. The sIgE assays were conducted using ISAC112, ALEX version 2 (ALEX2), and ImmunoCAP for whole extracts and major components. Technical validation of ALEX2 was performed by measuring repeatability and interassay, interbatch, and interlaboratory reproducibility. ResultsWhen measured globally (detection by 1 or more allergen components), ALEX2 had adequate sensitivity and specificity for most of the allergens studied, comparable in general with that of ISAC112 (except for olive pollen and walnut) and similar to that of ImmunoCAP whole extract measurements. Component-by-component analysis revealed comparable results for all techniques, except for Ole e 1 and Jug r 3, in both ISAC112 and ImmunoCAP comparisons, and Alt a 1, when compared with ISAC112. Continuous sIgE levels correlate with sIgE by ImmunoCAP. Good reproducibility and repeatability were observed for ALEX2. ConclusionALEX2 has sound technical performance and adequate diagnostic capacity, comparable in general with that of ISAC112 and ImmunoCAP.

Current Medicine for Allergy, Toxic Reaction, And Disease Caused by Arthropods


 
 
 
 Abstract
 Background: The presence of erusism and lepidopterism cases in Indonesia is influenced by butterfly species, regional conditions and community habits as farmers or garden workers. In addition, the population of house dust mites depends on several factors that are still being studied. Parasitological reviews of current treatments for insect disease are still poorly understood.
 Purpose: This article aims to review current treatments for allergies, toxic reactions, and insect-borne diseases.
 Methods: Recent literature search, obtained 11 relevant articles for review.
 Results: Local treatment due to contact with insects can be given a solution of iodine, corticosteroids and antihistamines. In severe cases, the drug can be given orally or parenterally.
 Conclusion: Based on the results of the review, it can be concluded that to treat airway attacks due to mite allergy, bronchodilators and corticosteroids can be given.
 
 
 

Clinical and anamnestic characteristics and results of allergological testing in children with bronchial asthma and allergic rhinitis in case of allergy to house dust mites

House dust mites (HDM) are a common cause of allergies, however, it is not always easy to suspect a mite allergy from a patient's history. 
 Objective: to determine clinical characteristics of patients, tactics for demonstrating the role of HDM sensitization in pediatric patients with allergic rhinitis (AR) and bronchial asthma (BA) with domestic sensitization. 
 Materials and methods. The study included 420 patients, 256 boys, 164 girls, aged 5 to 17,9 years (mean 8,44 ± 3,06 years), with AR (100%) and AR in combination with BA (41,9%). The prick test on the forearm skin with water-soluble extracts was carried out and evaluated according to the standard method. The test was considered positive with a maximum wheal diameter of ≥3 mm 15 minutes after applying the prick. 
 Results. Among patients with HDM sensitization (n=268), sensitization to both mites was detected in 218 cases (81,3%), and in 139 cases (51,9%) polysensitization to HDM allergens, house dust and epidermal allergens (cat, dog) was found. Patients noted persistent symptoms of nasal congestion, and rhinorrhea; the provoking factor was not determined by history in 46% of cases. In 69,8% of cases (97 children), it was impossible to isolate the leading allergen according to the history, since patients had contact with cats, dogs, dust, and polysensitization according to the prick tests. Nasal provocation test (NPT) with HDM allergens was performed in 92 children. Positive NPT was obtained in 83 cases (90,2%), negative in 9 cases (9,8%). 
 Conclusions. With HDM sensitization, often (46%) the provoking factor is not determined by history. Monotonous symptoms are characteristic with the absence of obvious relationships with allergens, the location and activities of the child. In terms of frequency, the leading variant is sensitization to both mites D.pteronyssinus, D.farinae (81,3%), and polysensitization to HDM, house dust and cat and dog allergens (51,9%). NPT allows in 90% of cases to show the causal role of HDM allergens in polysensitized patients with insufficiently convincing anamnesis data.

Епідеміологія кліщових та поєднаних із ними харчових алергій серед дитячого населення Рівненської області

Актуальність. Визначальним при вивченні ризиків розвитку в дітей поєднаних кліщових і харчових алергій є їх епідеміологічна нестабільність у світі, країні, Рівненській області зокрема внаслідок зростання тригерного навантаження, одним із найбільш потужних чинників якого є алергени кліщів побутового пилу. Мета дослідження — проведення епідеміологічного моніторингу особливостей взаємного впливу кліщових та харчових алергій на імунологічні механізми серед дітей Рівненської області та контамінації середовища життєдіяльності людини кліщами побутового пилу. Матеріали та методи. За період 2007–2017 рр. амбулаторно та санітарно-паразитологічно обстежено 410 вогнищ харчових алергій у різних вікових групах із дослідженням акарофауни в них. Результати. У зразках побутового пилу з вогнищ харчових та кліщових алергій визначено представників 8 видів 4 родин алергенних кліщів, із них паразитологічно й імунологічно встановлений патогенний вплив видів Dermatophagoides pteronyssinus, Dermatophagoides farinae, Acarus siro та Glycyphagus domesticus на сенсибілізацію дитячого населення. У 91 % дітей 0–3 років діагностована лише харчова IgE-опосередкована алергія, вплив кліщів побутового пилу на алергічні процеси не доведений. Зі збільшенням віку сенсибілізованих дітей спостерігалось зростання лабораторно ідентифікованих IgE-залежних харчових алергій — від 68 % у групі 3–6 років до 88 % у підлітків 10–14 років, переважно полівалентного типу. Аналогічно від 32 % дітей 3–6 років до 54 % підлітків 10–14 років мали встановлену й підтверджену кліщову алергію, що вказує на роль кліщів побутового пилу у формуванні й підтримці генералізованих форм атопічних реакцій. Висновки. Епідеміологічна ситуація серед дитячого населення території Рівненської області з харчових і кліщових алергій визначена як нестабільна; здійснений ситуаційний аналіз імунологічного стану дитячого населення віком 0–14 років із кліщових та харчових алергій, прослідкована роль стану забруднення навколишнього середовища кліщами побутового пилу як фактора створення високого алергізуючого фону.

Allergen immunotherapy against house dust mites in patients with local allergic rhinitis and asthma

Local allergic rhinitis (LAR) is a clinical rhinitis phenotype characterized by the presence of nasal symptoms of AR in nonatopic patients with a negative skin prick test and undetectable specific IgE (sIgE) in serum against inhalant allergens but with a positive nasal allergen provocation test. This study evaluated the effectiveness of a 12-month course of sublingual immunotherapy (SLIT) for house dust mite (HDM) allergies in adult patients with confirmed LAR and concomitant asthma. Methods The study was a prospective, double-blind, placebo-controlled trial with patients diagnosed with LAR to HDMs and with concomitant asthma who underwent a 12-month treatment course of SLIT for HDM allergies. Seventeen patients were randomized to SLIT with the use of allergen extracts of D. pteronyssinus and D. farinae (50/50%) in SQ-HDM SLIT tablets and 15 patients were randomized to the placebo group. The total rhinitis score (TRSS), total asthma symptom score (TASS), combined total symptom score (TSS), total medication score (TMS), and FEV1 were analyzed. Results: In the final analysis, 16 patients who received SLIT and 14 who received placebo who completed the study protocol were included. Significant reductions in TRSS, TASS, TSS, and TMS after 12 months of treatment were observed in patients after SLIT (p < 0.05). A significant increase in the mean FEV1 between baseline and after 12 months of therapy was observed in the study, with p = 0.03 in the study group. Conclusion: SLIT can improve nasal and bronchial symptoms and reduce symptomatic treatment in patients with LAR and asthma and with hyperresponsiveness to HDMs.

Retrospective Study of Mite-Specific Subcutaneous Immunotherapy in Children

To explore the clinical efficacy and influencing factors of children receiving mite-specific subcutaneous immunotherapy (SCIT). We retrospectively analyzed the data of children who had received mite SCIT for 3 years at the Desensitization Center of our hospital. We used the daily medication score (DMS) to evaluate the medication use status (the higher the score, the higher the amount of medications given and the less satisfactorily was the primary disease controlled) and we used the visual analogue scale (VAS) to evaluate clinical symptoms (the higher the score, the more severe the symptoms). Evaluation was performed after the first SCIT treatment and after treatment was given for 3 months, 4 months, 12 months, and 3 years. According to whether medication for the primary disease was stopped after 3 years, the patients were divided into two groups, the discontinued medication group (discontinued group) and the continued medication group (continued group). The general data, DMS, VAS and the decline rate of the two groups were compared, and logistic regression was performed to analyze the influencing factors of the outcome. A total of 711 children were enrolled in the study, with an average age of 8.38 years at the time of the first visit to the hospital. There were 442 males and 269 females. Skin prick test showed that 445 cases only had mite allergy, and 266 cases had mite allergy combined with other allergies. 360 cases have discontinued the medication for the primary disease after 3 years, and 351 cases had relieved symptoms, but still needed to continue with the medication. At the beginning of SCIT treatment, the DMS and VAS of the discontinued group were lower than those of the continued group ( P<0.05). Evaluations from 3 months to 3 years showed that both DMS and VAS continued to decrease compared with those from the beginning, and the decline rate of DMS and VAS of the discontinued group was higher than that of the continued group after 3 years of SCIT ( P<0.05). After 3 months of SCIT, the positive rates of nasal and ocular symptoms in the discontinued group were lower than those in the continued group ( P<0.05). After 3 years of SCIT, the positive rates of nasal, ocular, and chest symptoms in the discontinued group were lower than those in the continued group ( P<0.05). Univariate analysis combined with multivariate logistic regression showed that initial DMS>4 points and initial VAS>3.5 points were protective factors for the discontinuation of the medication for the primary disease at the end of 3 years of SCIT, while the female sex and DMS reduction rate after 12 months of treatment>50% were risk factors for discontinuation. Mite SCIT can help relieve clinical symptoms and reduce the use of medication for symptomatic treatment. Symptoms can be improved after 3 months of SCIT, with the fastest improvement shown in nasal and eye symptoms. It is not recommended to discontinue the medication for the primary disease for too much after 1 year of treatment.

Association between serum zonulin level and severity of house dust mite allergic asthma

BackgroundIncreased intestinal permeability, either due to the exposure to antigens in asthmatic patients or due to a barrier defect, plays a critical role in susceptibility to environmental allergens. House dust mite allergy occurs more commonly than any other type of allergy among Egyptian asthmatic patients.AimTo assess the relation between serum zonulin level as a marker of increased intestinal permeability and the severity of house dust mite allergic asthma.MethodsA case–control study which included 48 patients with house dust mite allergic asthma and 48 healthy control subjects attending the Allergy and Immunology Unit, Microbiology and Immunology Department, Faculty of Medicine, Zagazig University.ResultsA statistically significant difference was detected between the two studied groups with respect to serum IgE and serum zonulin levels (p ˂ 0.001 and ˂ 0.001, respectively). The mean serum zonulin was equal to 258.3 ± 153.01 ng/ml in the asthmatic group and 80 ± 13 ng/ml in the control group. Serum zonulin level significantly increased with the increase of asthma severity (p ˂ 0.001). The cut off value of serum zonulin was ≥ 198 ng/ml, and the area under the curve was 0.76. It displayed sensitivity equal to 80% and specificity equal to 71.4%. Its negative predictive value was equal to 83.3%.ConclusionIntestinal barrier dysfunction contributes to the pathogenesis of allergic asthma. Serum zonulin level reflects an increase in intestinal permeability. Zonulin acts as prognostic factor of severity in asthma. Correction of the gut barrier defect may have a potential positive prognostic effect in asthma.

Efficacy of Subcutaneous and Sublingual Immunotherapy for House Dust Mite Allergy: A Network Meta-Analysis–Based Comparison

Meta-analyses comparing the efficacy of sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) for house dust mite allergy are lacking. To compare the efficacy of SLIT drops, SLIT tablets, and SCIT in patients with perennial allergic rhinitis through network analysis. Frequentist network meta-analyses estimated the standardized mean difference (SMD) across the three immunotherapy modalities on allergic rhinitis symptom and medication score data from double-blind randomized clinical trials. Random effects models were investigated. We included 26 double-blind randomized clinical trials in this meta-analysis for the symptom score and 18 for the medication score. In the direct pairwise meta-analysis, a significant reduction of the symptom score was observed for all immunotherapy modalities compared with the placebo: pooled SMDs of -0.461 (95% confidence interval [CI], -0.795 to -0.127) for SLIT drop, -0.329 (95% CI, -0.426 to -0.231) for SLIT tablet, and -1.669 (95% CI, -2.753 to -0.585) for SCIT. For the medication score, a significant reduction was observed for all modalities. In network meta-analysis, the clinical efficacy of SCIT based on the symptom score was greater than for SLIT drop or SLIT tablet (SMD: -0.697, 95% CI, -1.105 to -0.288; and SMD: -0.819, 95% CI, -1.242 to -0.397). However, there was no significant difference in the symptom score between SLIT drop and SLIT tablet. This study demonstrated the clinical efficacy of all house dust mite immunotherapy modalities and suggests that SCIT may be more effective than SLIT drops or tablets in controlling symptoms of allergic rhinitis.

Fractional exhaled nitric oxide (FeNO) in students in Northern Thailand: associations with respiratory symptoms, diagnosed allergy and the home environment

Objective There are few studies on fractional exhaled nitric oxide (FeNO) among children in subtropical areas. We studied associations between FeNO and respiratory symptoms, reported diagnosed allergies and indoor and outdoor environmental factors in first grade junior high school students (N = 270) in upper northern Thailand. Methods Data on demographics, health and home environment were collected by a questionnaire distributed in dry season (February–March 2018). FeNO was measured when the research team visited the school. Daily outdoor pollution data (PM10 and ozone) were collected from the nearest monitoring station 3 days (lag 3) and 7 days (lag 7) before the FeNO measurements. Two-level (student, school) linear mixed models were used to analyze associations, adjusting for gender and family education level. Results In total, 29.6% had elevated FeNO level (>20 ppb) and 7.8% reported any allergy diagnosed by a doctor. Male gender (p = 0.02), diagnosed allergy (p = 0.001), especially to cat (p = 0.001) and house dust mite (HDM) allergies (p = 0.001) were associated with FeNO. Eye symptoms (p = 0.01), rhinitis symptoms (p = 0.03) and dyspnea (p = 0.05) in the last 3 days were associated with FeNO. Household indoor mold (p = 0.03), gas cooking (p = 0.03) and PM10 (lag 3 and lag 7) were negatively (protective) associated with FeNO. Conclusions Diagnosed allergy, especially to cat and HDM, can be associated with increased FeNO. Indoor mold and gas cooking can be associated with lower FeNO. Ocular, nasal and dyspnea symptoms reported by students in dry season in northern Thailand can be associated with FeNO, a biomarker of Th2 driven airway inflammation.

Quantile regression to examine the association of air pollution with subclinical atherosclerosis in an adolescent population

BACKGROUND AND AIM: Air pollution has been associated with early risk factors for later cardiovascular outcomes, including carotid intima-media thickness test (CIMT), a marker of subclinical atherosclerosis. To our knowledge, this is the first study to examine the association between air pollution exposure and CIMT in a younger adolescent population. We utilize quantile regression to examine the associations beyond mean regression analysis and examine if associations occur in the tails of the CIMT distribution. METHODS: We measured CIMT at the age of 16 years in 418 adolescents participating in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) population-based birth cohort in the Netherlands. We fit separate quantile regressions to examine whether the associations of annual averages of air pollutants up to age 14 for nitrogen dioxide (NO2), fine particulate matter (PM2.5), PM2.5 absorbance (a marker for black carbon) and PM coarse assigned at the participants’ residential addresses varied across deciles of CIMT. We report the quantile regression coefficients that corresponded to an average change in CIMT (µm) associated with an interquartile range increase in the air pollution concentrations. Models were adjusted for age, sex, body mass index (BMI), gestational age at birth and birthweight, parental education, parental smoking status and maternal BMI and breastfeeding status. RESULTS:Interquartile range increases in NO2, PM2.5 and PM2.5 absorbance during the first 2 years of life were associated with significantly higher CIMT in the lower tails of the distribution. NO2 exposure at birth had the largest statistically significant association with a 7.22 µm (95% CI: 5.28, 10.42) increase per IQR increase in NO2 for the 10th quantile of CIMT but was not significantly related to the 50th quantile (estimate: 1.64 µm, 95% CI: -1.49, 6.78). CONCLUSIONS:Early childhood exposure to air pollution concentrations was associated with an increase at the lower tails of the CIMT distribution during adolescence. KEYWORDS: Quantile regression, Environmental Epidemiology, Air pollution, Cardiovascular, Atherosclerosis

Significance of molecular diagnostics in allergen immunotherapy : Practical tips for the application in various groups of allergens with exemplary cases

The basis of allergen immunotherapy (AIT) is the diagnosis of the eliciting allergen sources, which is achallenge, especially in the case of multiple sensitizations. Molecular allergy diagnostics can be of special help, since detection of "marker allergens", usually important major allergens, allows to distinguish between primary sensitization and cross-reactions. Thus, the indication and extract selection for AIT can be facilitated. While molecular diagnosis is particularly useful for double-sensitized hymenoptera venom and polysensitized pollen allergic patients, the benefit is probably lower in case of house dust mite allergy.

Retrospective Cross-sectional Analysis of Factors Associated with Asthma in a Pediatric Cohort from Turkey.

It is difficult to identify young children at increased risk of developing asthma amongst those with recurrent wheezing. In this study, we aimed to determine factors associated with asthma in Turkish children. We performed a retrospective cross-sectional analysis on factors associated with asthma in 651 children (200 girls, 451 boys) admitted for recurrent wheezing. Amongst all included children, asthma frequency was 57.7%. Maturity, consanguinity, family income, passive smoking, father's, siblings' asthma were not found to be associated with asthma. Factors associated with asthma were: family's, parents', siblings' atopy, family's, mother's asthma, allergic rhinitis and atopic dermatitis, respiratory symptoms between wheezing attacks. The sensitivity (SN) of the modified asthma predictive index (mAPI) was 59.2% with a specificity (SP) of 91.3%, positive predictive index (PPI) of 65.1% and negative predictive index (NPI) of 82.3%. The SN of the modified Prevention and Incidence of Asthma and Mite Allergy (PIAMA) score was 22.9% with a SP of 89.2%, PPI of 84.6%, and NPI of 42.2%. Adjusted odds ratio for mAPI was 12.9, and for the modified PIAMA score 4. Our analysis confirmed previously described factors associated with asthma. Although the SN is limited, the mAPI and PIAMA risk scores can be used to predict asthma in Turkish children. Differential diagnoses and overlaps with other chronic pediatric diseases such as immunodeficiencies need to be carefully excluded when confirming the diagnosis asthma.

Immunological effects of adjuvanted low-dose allergoid allergen-specific immunotherapy in experimental murine house dust mite allergy.

Native allergen extracts or chemically modified allergoids are routinely used to induce allergen tolerance in allergen-specific immunotherapy (AIT), although mechanistic side-by-side studies are rare. It is paramount to balance optimal dose and allergenicity to achieve efficacy warranting safety. AIT safety and efficacy could be addressed by allergen dose reduction and/or use of allergoids and immunostimulatory adjuvants, respectively. In this study, immunological effects of experimental house dust mite (HDM) AIT were investigated applying high-dose HDM extract and low-dose HDM allergoids with and without the adjuvants microcrystalline tyrosine (MCT) and monophosphoryl lipid A (MPL) in a murine model of HDM allergy. Cellular, humoral, and clinical effects of the different AIT strategies were assessed applying a new experimental AIT model of murine allergic asthma based on physiological, adjuvant-free intranasal sensitization followed by subcutaneous AIT. While low-dose allergoid and high-dose extract AIT demonstrated comparable potency to suppress allergic airway inflammation and Th2-type cytokine secretion of lung-resident lymphocytes and draining lymph node cells, low-dose allergoid AIT was less effective in inducing a potentially protective IgG1 response. Combining low-dose allergoid AIT with MCT or MCT and dose-adjusted MPL promoted Th1-inducing mechanisms and robust B-cell activation counterbalancing the allergic Th2 immune response. Low allergen doses induce cellular and humoral mechanisms counteracting Th2-driven inflammation by using allergoids and dose-adjusted adjuvants. In light of safety and efficacy improvement, future therapeutic approaches may use low-dose allergoid strategies to drive cellular tolerance and adjuvants to modulate humoral responses.

Correlation between induration diameter of skin prick test result to house dust mite allergen with immunotherapy efficacy

Background: House dust mite (HDM) is one of the most aeroallergen causing allergy diseases. Skin prick test (SPT) is a simple test for hypersensitivity-related IgE. Positivity of house dust mite skin prick test results is essential to start immunotherapy. Objective: This study aimed to investigate the correlation between the induration diameter of skin prick test results to house dust mite allergen with immunotherapy efficacy. Methods: This retrospective study was conducted in the Pediatric allergy and immunology outpatient clinic of Dr. Soetomo General Hospital Surabaya. The medical record was taken from January 1st until December 31st 2020 period. House dust mite allergy was diagnosed based on the positivity of skin prick test to HDM. Immunotherapy efficacy was evaluated with daily symptom score (dSS), daily medication score (DMS), and Combined Symptom and Medication Score (CSMS) at least 3 months after immunotherapy. Age, gender, duration of illness, nutritional status, family history of atopic allergic disease, and other allergic comorbidities were stipulated as confounding variables. Statistical analysis was normality distribution test, wilcoxon rank test, spearman test, and regression analysis. Results: Sixty patients with HDM allergy (33 boys and 27 girls), were included in this study. Significant alteration of dSS, dMS, and CSMS before and after immunotherapy evaluated with wilcoxon rank test result (p=0.000 respectively). There was no correlation of each confounding variable to the induration diameter of SPT. Positive correlation between induration diameter and CSMS score was tested with Spearman test (p=0.003, r= 0.373). Conclusions: Smaller induration diameter of HDM SPT result could be predictive for immunotherapy efficacy.

Estimating the Risk of Severe Peanut Allergy Using Clinical Background and IgE Sensitization Profiles.

Background: It is not well-understood why symptom severity varies between patients with peanut allergy (PA).Objective: To gain insight into the clinical profile of subjects with mild-to-moderate and severe PA, and investigate individual and collective predictive accuracy of clinical background and IgE to peanut extract and components for PA severity.Methods: Data on demographics, patient history and sensitization at extract and component level of 393 patients with probable PA (symptoms ≤ 2 h + IgE sensitization) from 12 EuroPrevall centers were analyzed. Univariable and penalized multivariable regression analyses were used to evaluate risk factors and biomarkers for severity.Results: Female sex, age at onset of PA, symptoms elicited by skin contact with peanut, family atopy, atopic dermatitis, house dust mite and latex allergy were independently associated with severe PA; birch pollen allergy with mild-to-moderate PA. The cross-validated AUC of all clinical background determinants combined (0.74) was significantly larger than the AUC of tests for sensitization to extract (0.63) or peanut components (0.54–0.64). Although larger skin prick test wheal size, and higher IgE to peanut extract, Ara h 1 and Ara h 2/6, were associated with severe PA, and higher IgE to Ara h 8 with mild-to-moderate PA, addition of these measurements of sensitization to the clinical background model did not significantly improve the AUC.Conclusions: Models combining clinical characteristics and IgE sensitization patterns can help establish the risk of severe reactions for peanut allergic patients, but clinical background determinants are most valuable for predicting severity of probable PA in an individual patient.

Analysis of Results of Specific IgE in 100 Atopic Dermatitis Patients with the Use of Multiplex Examination ALEX2-Allergy Explorer.

Background and aim: Progress in laboratory diagnostics of IgE-mediated allergy is the use of component-resolved diagnosis. Our study analyses the results of specific IgE to 295 allergen reagents (117 allergenic extracts and 178 molecular components) in patients suffering from atopic dermatitis (AD) with the use of ALEX2 Allergy Explorer. Method: The complete dermatological and allergological examination, including the examination of the sensitization to molecular components with ALEX2 Allergy Explorer testing, was performed. The statistical analysis of results was performed with these methods: TURF (total unduplicated reach and frequency), best reach and frequency by group size, two-sided tests, Fisher’s exact test, and chi-square test (at an expected minimum frequency of at least 5). Results: Altogether, 100 atopic dermatitis patients were examined: 48 men, 52 women, the average age 40.9 years, min. age 14 years, max. age 67 years. The high and very high level of specific IgE was reached in 75.0% of patients to 18 molecular components: from PR-10 proteins (Aln g 1, Bet v 1, Cor a1.0103, Cor a1.0401, Fag s 1), lipocalin (Can f 1), NPC2 family (Der f 2, Der p 2), uteroglobin (Fel d 1), from Alternaria alternata (Alt a 1), Beta expansin (Lol p 1, Phl p 1), molecular components from Timothy, cultivated rye (Secc pollen) and peritrophin-like protein domain Der p 23. The high and very high level of specific IgE to other lipocalins (Fel d 7, Can f 4), to arginine kinase (Bla g 9, German cockroach), and to allergen extracts Art v (mugwort), and Cyn d (Bermuda grass) reached 52.0% of patients. The severity of AD is in significant relation to the sensitization to molecular components of storage mites (Gly d 2, Lep d 2—NPC2 family), lipocalins (Can f 1, Can f 2, Can f 4, and Can f 6), arginine kinase (Asp f 6, Bla g 9, Der p 20, Pen m 2), uteroglobin (Fel d 1, Ory c 3), Mn superoxide dismutase (Mala s 11), PR-10 proteins (Fag s 1, Mal d 1, Cor a 1.0401, Cor a 1.0103), molecular components of the peritrophin-like domain (Der p 21, Der p 23), and to Secc pollen. In the subgroup of patients suffering from bronchial asthma, the significant role play molecular components from house dust mites and storage mites (Lep d 2, Der p 2, Der f 2—NPC2 family), cysteine protease (Der p 1), peritrophin-like protein domain (Der p 21, Der p 23), enolase from Alternaria alternata (Alt a 6), and Beta expansin Phl p 1. Conclusion: The results of our study demonstrate the detailed profile of sensitization to allergens reagents (allergen extract and molecular components) in patients with atopic dermatitis. We show the significance of disturbed epidermal barrier, resulting in increased penetration of allergens. We confirmed the significant relationship between the severity of AD, the occurrence of bronchial asthma and allergic rhinitis, and high levels of specific IgE to allergen reagents. Our results may be important for regime measures and immunotherapy; Der p 23 shall be considered as an essential component for the diagnosis and specific immunotherapy of house dust mite allergy.

Climate change and house-dust mite allergy

Climate change and house-dust mite allergy