Effects of Vacuuming Mattresses on Allergic Rhinitis Symptoms in Children

PURPOSE: To evaluate the effects of daily vacuuming of mattresses on the concentration of house dust mite (HDM) allergens and on allergic rhinitis (AR) symptoms in children sensitized to HDM. METHODS: Forty children between the ages of 6 and 12 years with mild persistent AR and sensitized only to HDM were enrolled and randomly allocated to 2 groups. Caregivers of children in the experimental group cleaned the children's rooms and vacuumed their mattresses daily for 2 weeks. Caregivers of children in the control group cleaned the children's rooms without vacuuming mattresses. Symptoms of AR were checked weekly and dust samples were collected from the mattresses before and after the study. RESULTS: Demographics at the beginning of the study were not significantly different between the 2 groups. In the experimental group, symptoms of AR and dust weight were significantly decreased after 2 weeks (total symptoms of AR, P <0.001; sneezing, P < 0.001; rhinorrhea, P <0.001; nasal obstruction, P < 0.001; itching, P <0.001; and dust weight, P = 0.006). The concentrations of HDM allergens were not changed significantly (Der p1, P = 0.333; Der f1, P = 0.841). In the control group, there were no significant changes in symptoms of AR, dust weight, or the concentration of HDM allergens. CONCLUSIONS: Our findings showed that daily vacuuming of mattresses reduced dust weight and symptoms of AR. However, the concentration of HDM allergens did not significantly decrease.

House Dust Mite Allergy Under Changing Environments

Environmental variations induced by industrialization and climate change partially explain the increase in prevalence and severity of allergic disease. One possible mechanism is the increase in allergen production leading to more exposure and sensitization in susceptible individuals. House dust mites (HDMs) are important sources of allergens inducing asthma and rhinitis, and experimentally they have been demonstrated to be very sensitive to microenvironment modifications; therefore, global or regional changes in temperature, humidity, air pollution or other environmental conditions could modify natural HDM growth, survival and allergen production. There is evidence that sensitization to HDMs has increased in some regions of the world, especially in the subtropical and tropical areas; however, the relationship of this increase with environmental changes is not so clear as has reported for pollen allergens. In this review, we address this point and explore the effects of current and predicted environmental changes on HDM growth, survival and allergen production, which could lead to immunoglobulin E (IgE) sensitization and allergic disease prevalence. We also assess the role of adjuvants of IgE responses, such as air pollution and helminth infections, and discuss the genetic and epigenetic aspects that could influence the adaptive process of humans to drastic and relatively recent environmental changes we are experiencing.

A Retrospective Study of Clinical Response Predictors in Subcutaneous Allergen Immunotherapy With House Dust Mites for Allergic Rhinitis

PURPOSE: House dust mites (HDM) are major allergens that cause allergic rhinitis (AR). Allergen-specific subcutaneous immunotherapy (SCIT) has been shown to be clinically beneficial in many clinical trials. Such trials, however, are not reflective of all patient populations. The aim of this study was to describe the efficacy and safety of SCIT in routine clinical practice in Korean adults with AR sensitized to HDM. METHODS: We reviewed medical records of 304 patients with AR treated at an allergy clinic of a tertiary hospital using SCIT with aluminum hydroxide-adsorbed allergen extract targeting HDM alone or with pollens for at least 1 year from 2000 to 2012. Patients with asthma were excluded. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Specific immunoglobulin E (IgE) levels to HDM were categorized into 6 classes. RESULTS: The mean time until achieving remission was 4.9±0.1 years, and the cumulative incidence of remission from AR was 76.6%. Severe AR (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.23-0.69; P=0.001), specific IgE levels to HDM ≥17.5 kU/L (OR, 1.85; 95% CI, 1.01-3.37; P=0.045), and duration of immunotherapy ≥3 years (OR, 7.37; 95% CI, 3.50-15.51; P<0.001) were identified as significant predictors of clinical remission during SCIT for patients with AR sensitized to HDM. Overall, 73 patients (24.0%) experienced adverse reactions to SCIT, and only 1 case of anaphylaxis (0.3%) developed. CONCLUSIONS: SCIT with HDM was found to be effective and safe for patients with AR. Specific IgE levels to HDM and a duration of SCIT ≥3 years may be predictors of clinical responses to SCIT in AR patients.

Decreased CRTH2 Expression and Response to Allergen Re-stimulation on Innate Lymphoid Cells in Patients With Allergen-Specific Immunotherapy

PURPOSE: Group 2 innate lymphoid cells (ILC2s) have been implicated in the pathogenesis of allergic disease. However, the effect of allergen-specific immunotherapy (AIT) on ILCs remains to be clarified. The aim of this study was to evaluate the levels of ILC subsets in allergic rhinitis (AR) patients in response to house dust mite (HDM)-specific immunotherapy. METHODS: We enrolled 37 AR patients undergoing AIT (16 responders and 11 non-responders) for 2 years, 35 HDM AR patients and 28 healthy subjects. Peripheral blood mononuclear cells (PBMCs) were analyzed by flow cytometry to identify ILC subsets. Stimulation of ILC2s with recombinant allergen-specific protein was used to determine ILC2's activation (CD69 expression). RESULTS: Responder AIT patients and healthy subjects had a decreased frequency of circulating ILC2s compared to non-responder AIT and AR patients. Conversely, ILC1s from responder AIT patients and healthy subjects showed increased frequency compared to non-responder AIT and AR patients. The frequency of ILC3s natural cytotoxicity receptor (NCR)+ and NCR− in responder AIT patients was significantly lower compared to AR patients and healthy subjects. The ILC1: ILC2 proportion in responder AIT patients was similar to that of healthy subjects. PBMCs from patients who were responders to AIT had a significantly lower expression of the activation marker CD69 on ILC2s in response to allergen re-stimulation compared to AR patients, but no difference compared to non-responder AIT patients and healthy subjects. CONCLUSIONS: We propose that AIT might affect ILC responses. The activation of ILC2s was reduced in AR patients treated with AIT. Our results indicate that a relative ILC1/ILC2 skewed response is a possible key to successful AIT.

Tolerogenic Dendritic Cells Reduce Airway Inflammation in a Model of Dust Mite Triggered Allergic Inflammation

PURPOSE: The use of tolerogenic dendritic cells (TolDCs) to control exacerbated immune responses may be a prophylactic and therapeutic option for application in autoimmune and allergic conditions. The objective of this work was to evaluate the effects of TolDC administration in a mouse model of allergic airway inflammation caused by mite extract. METHODS: Mouse bone marrow-derived TolDCs were induced by incubation with granulocyte-macrophage colony-stimulating factor (GM-CSF) and dexamethasone, and then characterized by flow cytometry and cytokine production by enzyme-linked immunosorbent assay (ELISA). For the in vivo model of Blomia tropicalis-induced allergy, mice transplanted with antigen-pulsed TolDCs were sensitized intraperitoneally with B. tropicalis mite extract (BtE) adsorbed to aluminium hydroxide. After challenge by nasal administration of BtE, bronchoalveolar lavage fluid (BALF), lungs, spleen and serum were collected for analysis. RESULTS: Induction of TolDCs was efficiently achieved as shown by low expression of major histocompatibility complex (MHC) II, programmed death-ligand (PD-L) 2 and pro-inflammatory cytokine production, and up-regulation of interleukin (IL)-10, upon LPS stimulation in vitro. Transplantation of 1 or 2 doses of BtE-pulsed TolDCs reduced the number of inflammatory cells in BALF and lungs as well as mucus deposition. Moreover, compared to saline-injected controls, TolDC-treated mice showed lower serum levels of anti-BtE immunoglobulin E (IgE) antibodies as well as reduced Gata3 and IL-4 gene expression in the lungs and decreased IFN-γ levels in the supernatant of splenocyte cultures Transplantation of TolDCs increased the percentage of the regulatory T cells in the spleen and the lungs. CONCLUSIONS: Preventive treatment with TolDCs protects against dust mite-induced allergy in a mouse model, reinforcing the use of tolerogenic dendritic cells for the management of allergic conditions.

Changes in skin reactivity and associated factors in patients sensitized to house dust mites after 1 year of allergen-specific immunotherapy

BACKGROUND: Allergen-specific immunotherapy (SIT) can significantly improve symptoms and reduce the need for symptomatic medication. OBJECTIVE: The aim of this study was to investigate changes in skin reactivity to house dust mites (HDMs) as an immunologic response and associated factors after 1 year of immunotherapy. METHODS: A total of 80 patients with allergic airway diseases who received subcutaneous SIT with HDMs from 2009 to 2014 were evaluated. The investigated parameters were basic demographic characteristics, skin reactivity and specific IgE for HDM, serum total IgE level, blood eosinophil counts, and medication score. RESULTS: The mean levels of skin reactivity to HDMs, blood eosinophil counts, and medication scores after 1 year were significantly reduced from baseline. In univariate comparison of the changes in skin reactivity to HDMs, age ≤30 years, HDMs only as target of immunotherapy, and high initial skin reactivity (≥2) to HDMs were significantly associated with the reduction in skin test reactivity. In multivariate analysis, high initial skin reactivity and HDMs only as target allergens were significantly associated with changes in skin reactivity to HDMs. In the receiver operating characteristic curve of the initial mean skin reactivity to HDMs for more than 50% reduction, the optimal cutoff value was 2.14. CONCLUSION: This study showed significant reductions in allergen skin reactivity to HDMs after 1 year of immunotherapy in patients sensitized to HDMs. The extent of initial allergen skin reactivity and only HDMs as target allergen were important predictive factors for changes in skin reactivity.

Construction of recombinant plasmids Der f 6/pET32a (+) and its expression, purification,IgE-binding reactivity / 中国免疫学杂志

Objective:To obtain the prokaryotic expression product for the group 6 allergen of Dermatophagoides farine ( Der f 6) and detect its IgE-binding rates with sera from asthmatic children. Methods: By enzyme digestion of pET28a (+)-Der f 6 with BamHⅠ plus XhoⅠ,the target gene Der f 6 was obtained and linked into the vector pET32a (+) to construct the recombinant plasmid pET32a(+)-Der f 6, which was then transfected into E. coli BL21 cells for expression, induced with isopropyl-β-D-thiogalactoside ( IPTG) ,purified by affinity chromatography and identified by SDS-PAGE,Western blot and AMLDI-TOF,and tested by ELISA for IgE reactivity with sera from asthmatic children. Results:The plasmids pET32a(+)-Der f 6 were constructed,transformed into E. coli BL21 and expressed successfully. SDS-PAGE of the purification product showed a specific band,Western blot showed the successful binding between the purification product and the His-tag in the plasmids,and MALDI-TOF/TOF identified the identical structure to the allergen Der f 6. Using the ELISA method developed with the recombinant proteins as coating antigen,the positive rate was 41. 3% (19/46) in asthmatic children allergic to dust mite. Conclusion: The plasmids pET32a (+)-Der f 6 were constructed successfully,expressed in E. coli BL 21 (DE3). The recombinant fusion protein has a good reactivity with sera from asthmatic children.

Subcutaneous Immunotherapy for Allergic Asthma in a Single Center of Korea: Efficacy, Safety, and Clinical Response Predictors

Allergen-specific immunotherapy is the only causal treatment for allergic diseases. However, the efficacy of immunotherapy may vary around the world due to differences in climate, the nature of aero-allergens and their distribution. The aim of this study was to describe the effects of subcutaneous immunotherapy (SCIT) in Korean adults with allergic asthma (AA). As a retrospective cohort study, we reviewed medical records for 627 patients with AA in Korea who were sensitized to house dust mite (HDM) and/or pollens and who underwent SCIT with aluminum hydroxide adsorbed allergen extract from 2000 to 2012. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Herein, 627 asthmatic patients achieved remission within a mean of 4.7 ± 0.2 years. The cumulative incidence rates of remission from AA were 86.9% upon treatment with SCIT. Baseline forced expiratory volume in the first second (FEV1) ≥ 80% (hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.79–5.39; P < 0.001), and maintenance of immunotherapy for more than 3 years (HR, 1.82; 95% CI, 1.21–2.72; P = 0.004) were significant predictors of asthma remission during SCIT. In 284 patients on SCIT with HDM alone, initial specific immunoglobulin E (IgE) levels to Dermatophagoides pteronyssinus and Dermatophagoides farinae did not show significant difference between remission and non-remission group after adjusting demographic variables. In conclusion, SCIT was effective and safe treatment modality for patients with AA. Initial FEV1 ≥ 80% and immunotherapy more than 3 years were found to be associated with favorable clinical responses to SCIT.

Effectiveness of Specific Sublingual Immunotherapy in Korean Patients with Atopic Dermatitis

BACKGROUND: Sublingual immunotherapy (SLIT) with house dust mites (HDM) preparation has recently been proven to be beneficial for treating allergic rhinitis and asthma. However, there has been no report regarding the efficacy and safety of SLIT in Korean patients with atopic dermatitis (AD). OBJECTIVE: We intended to investigate the efficacy and safety of SLIT in Korean patients with AD. METHODS: A total of 34 patients with AD and immunoglobulin E (IgE)-proven HDM sensitization (Class ≥3) were recruited. Eczema area and severity index (EASI) score, total serum IgE level, specific IgE assays to Dermatophagoides pteronyssinus, D. farinae, and adverse effects were recorded during follow-up. "Responder" was defined as a patient with ≥30% improvement in EASI score after SLIT. RESULTS: Twenty-three patients continued SLIT for 12 months or more, whereas 3 patients (8.8%) dropped out because of exacerbation of dermatitis, and 8 patients (23.5%) were lost to follow-up. The average duration of SLIT treatment was 22.4 months (range, 12~32 months). EASI scores reduced significantly after 6 months of treatment (p<0.05) compared with those at baseline. A total of 18 patients were determined to be responders to SLIT after 6 months. Total and specific IgE serum levels did not significantly reduce after SLIT. No patients experienced serious adverse events, with the exception of two patients who developed transient lip and tongue swelling. CONCLUSION: Our study demonstrated that SLIT with HDM extracts is effective and tolerable in Korean patients with AD. Further controlled long-term trials are required to reinforce the current results.

Retrospective Analysis on the Effects of House Dust Mite Specific Immunotherapy for More Than 3 Years in Atopic Dermatitis

PURPOSE: In extrinsic atopic dermatitis (AD), house dust mites (HDM) play a role in eliciting or aggravating allergic lesions. The nature of skin inflammation in AD has raised a growing interest in allergen-specific immunotherapy (SIT). Thus, we assessed clinical improvement and laboratory parameters for evaluation of the benefit of long-term SIT. MATERIALS AND METHODS: A total of 217 AD patients who were treated with SIT for at least 3 years were retrospectively assessed, by using their investigator global assessment, pruritus scores, loss of sleep (LOS), total serum IgE, and eosinophil counts collected. Patients were additionally classified into subgroups according to age, initial AD severity and mono- or multi-sensitization to include different individual factors in the evaluation of SIT efficacy. Lastly, we compared laboratory data of good responders to SIT with that of poor responders to SIT. RESULTS: Improvement after SIT therapy was observed in 192 out of 217 patients (88.4%). Among these patients, 138 (63.5%) achieved excellent, near-complete or complete clinical remission. Significant reduction of pruritus, LOS, and the mean value of total serum IgE were observed (p0.05). CONCLUSION: We emphasize the usefulness of long-term HDM SIT as a disease-modifying therapy for AD.

Sensitization study of dogs with atopic dermatitis in the central region of Rio Grande do Sul / Estudo da sensibilização de cães com dermatite atópica na região central do Rio Grande do Sul

Canine atopic dermatitis (CAD) is a common dermatosis, defined as a genetic-related disease which predisposes to skin inflammation and pruritus, associated to a IgE-specific response in most of cases. Clinical diagnosis may be later complemented by skin allergy and/or serological tests. The aim of these tests is to identify possible allergens in order to enable the clinicians to select candidate antigens for allergen specific immunotherapy. In the present study 58 CAD positive animals were tested. All were submitted to the intradermal test (IDT) and screened for the presence of antibodies against different antigens using ELISA. The obtained results show a high prevalence of sensitization among the tested dogs to house dust mites and to pollen ofC. dactylon. With this work it was possible to identify the main allergens involved in immunological response of dogs with CAD living in central area of Rio Grande do Sul.

A dermatite atópica canina (DAC) é uma dermatose comum, definida como doença de cunho genético que predispõe à inflamação e ao prurido cutâneo, associados à resposta IgE específica na maior parte dos casos. O diagnóstico da DAC é clínico e pode ser posteriormente complementado por testes alérgicos cutâneos e/ou sorológicos. O objetivo desses testes é identificar possíveis alérgenos e, com isso, possibilitar ao clínico a seleção de antígenos candidatos para a imunoterapia alérgeno-específica. No presente estudo, foram testados 58 animais diagnosticados para DAC. Todos os animais foram submetidos ao teste cutâneo intradérmico (TID), e amostras de sangue foram coletadas para a realização de testes sorológicos. Os resultados obtidos demonstraram elevada prevalência de sensibilização aos ácaros domiciliares e ao pólen da gramínea C. dactylon nos cães testados. Com este trabalho, foi possível identificar os principais alérgenos envolvidos na resposta imunológica de cães atópicos residentes na região central do Rio Grande do Sul.

Three-Year Follow-up Results of Sublingual Immunotherapy in Patients With Allergic Rhinitis Sensitized to House Dust Mites

PURPOSE: This study investigated the long-term efficacy, safety, and compliance associated with sublingual immunotherapy (SLIT) in Korean patients with allergic rhinitis sensitized to house dust mites. METHODS: This is a retrospective cohort study. A total of 164 patients who were sensitized to Dermatophagoides pteronyssinus and Dermatophagoides farinae and who received SLIT were enrolled between November 2007 and January 2010. Each patient was followed up using a diary card, on which a symptom score, rescue medication score, and adverse events (AEs) were recorded. RESULTS: All allergic rhinitis symptoms improved after 3 years of SLIT (P<0.05), and the rescue medication score decreased with time (P<0.05). The incidence of AEs associated with SLIT was 31% (51 of 164 patients) during the first month of therapy, and there were no severe AEs. The dropout rate was 19.5% (32 of 164 patients) during the first month, 34% (56 of 164 patients) after 6 months, and 41% (68 of 164 patients) after 1 year of SLIT. The 3-year compliance rate was approximately 40% (65 of 164 patients). The most common causes of dropout during the first month of SLIT were high cost and inconvenience. The improvement in allergic symptoms was the most common cause of dropout after 6 months. CONCLUSIONS: Allergic symptoms significantly decreased after 1 year of SLIT treatment, and this effect was sustained after 2 or 3 years of treatment. By increasing compliance through patient education, the 3-year use of SLIT for house dust mite allergies may be effective in the management of allergic rhinitis.

Profiles of IgE Sensitization to Der f 1, Der f 2, Der f 6, Der f 8, Der f 10, and Der f 20 in Korean House Dust Mite Allergy Patients

PURPOSE: Measurement of IgE specific to purified house dust mite (HDM) allergens may improve allergy diagnosis. This study aimed to investigate the sensitization profiles of Korean HDM allergic subjects suffering from respiratory allergy and atopic dermatitis (AD) to Der f 1, Der f 2, Der f 6, Der f 8, Der f 10, and Der f 20. METHODS: Recombinant HDM allergens were produced in Pichia pastoris (Der f 1) or Escherichia coli (5 allergens). IgE reactivity to the individual recombinant allergens and total extract of mite was assessed by ELISA. RESULTS: Der f 1 was recognized by 79.1%, Der f 2 by 79.1%, Der f 6 by 9.3%, Der f 8 by 6.2%, Der f 10 by 6.2%, and Der f 20 by 6.6% of the patients' sera tested, while the prevalence of IgE reactivity to total mite extract was 94.7%. Combination of Der f 1 and Der f 2 had a sensitivity of 87.6%. Specific IgE to Der f 2 alone was detected from 89.4% of HDM-sensitized respiratory allergy subjects and 92.3% to the combination of the 2 major allergens Der f 1 and Der f 2. However, sera from fewer patients with AD, namely 72.4% and 71.0%, recognized Der f 1 and Der f 2, respectively. The combination of 2 major allergens allowed diagnosis of 84.5% of the AD patients. No correlation between sensitization to specific allergens and HDM allergy entity was found. CONCLUSIONS: Der f 2 was the most frequently sensitized allergen among the HDM-sensitized respiratory and AD patients in Korea, and the combination of the group 1 and 2 major allergens increased the diagnostic sensitivity. Minor allergens did not significantly improve diagnostic sensitivity. However, further studies are needed to analyze the relationship between sensitization to other HDM allergens and the disease entity of the HDM allergy.

Actividad acaricida del aceite esencial de la corteza de Croton malambo H. Karst, metil-eugenol y metil-isoeugenol contra Dermatophagoides farinae Hughes, 1961 / Acaricide activity of essential oil of Croton malambo H. Karst, methyl-eugenol and methyl-isoeugenol against Dermatophagoides farinae Hughes, 1961

Dermotophagoides farinae lives in the indoor environment of houses, where it is source of allergens; therefore its control is a priority in preventing respiratory allergies. The aim of this study was to evaluate the acaricidal activity of essential oil of Croton malambo H. Karst bark and their components methyl-eugenol and methyl-isoeugenol against Dermatophagoides farinae. The essential oil was obtained through hydro-distillation assisted by microwave radiation and analyzed by GC-MS. Acaricidal activity was assessed by dose- response bioassay, at different times, using benzyl benzoate as a positive control. The relative amount of methyl-eugenol and methyl- isoeugenol in the essential oil was 68.4 percent and 4.9 percent, respectively. The acaricidal activity was: essential oil > methyl-eugenol > benzyl benzoate > methyl-isoeugenol. The acaricidal properties of essential oil of Croton malambo bark and methyl-eugenol against Dermatophagoides farinae were established...

Dermatophagoides farinae habita en el interior de las casas, donde es fuente importante de alérgenos, por tanto su control es una prioridad en la prevención de alergias respiratoria. El objetivo de este estudio fue evaluar la actividad acaricida del aceite esencial de la corteza de Croton malambo H. Karst y sus componentes metil-eugenol y metil-isoeugenol contra Dermatophagoides farinae. El aceite esencial se obtuvo por hidrodestilación asistida por radiación de microondas y se analizó por CG-EM. La actividad acaricida se evaluó mediante bioensayo de dosis-respuesta a diferentes tiempos, usando benzoato de bencilo como control. La cantidad relativa de metil-eugenol y metil-isoeugenol en el aceite fue 68.4 por ciento y 4.9 por ciento, respectivamente. La actividad acaricida fue: aceite esencial > metil-eugenol > benzoato de bencilo > metil-isoeugenol. Se establecieron las propiedades acaricidas del aceite esencial de la corteza de Croton malambo y metil-eugenol contra Dermatophagoides farinae...

Staloral(R) in Adult Patients with Allergic Rhinitis

BACKGROUND: Sublingual immunotherapy (SLIT) is currently accepted as a treatment of allergic rhinitis. SLIT has been demonstrated to be an effective and safe treatment in many studies; however, there have been few studies on Asian patients with allergic rhinitis. The goal of this study was to investigate the efficacy and safety of SLIT for Asian patients with allergic rhinitis to house-dust mites. METHODS: A total of 116 adult patients who had allergic rhinitis to Dermatophagoides pteronyssinus and Dermatophagoides farinae were included. All patients were treated with SLIT (Staloral(R)). Symptom scores and quality of life were evaluated by questionnaires for one year after SLIT. The medication score was also assessed monthly by a medication diary card. Adverse effects and compliance were also investigated. RESULTS: All nasal and non-nasal symptoms and quality of life were significantly improved after treatment except for itchy palate (p < 0.05). The total medication score was decreased significantly after SLIT (p < 0.05). Some minor adverse effects were reported, but no patient developed a systemic reaction. The drop-out rate was 19%. CONCLUSION: Staloral(R) for Asian patients with allergic rhinitis to house-dust mites is an efficient and safe therapeutic tool.

Positive conversion of specific IgE against house dust mite in children with atopic dermatitis under 24 months of age

PURPOSE: A considerable number of children with atopic dermatitis (AD) is known to be sensitized with respiratory allergen and developed to respiratory allergic disease. We aimed to determine the time of sensitization to house dust mite (HDM) allergen and identify the risk factors of sensitization in children with AD. METHODS: Data from 159 children with AD aged less than 24 months and with no sensitization to HDM were analyzed retrospectively. Disease severity, total IgE, specific IgE levels to HDM and food allergens were assessed. They were followed to monitor positive conversion of specific IgE against HDM and development of allergic respiratory diseases. The specific IgE was considered as positive when its level was over 0.69 kU/L. RESULTS: The 44.7% of children with AD were sensitized to HDM. The 50% of sensitization to HDM occurred at the median age of 52 months using survival analysis. The severity of atopic dermatitis (six area, six sign in atopic dermatitis score>15; hazard ratio, 2.62) and high peak total IgE in 2 years old (hazard ratio, 1.58) was associated with an increased risk of sensitization to HDM. Sensitization to food allergen, family history of allergic disease and total IgE of 1st visit of hospital were not associated with early sensitization to HDM. CONCLUSION: The sensitization of HDM of children with AD occurred at the median age of 52 months. The risk factors of sensitization to HDM were AD severity and total IgE level. Children with severe AD need to control the indoor environment before 24 months of age.

The Innate Immune Response in House Dust Mite-Induced Allergic Inflammation

Hypersensitivity to house dust mite (HDM; Dermatophagoides sp.) allergens is one of the most common allergic responses, affecting up to 85% of asthmatics. Sensitization to indoor allergens is the strongest independent risk factor associated with asthma. Additionally, >50% of children and adolescents with asthma are sensitized to HDM. Although allergen-specific CD4+ Th2 cells orchestrate the HDM allergic response through induction of IgE directed toward mite allergens, activation of innate immunity also plays a critical role in HDM-induced allergic inflammation. This review highlights the HDM components that lead to activation of the innate immune response. Activation may due to HDM proteases. Proteases may be recognized by protease-activation receptors (PARs), Toll-like receptors (TLRs), or C-type lectin receptors (CTRs), or act as a molecular mimic for PAMP activation signaling pathways. Understanding the role of mite allergen-induced innate immunity will facilitate the development of therapeutic strategies that exploit innate immunity receptors and associated signaling pathways for the treatment of allergic asthma.

Update of Sublingual Immunotherapy for Allergic Rhinitis

Current treatment strategies for allergic rhinitis include avoidance of the offending allergens, pharmacotherapy, immunotherapy and surgery. Among them, immunotherapy is the only therapeutic option that modifies the basic allergic mechanism by inducing desensitization and producing a state of anergy in the presence of offending allergens. Immunotherapy by subcutaneous allergen injection (subcutaneous immunotherapy, SCIT) has been used since 1911 and has been demonstrated to be a clinically effective treatment for allergic disorders such as rhinoconjunctivitis and asthma. However, the inconvenience, invasiveness and potentially lethal adverse systemic events associated with SCIT have motivated physicians to develop other routes for the administration of allergens such as orally, sublingually or intranasally. Sublingual immunotherapy (SLIT) has recently received considerable attention around the world as a treatment for allergic rhinitis and is now widely used as an alternative to the subcutaneous route. The Allergic Rhinitis and Its Impact on Asthma (ARIA) group of the WHO has acknowledged the potential effectiveness of SLIT for pollen or mite-sensitized allergic rhinitis. Clinical trials evaluating the efficacy and safety of SLIT have been ongoing worldwide since 1980, and newer studies are evaluating practical applications for improving patient care. SLIT has recently been introduced and become widely available for allergic rhinitis treatment in Korea. We previously published our experiences with SLIT and its use in allergic rhinitis patients sensitized to house dust mites. As evidence continues to accumulate, the validity of SLIT as one of the initial treatment options for allergic rhinitis is now becoming more widely accepted.

Acaricidal activity of Cymbopogon citratus and Azadirachta indica against house dust mites

Objective: To examine the acaricidal effects of the essential oil of Cymbopogon citratus leaf extract (lemongrass) and ethanolic Azadirachta indica leaf extract (neem) against house dust mites Dermatophagoides farinae (D. farinae) and Dermatophagoides pteronyssinus (D. pteronyssinus). Methods: Twenty-five adults mites were placed onto treated filter paper that is soaked with plant extract and been tested at different concentrations (50.00%, 25.00%, 12.50%, 6.25% and 3.13%) and exposure times (24hrs, 48hrs, 72hrs and 96 hrs). All treatments were replicated 7 times, and the experiment repeated once. The topical and contact activities of the two herbs were investigated.Results:Mortalities from lemongrass extract were higher than neem for both topical and contact activities. At 50 % concentration, both 24 hrs topical and contact exposures to lemongrass resulted in more than 91% mortalities for both species of mites. At the same concentration and exposure time, neem resulted in topical mortalities of 40.3% and 15.7% against D. pteronyssinus and D.farinae respectively; contact mortalities were 8.0% and 8.9% against the 2 mites, respectively. There was no difference in topical mortalities of D. pteronyssinus from exposure to concentrations of lemongrass and neem up to 12.50%; lemongrass was more effective than neem at the higher concentrations. Conclusions: Generally, topical mortalities of D. farinae due to lemongrass are higher than that due to neem. Contact mortalities of lemongrass are always higher that neem against both species of mites.

Acaricidal activity of Cymbopogon citratus and Azadirachta indica against house dust mites

<p><b>OBJECTIVE</b>To examine the acaricidal effects of the essential oil of Cymbopogon citratus leaf extract (lemongrass) and ethanolic Azadirachta indica leaf extract (neem) against house dust mites Dermatophagoides farinae (D. farinae) and Dermatophagoides pteronyssinus (D. pteronyssinus).</p><p><b>METHODS</b>Twenty-five adults mites were placed onto treated filter paper that is soaked with plant extract and been tested at different concentrations (50.00%, 25.00%, 12.50%, 6.25% and 3.13%) and exposure times (24hrs, 48hrs, 72hrs and 96 hrs). All treatments were replicated 7 times, and the experiment repeated once. The topical and contact activities of the two herbs were investigated.</p><p><b>RESULTS</b>Mortalities from lemongrass extract were higher than neem for both topical and contact activities. At 50 % concentration, both 24 hrs topical and contact exposures to lemongrass resulted in more than 91% mortalities for both species of mites. At the same concentration and exposure time, neem resulted in topical mortalities of 40.3% and 15.7% against D. pteronyssinus and D. farinae respectively; contact mortalities were 8.0% and 8.9% against the 2 mites, respectively. There was no difference in topical mortalities of D. pteronyssinus from exposure to concentrations of lemongrass and neem up to 12.50%; lemongrass was more effective than neem at the higher concentrations.</p><p><b>CONCLUSIONS</b>Generally, topical mortalities of D. farinae due to lemongrass are higher than that due to neem. Contact mortalities of lemongrass are always higher that neem against both species of mites.</p>