IgE AND IgG antibody responses to Dermatophagoides pteronyssinus in dogs with demodicosis and atopic dermatitis / Respostas de anticorpos IgE E IgG específicos à Dermatophagoides pteronyssinus em soros de cães com demodicose e dermatite atópica

Canine demodicosis is a common inflammatory parasitic skin disease caused by Demodex mites. House dust mites, such as Dermatophagoides spp., play an important role in the pathogenesis of canine atopic dermatitis (AD). The goal of this experimental work was to investigate whether demodectic dogs could be previously exposed/sensitized to house dust mites' antigens. First the prevalence of demodicosis in a southeastern region of Brazil was investigated by analyzing clinical files of dogs that were admitted to a Veterinary Hospital. Subsequently, the IgG responses to Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) and IgE to D.pteronyssinus (Dp) were evaluatedin two groups, AD or demodicosis dogs. Additionally, the major IgE-binding Dp proteins that are recognized by sera from dogs with demodicosis and AD were evaluated. A total of 2,599 clinical files were analyzed to identify the major parasitic skin diseases in dogs from this region, considering the age, sex and breed of the animals. The epidemiological study identified 111 animals with skin diseases; from these 20.7% presented demodicosis. Afterwards, serum samples were obtained from another groups of demodicosis, AD, and healthy dogs, and analyzed for Dp and Df-specific IgG, and IgE antibody levels, Dp IgG avidity by ELISA and IgE-binding Dp-specific proteins by immunoblot. IgG and IgE antibodies to Dp were detected in sera from additional groups of dogs with AD, demodicosis or healthy, with higher IgE levels to Dp in AD than demodectic or healthy dogs. IgG to Df was detected, despite with smaller levels compared to Dp in sera from demodectic dogs, and also in healthy dogs. Immunoblot showed IgE-binding to Dp proteins in sera of dogs with demodicosis and AD; with strong reactivity for the 72 and 116 kDa antigens detected by sera from demodicosis dogs. However, sera from healthy dogs >12 months old also presented reactivity to these bands. In conclusion, the detection of Dp-IgG and IgE antibodies in sera from demodectic dogs indicates previous exposure and sensitization to the house dust mite, respectively, more than cross-reactivity between demodex mites and Dp antigens detected by canine antibodies. Additionally, higher Dp-specific IgE levels were found in dogs with AD compared with those with demodicosis or healthy, suggesting that Dp-specific IgE could better discriminate dogs with AD from healthy ones or even those with demodicosis.

Demodicose canina é uma doença inflamatória comum da pele causada por ácaros do gênero Demodex. Ácaros da poeira doméstica como Dermatophagoides spp. desempenham papel importante na patogênese da dermatite atópica canina (DA). O objetivo desse trabalho experimental foi investigar se cães com demodicose poderiam ser previamente expostos/sensibilizados com antígenos de ácaros da poeira doméstica. A princípio, investigou-se a prevalência de demodicose em uma região sudeste do Brasil, analisando-se prontuários clínicos de cães admitidos em um Hospital Veterinário. Posteriormente, as respostas de IgG a Dermatophagoides pteronyssinus (Dp) e D. farinae (Df) e IgE a D. pteronyssinus (Dp) foram avaliadas em dois grupos, DA ou demodicose. Também foram avaliadas as principais proteínas Dp reconhecidas por anticorpo IgE presente em soros de cães com demodicose e DA. Um total de 2.599 prontuários clínicos foram analisados para identificar as principais doenças parasitárias da pele em cães dessa região, considerando a idade, sexo e raça dos animais. O estudo epidemiológico detectou 111 animais com doenças de pele e destes, 20,7% apresentavam demodicose. Posteriormente, amostras de soro foram obtidas de outros grupos de cães com demodicose, DA ou saudáveis, e analisadas quanto aos níveis de IgG e IgE específicos para Dp e Df, avidez de IgG a Dp por ELISA e proteínas específicas de Dp reconhecidas por IgE por immunoblot. Anticorpos IgG e IgE para Dp foram detectados em soros de grupos adicionais de cães com DA, demodicose ou saudáveis, com níveis mais altos de IgE para Dp na DA do que no soro de animais saudáveis. Níveis de IgG específicos para Df foram detectados, apesar serem menores em comparação com os detectados para Dp em soros de cães demodéticos, e também em cães saudáveis. A análise de immunoblot demonstrou detecção de IgE para proteinas de Dp em soros de cães com demodicose e DA; com forte reatividade para os antígenos de 72 e 116 kDa detectados por soros de cães com demodicose. No entanto, soros de cães saudáveis > 12 meses de idade também apresentaram reatividade a essas bandas. Em conclusão, a detecção de anticorpos Dp-IgG e IgE específicos em soros de cães demodéticos indica exposição prévia e sensibilização aos ácaros, respectivamente, mais do que reatividade cruzada entre ácaros Demodex e antígenos Dp detectados por anticorpos caninos. Além disso, níveis de Dp-IgE específicos mais elevados encontrados em cães com DA, sugerem que esses anticorpos poderiam discriminar melhor cães com DA daqueles saudáveis ou mesmo demodéticos.

Evaluation of the action of precipitating agents to obtain allergenic proteins from crude mite extracts / Avaliação da ação de agentes precipitantes na obtenção de proteínas alergênicas presentes em extratos brutos de ácaros

Introduction: Allergen proteins found in dust mite extracts, such as Dermatophagoides farinae (DF), Dermatophagoides pteronyssinus (DP) and Tyrophagus putrescentiae (TP), are relevant for scientific studies in the allergy and immunotherapy fields. The precipitation/concentration of protein extracts may favor the aggregation of the allergens in homogenates. Objective and method: This paper investigates the precipitation process by submitting crude mite extracts to compounds such as ammonium sulfate (NH4)2SO4, trichloroacetic acid (TCA) and acetone. Results: The best results were obtained by fractionation with (NH4)2SO4 at 80% (w/v) saturation (~0° C), observing the protein markings on the electrophoresis gel. Major allergens were identified by immunoblot at 25 kDa (cysteine protease) for Der f and Der p; and 25 kDa, 30 kDa (tropomyosin) and Try p 3, near 26 kDa. For this percentage the total protein contents were 12.83 mg mL-1 for Der f, 24.78 mg mL-1 for Der p and 27.35 mg mL-1 for Try. Conclusion: An advantage of precipitation with (NH4)2SO4 over precipitation with acetone was the possibility of gradually obtaining protein fractions, which does not happen when using the latter. The addition of 80% (v/v) acetone to the mite extracts favored total protein precipitation in the concentrations 16.42 mg mL-1, 28.47 mg mL-1 and 13.41 mg mL-1. The use of TCA in concentrations above 20% (w/v) forms peptides that are not retained in the gel under the established experimental conditions, and dilute solutions of this acid are more efficient.

Introdução: As proteínas alergênicas presentes nos extratos dos ácaros de poeira, tais como Dermatofagoides farinae (DF), Dermatofagoides pteronyssinus (DP) e Tyrophagus putrescentiae (TP) são relevantes para estudos científicos na área de alergias e aplicação em imunoterapias. A precipitação/concentração desses extratos proteicos pode favorecer a agregação de alérgenos nos homogenatos. Objetivo e método: O trabalho investiga o processo de precipitação, submetendo os extratos brutos de ácaros de poeira a compostos como sulfato de amônio (NH4)2SO4, ácido tricloroacético (ATC) e acetona. Resultados: Os melhores resultados foram obtidos por fracionamento com (NH4)2SO4 em 80% (m/v) de saturação (~ 0°C), observando as marcações proteicas no gel de eletroforese. Os alérgenos principais foram identificados por immunoblot em 25 kDa (cisteína protease) para Der f 1 e Der p 1; e 25 kDa, 33 kDa (tropomyosin), 11 kDa para Tyr. Para esse percentual, os teores de proteína total foram de 12.83 mg mL-1 para DF; 24,78 mg mL-1 para DP; e 27,35 mg mL-1 para TP. Conclusão: A vantagem da precipitação com (NH4)2SO4 frente à precipitação com acetona foi a possibilidade de gradativamente se obter frações proteicas, o que não acontece quando utilizado esse solvente. A adição de 80% (v/v) de acetona aos extratos de ácaros favoreceu a precipitação total de proteína nas concentrações 16,42 mg mL-1; 28,47 mg mL-1; e 13,41 mg mL-1. O uso de ATC em concentrações acima de 20% (m/v) forma peptídeos que não são retidos no gel nas condições experimentais estabelecidas, sendo eficiente soluções mais diluídas desse ácido.

Risk Factors and Comorbidities Associated With the Allergic Rhinitis Phenotype in Children According to the ARIA Classification

PURPOSE: Data are lacking on the association between the allergic rhinitis (AR) phenotype and sensitization to specific allergens or bronchial hyperresponsiveness (BHR) in children. We here investigated risk factors and comorbidities, including sensitization to specific allergens and BHR, for the AR phenotype by AR and its Impact on Asthma (ARIA) classification in a general population-based birth cohort study. METHODS: We enrolled 606 children aged 7 years from the Panel Study of Korean Children. The AR phenotype was assigned in accordance with the ARIA classification in children. Skin prick tests and Provocholine provocation test were performed. Risk factors and comorbidities for AR phenotypes were then analyzed. RESULTS: The prevalence of mild and moderate to severe AR in our study cohort was 37.2% and 8.8%, respectively. Recent use of analgesics or antipyretics and current cat ownership were associated with the risk of mild persistent AR. Sensitizations to Dermatophagoides Pteronyssinus (Der p), Japanese hop and cat were associated with moderate to severe persistent AR. Children with moderate to severe AR had a higher risk of current asthma and BHR compared to mild AR cases (adjusted odds ratio [aOR], 5.26; 95% confidence interval [CI], 1.77–15.62). Moderate to severe AR with allergic sensitization was associated with the highest risk of BHR (aOR, 11.77; 95% CI, 3.40–40.74). CONCLUSIONS: Moderate to severe-persistent AR is more closely related to respiratory comorbidities and sensitizations than mild AR. Stratifying the AR phenotype by ARIA classification may assist in disease management.

Evaluation of multiple allergen simultaneous (sIgE) testing compared to intradermal testing in the etiological diagnosis of atopic dermatitis in horses

Although intradermal testing (IDT) is commonly used in the etiological diagnosis of allergies, in vitro testing for specific IgE (sIgE) is an attractive alternative. Currently, new laboratory techniques in veterinary allergological practice, including multiple allergen simultaneous tests (MASTs), gradually supersede in vivo tests. Both, serological (sIgE) and IDTs in fourteen atopic Malopolski horses were performed. Correlation and agreement between test results were evaluated. Receiver operating characteristic analysis showed that sIgE to Acarus siro had the best diagnostic performance (Area under the ROC curve [AUC] = 0.969), followed by Dermatophagoides pteronyssinus (AUC = 0.844), Dermatophagoides farinae (AUC = 0.813) and Tyrophagus putrescentiae (AUC = 0.803). A significant positive correlation between IDT and MAST was found for A. siro (r(S) = 0.870; p = 0.00005), and D. farinae (r(S) = 0.657; p = 0.011). There was significant moderate agreement for 2 of 5 allergens, A. siro (κ = 0.569) and D. farinae (κ = 0.485) in semiquantitative assessment and significant fair to substantial agreement for 3 of 5 allergens, D. pteronyssinus (κ = 0.689), A. siro (κ = 0.569), D. farinae (κ = 0.432) in dichotomic assessment. Sensitivity ranged from 44% to 89%, depending on the allergen, while specificity was significantly higher for all allergens in MAST (60%–100%); the mean accuracy was 73% (manufacturer cut-off) and 77.4% (optimal cut-off) based on the Youden index. Compared with IDT, serological MAST showed good detection performance for 60% allergen sIgE in dichotomic assessment with substantial diagnostic capability, but careful clinical interpretation is needed for some allergens.

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.

Validation of PROTIA™ Allergy-Q 64 Atopy® as a Specific IgE Measurement Assay for 10 Major Allergen Components

PURPOSE: Component-resolved diagnostics (CRD) is expected to provide additional diagnostic information in allergic patients. PROTIA™ Allergy-Q 64 Atopy®, a recently developed CRD-based multiplex specific immunoglobulin E (sIgE) assay, can quantitatively measure sIgE to major allergen components. METHODS: The sIgE detection by PROTIA™ Allergy-Q 64 Atopy® and ImmunoCAP® assays was compared using the sera of 125 Korean allergic patients. Group 1 and 2 allergens of house dust mites (HDMs; Dermatophagoides farinae (Der f) 1 and Der f 2 in PROTIA™ Allergy-Q 64 Atopy®, Dermatophagoides pteronyssinus (Der p) 1 and Der p 2 in ImmunoCAP®), Bet v 1, Fel d 1, Que a 1, ω-5 gliadin, α-lactalbumin, β-lactoglobulin, casein and α-Gal were measured by both assays. RESULTS: Comparing the results from the 2 assays, the agreement rate for all the 10 allergens was > 88% (group 1 HDM allergen, 100%; group 2 HDM allergen, 94.6%; Bet v 1, 97.4%; Fel d 1, 90.5%; Que a 1, 89.2%; α-lactalbumin, 96%; β-lactoglobulin, 88%; casein, 88%; ω-5 gliadin, 96%; α-Gal, 100%). Correlation analysis indicated that, all the 10 allergen sIgEs showed more than moderate positive correlation (Pearson correlation coefficients > 0.640). Additionally, intra-class comparison showed more than high correlation for all the 10 allergens (Spearman's rank correlation coefficients > 0.743). CONCLUSIONS: PROTIA™ Allergy-Q 64 Atopy® is reliable and comparable to the ImmunoCAP® assay for component-resolved diagnosis.

Immunological analysis of allergenic cross-reactivity between Cheyletus malaccensis and Dermatophagoides farinae, Dermatophagoides pteronyssinus and Blomia tropicalis / Análise imunológica da reatividade cruzada alergênica entre Cheyletus malaccensis e Dermatophagoides farinae, Dermatophagoides pteronyssinus e Blomia tropicalis

Objective: The mite Cheyletus malaccensis is cited in the literature as a predator of other mite species. Little is known about its protein composition, and few studies have evaluated its ability to trigger atopic respiratory allergic reactions. The present study aims to investigate the protein profile fingerprint present in Cheyletus malaccensis extract and to evaluate its immunologic reactivity in the presence of specific immunoglobulins (IgE) from the serum of individuals diagnosed with allergy to the mites Dermatophagoides farinae, Dermatophagoides pteronyssinus and Blomia tropicalis. These three species carry proteins responsible for the most cases of atopic respiratory allergies, hence the interest in comparing them to Cheyletus malaccensis. Methods: Samples of aspirated dust containing Cheyletus malaccensis were collected from households in the city of Rio de Janeiro, Brazil. From the collected mass of this mite, extracts were prepared for analysis. Proteins present in the extracts were identified by electrophoresis under denaturing conditions. Results: Proteins with a molecular mass of 24 kDa, 26 kDa, 12 kDa, 45 kDa and 70 kDa were visualized. The immunoblotting assay showed positive cross-reactivity for proteins of molecular mass ranging from 20 kDa to 45 kDa. These results indicate that specific links were established between IgE present in the serum of individuals allergic to the comparator mite and proteins from Cheyletus malaccensis. Conclusions: These findings are relevant for their potential clinical and immunotherapeutic applications, as well as information base for further studies.

Objetivo: O ácaro Cheyletus malaccensis é referido na literatura como um predador de outras espécies de ácaro. Pouco se sabe sobre sua composição proteica, e poucos estudos avaliaram sua habilidade de desencadear reações alérgicas respiratórias atópicas. O objetivo do presente estudo é investigar a impressão digital do perfil proteico presente em um extrato de Cheyletus malaccensis e avaliar sua reatividade imunológica na presença de imunoglobulinas (IgE) específicas do soro de indivíduos diagnosticados com alergia aos ácaros Dermatophagoides farinae, Dermatophagoides pteronyssinus e Blomia tropicalis. Essas três espécies carregam proteínas responsáveis pela maioria dos casos de alergias respiratórias atópicas, o que justifica o interesse em compará-las ao Cheyletus malaccensis. Métodos: Amostras de poeira aspirada contendo Cheyletus malaccensis foram coletadas de domicílios na cidade do Rio de Janeiro, no Brasil. A partir da massa coletada desse ácaro, extratos foram preparados para análise. As proteínas presentes nos extratos foram identificadas por eletroforese sob condições desnaturantes. Resultados: Proteínas com massa molecular de 24 kDa, 26 kDa, 12 kDa, 45 kDa e 70 kDa foram visualizadas. O ensaio imunoenzimático mostrou reatividade cruzada positiva para proteínas de massa molecular variando de 20 kDa a 45 kDa. Esses resultados indicam que ligações específicas foram estabelecidas entre a IgE presente no soro de indivíduos alérgicos ao ácaro usado como comparador e proteínas de Cheyletus malaccensis. Conclusões: Os achados são relevantes por seu potencial clínico e aplicações imunoterapêuticas, bem como sua base de informações para futuros estudos.

Dispositivos únicos ou múltiplos para testes cutâneos alérgicos em crianças? / Single or multiple devices for allergic skin test in children?

Objetivos: Comparar os resultados obtidos com agulha e Multi-Test II® em testes cutâneos por puntura com diferentes concentrações de histamina e de extrato de Dermatophagoides pteronyssinus e a dor relatada em cada teste. Métodos: Estudo experimental, realizado no complexo Hospital de Clínicas em Curitiba, Paraná. Foram incluídas no estudo 104 crianças com idade entre 6 e 15 anos, com diagnóstico de asma e/ou rinite e/ou dermatite atópica e teste cutâneo alérgico positivo para Dermatophagoides pteronyssinus. Foram realizados testes com agulha hipodérmica descartável BD Precision Glide® 13 x 0,3 e com dispositivo Multi-test II® com histamina 10 mg/mL e 1 mg/ mL, Dermatophagoides pteronyssinus 5000 PNU/mL e 10000 PNU/mL e solução salina. Avaliação da dor foi obtida após cada teste pela escala de faces de dor de Wong-Baker. Resultados: A sensibilidade do teste cutâneo alérgico para os dois dispositivos foi 100% nas concentrações de histamina 10 mg/mL. Com histamina 1 mg/mL o Multi-test II® apresentou maior valor de sensibilidade (S = 86,5%) que a agulha (S = 56,7%). Alto nível de concordância entre os dois dispositivos foi observada com extrato de Dermatophagoides pteronyssinus na concentração de 10000 PNU/mL. Com a concentração de 5000 PNU/mL, o nível de concordância entre os testes foi 69,1% (Kappa = 0,2). A dor foi relatada por 65 (62,5%) crianças com Multi-Test II®, e 48 (46,2%) com agulha (p = 0,01). Conclusão: Houve alta sensibilidade para os dispositivos utilizados. Houve diferenças entre os tamanhos das pápulas nos testes cutâneos alérgicos com os dois dispositivos, porém resultados falso-positivos foram pouco observados. Ambos os dispositivos foram bem tolerados pelas crianças.

Objectives: To compare results obtained with needle and with Multi-Test II® in skin prick tests with different concentrations of histamine and Dermatophagoides pteronyssinus, and the pain reported by patients with each device. Methods: This experimental study was conducted at Hospital de Clínicas, Curitiba, Brazil. A total of 104 children were included, aged 6 to 15 years and diagnosed with asthma and/or rhinitis and/or atopic dermatitis and showing a positive allergic skin test for Dermatophagoides pteronyssinus. Tests were performed using 13 x 0.3 BD Precision Glide® disposable hypodermic needles and also Multi Test II® with histamine 10 mg/mL and 1 mg/mL, Dermatophagoides pteronyssinus extract 5000 PNU/mL and 10000 PNU/mL, and saline solution. Pain was evaluated after each test using the Wong-Baker FACES Pain Rating Scale. Results: Allergic skin test sensitivity was 100% for the two devices with histamine 10 mg/ mL. With histamine 1 mg/mL, the Multi-test II® showed higher sensitivity (S = 86.5%) than the needle (S = 56.7%). A high level of concordance between the two devices was observed with Dermatophagoides pteronyssinus extract at the 10000 PNU/ mL concentration; with 5000 PNU/mL, the level of concordance was 69.1% (Kappa = 0.2). Pain was reported by 65 (62.5%) children after the use of Multi-Test II® and by 48 (46.2%) after the use of needles (p = 0.01). Conclusion: High sensitivity rates were observed for both single or multiple devices. There were differences in wheal sizes between the two devices, but few falsepositive results were found. Both devices were well tolerated by children.

Increasing Prevalence of the Sensitization to Cat/Dog Allergens in Korea

BACKGROUND: Recently, the number of domestic pets has increased. As a consequence, sensitization to animal allergens, such as cat or dog allergens, has become a problem. OBJECTIVE: We studied the annual trends of sensitization to cats or dogs, and the characteristics of the patients. METHODS: We retrospectively analyzed the medical records of 7,469 patients who visited a dermatology clinic and underwent an allergic profile test, from January 2011 to December 2015. Specific immunoglobulin E (IgE) levels to cat or dog antibody greater than 3.50 IU/ml were regarded as positive results. RESULTS: In all, 274 patients showed significant increase in levels of specific IgE antibody to dog, and 307 revealed increase in levels of of specific IgE antibody to cat. The prevalence of these specific IgEs increased from 2011 to 2015. Independent risks for sensitization to cat allergens were sensitization to dog, but not to house dust, Dermatophagoides pteronyssinus, and D. farinae. Independent risks for sensitization to dog allergens were sensitization to cat, but not to house dust, D. pteronyssinus, and D. farinae. Total IgE level was not related to specific IgE level against either cats or dogs. CONCLUSION: In conclusion, the prevalence of sensitization to cat or dog has increased. Sensitization to cat or dog is related to each other, but is irrelevant to the total IgE level.

Efficacy and Safety of Sublingual Immunotherapy in Elderly Rhinitis Patients Sensitized to House Dust Mites

PURPOSE: This study aims to determine the efficacy and safety of house dust mite (HDM)-sublingual immunotherapy (SLIT) in elderly patients with AR. METHODS: A total of 45 patients aged ≥ 60 years with HDM-induced AR who had ≥ 3 A/H ratio on skin prick test and/or ≥ 0.35 IU/L to both Dermatophagoides farinae and Dermatophagoides pteronyssinus by ImmunoCAP were enrolled in 4 university hospitals. To evaluate additional effects of HDM-SLIT, they were randomized to the SLIT-treated group (n = 30) or control group (n = 15). Rhinoconjunctivitis total symptom score (RTSS), rhinoscopy score, Korean rhinoconjunctivitis quality of life questionnaire, rhinitis control assessment test, asthma control test scores, and adverse reactions, were assessed at the first visit (V1) and after 1 year of treatment (V5); for immunological evaluation, serum levels of HDM-specific immunoglobulin A/IgE/IgG1/IgG4 antibodies and basophil response to HDMs were compared between V1 and V5 in both groups. RESULTS: There were no significant differences in demographics, RTSS, skin reactivity to HDMs, or serum total/specific IgE levels to HDMs (P < 0.05, respectively) between the 2 groups. Nasal symptom score and RTSS decreased significantly at year 1 in the 2 groups (P < 0.05). There were no significant differences in percent decrease in nasal symptom score and RTSS at year 1 between the 2 groups (P < 0.05); however, rhinoscopic nasal symptom score decreased significantly in the SLIT-treated group (P < 0.05). Immunological studies showed that serum specific IgA levels (not specific IgE/IgG) and CD203c expression on basophils decreased significantly at V5 in the SLIT-treated group (P = 0.011 and P = 0.001, respectively), not in the control group. The control group required more medications compared to the treatment group, but there were no differences in adverse reactions. CONCLUSIONS: It is suggested that HDM-SLIT for 1 year could induce symptom improvement and may induce immunomodulation in elderly rhinitis patients.

Relation of allergic rhinitis, allergen sensitization, and air pollutants in preschool children

PURPOSE: We aimed to investigate the prevalence and allergen sensitization of allergic rhinitis (AR) in preschool children. We assessed the relationship of AR, allergen sensitization, and air pollutants. METHODS: Between 2012 and 2016 in Jincheon, skin prick testing and questionnaire survey were performed on 2,958 children. AR have diagnosed on the basis of current symptoms and sign of AR on the Korean International Study of Asthma and Allergies in Childhood questionnaire and 1 or more proven allergen sensitization. RESULTS: A total of 2,052 children completed survey and skin prick testing, and were included in the analysis. The prevalence of AR symptom within last 12 months and AR were 27.0% and 10.9%, respectively. During study, both prevalences were increased from 20.1% and 8.6%, respectively in 2012 to 29.1% and 12.8%, respectively in 2016. The total inhalant allergen sensitization rate was 32.6%. The most common inhalant allergen was Dermatophagoides farinae (23.1%), followed by Dermatophagoides pteronyssinus (22.5%), tree pollens (5.3%), weed pollens (5.2%), fungi (4.7%), dog hair (4.5%) cat fur (3.6%), grass pollens (1.1%), and cockroach (0.8%). Although there was no difference tree or weed pollen sensitization, pollen seasonal prevalence of current AR symptoms is highest in spring (80%) versus autumn (52.3%). Seasonal PM10 (particulate matter with a median aerodynamic diameter less than or equal to 10 µm in diameter) and SO2 (sulfur dioxide) levels were correlated with the prevalence of seasonal AR symptoms. Pollen seasonal current AR symptoms were significantly related to seasonal pollen sensitization, but not inhalant allergens including dust mites. CONCLUSION: There was a rapid increasing prevalence of AR in preschool children in the areas of urbanization and industrialization. Pollen seasonal current AR symptoms have a close relationship with PM10 and seasonal pollen sensitization.

Analysis of the efficacy and compliance of conventional immunotherapy and rush immunotherapy in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

To analyze the efficacy and compliance of conventional immunotherapy(CIT)and rush immunotherapy(RIT)in patients with allergic rhinitis.This trial was a prospective study involved 404 patients with persistent AR who were allergic to house dust mite.328 patients were assigned to the conventional immunotherapy reaching the maintenance dose within 14 weeks,and 76 patients were assigned to the rush immunotherapy reaching the maintenance dose within 1 week.The visual analog scale(VAS)score and the patients' compliance were recorded during treatment and follow-up.After CIT and RIT,the VAS score were significantly reduced in each group,but the decrement of VAS score of RIT group was more evident than that of CIT in half ayear(<0.05).After 5 years follow-up,the VAS score of two groups was also significantly reduced.The rate of treatment continuation of CIT group in 1 year,2 years and 3 years were 18.5%,39.0% and 57.3%,higher than RIT group(11.8%,26.3%,42.1%),respectively.Both CIT and RIT were beneficial for allergic rhinitis patients,and the clinical efficacy lasts for at least 5 years.But RIT has the superiority of faster onset and better compliance.

Comparison between Newly Developed and Commercial Inhalant Skin Prick Test Reagents Using In Vivo and In Vitro Methods

BACKGROUND: We developed skin prick test (SPT) reagents for common inhalant allergens that reflected the real exposure in Korea. The study aim was to evaluate diagnostic usefulness and allergen potency of our inhalant SPT reagents in comparison with commercial products. METHODS: We produced eight common inhalant allergen SPT reagents using total extract (Prolagen): Dermatophagoides farinae, Dermatophagoides pteronyssinus, oak, ragweed, mugwort, Humulus japonicus pollens, as well as cat and dog allergens. We compared the newly developed reagents with three commercially available SPT reagents (Allergopharma, Hollister-Stier, Lofarma). We measured total protein concentrations, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), major allergen concentration, and biological allergen potencies measured by immunoglobulin E (IgE) immunoblotting and ImmunoCAP inhibition test. RESULTS: Diagnostic values of these SPT reagents were expressed as positivity rate and concordance rate of the results from ImmunoCAP allergen-specific IgE test in 94 allergic patients. In vitro analysis showed marked differences in protein concentrations, SDS-PAGE features, major allergen concentrations, and biological allergen potencies of four different SPT reagents. In vivo analysis showed that positive rates and concordance rates of Prolagen® SPT reagents were similar compared to the three commercial SPT reagents. CONCLUSION: The newly developed Prolagen® inhalant SPT reagents are not inferior to the commercially available SPT reagents in allergy diagnosis.

Aeroallergen sensitization and associated comorbid diseases of an adult Filipino population with allergic rhinitis

BACKGROUND: There is a large global variation in sensitization patterns to aeroallergens due to differences in climate, urbanization, and lifestyle. Knowledge of the most common inhalant allergens is important for appropriate prevention and management of allergic rhinitis (AR). OBJECTIVE: This study aims to provide data on aeroallergen sensitization patterns and associated comorbid diseases of adult Filipinos with AR. METHODS: Medical records of adult Filipinos seen in an Otolaryngology-Allergy Clinic from January 2011 to 2016 were reviewed. Inclusion criteria used was presence of clinically defined AR and positive skin test to at least one aeroallergen in the test panel. Demographics, comorbid conditions, and results of skin prick test were determined. Standard descriptive statistics were used for analysis. RESULTS: One hundred ninety-one adult patients were included in this study. Mean age was 38.8 years, and majority lived in an urban area (71.2%). Most patients exhibited polysensitization (97.4%). All exhibited sensitization to indoor and 86.9% to outdoor allergens. The most common indoor allergens were Dermatophagoides pteronyssinus (97.4%), Dermatophagoides farinae, (95.8%), cockroach (80.1%), and molds (72.8%). Bermuda (67%), Johnson grass (58.7%), and Acacia (58.2%) were the most common outdoor allergens. Urticaria (18.8%), dermatitis (16.8%), and asthma (11.5%) were the most common associated comorbid disease. Twelve percent of patients had more than one associated comorbid disease. Asthma + urticaria followed by asthma + dermatitis were the most common co-morbid combinations. One patient had three comorbid diseases: asthma + urticaria + rhinosinusitis. CONCLUSION: Compared to earlier studies, aeroallergen sensitization patterns of Filipinos remain unchanged. This study also identifies for the first time, the associated comorbid diseases of AR in this population. Understanding these factors can guide treatment strategies to reduce disease burden.

Skin prick test reactivity to aeroallergens in adult allergy clinic in Thailand: a 12-year retrospective study

BACKGROUND: The global prevalence of allergic rhinitis, asthma, and atopic dermatitis has risen significantly over the last 2 decades. Allergic sensitization to aeroallergen is a major risk factor in developing the allergic disease. The prevalence of aeroallergen sensitization varies in different regions and countries. OBJECTIVE: To determine the prevalence of common aeroallergen sensitization and the atopic status among adult patients. METHODS: A cross-sectional, retrospective study. The data were collected from medical records and database of the result of skin prick test of patients who had the allergic symptoms or chronic urticaria in adult allergy clinic, Ramathibodi hospital from January 2004 to December 2015. RESULTS: A total of 1,516 of patients (female, 1,118 [73.7%]) were enrolled. The mean ages of participants were 41.34 (standard deviation, ±16.5) years. Fifty-eight percent (58%) of patients were diagnosed with allergic rhinitis, 19.7%, 3.2%, and 9.2% with asthma, atopic dermatitis, and chronic urticaria respectively. In the chronic urticaria group, 57.4% underwent the positive skin prick test to common aeroallergens. Mites were responsible for the most common inhaled allergen sensitization in this study as 50.1% of Dermatophagoides pteronyssinus, 32% of Dermatophagoides farinae, and 31.5% of house dust. Cockroach was the second most common aeroallergen sensitization as 32.3% followed by grass pollen, Bermuda (21.1%) and timothy (13.6%). The animal dander, cat and dog, occupied 12.9 and 10% respectively. CONCLUSION: Mites were the most common cause of aeroallergen sensitization in all patients followed by cockroach, grass pollen, and animal dander. However, Bermuda sensitization has increased significantly in the last 6 years.

Accuracy of serum-specific IgE test with microfluidic array enzyme-linked immunosorbent assay for diagnosing inhalant allergen sensitization in asthma and/or rhinitis allergy patients in Jakarta, Indonesia

BACKGROUND: Asthma and allergic rhinitis are a global health burden. Inhalant allergens worsen the symptoms and clinical manifestations of asthma and allergic rhinitis. Skin prick test is the gold standard for diagnosing allergen sensitization but is associated with some limitations. In contrast, in vitro serum-specific immunoglobulin E (SSIgE) test is convenient and is not associated with an anaphylactic risk. OBJECTIVE: The present study compared the accuracy of the SSIgE test by using microfluidic array enzyme-linked immunosorbent assay (ELISA) with that of the skin prick test for diagnosing inhalant allergen sensitization in patients with asthma and/or allergic rhinitis. METHODS: This diagnostic study included patients with asthma and/or allergic rhinitis. Of these, 100 patients underwent the SSIgE test for diagnosing sensitization to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis), dog dander, cat dander, and cockroach allergen. All the patients also underwent the skin prick test for diagnosing allergen sensitization. The sensitivity, specificity, predictive value, and likelihood ratio (LR) of the SSIgE test were evaluated for each allergen. RESULTS: Sensitivity of the SSIgE test for diagnosing house dust mite sensitization was 48%–77%, with the highest sensitivity (77%) observed for diagnosing D. farinae sensitization. Specificity of the SSIgE test for diagnosing house dust mite sensitization was 64%–95%, with the highest specificity (95%) observed for diagnosing B. tropicalis sensitization. Although the SSIgE test showed high specificity and LR+ for diagnosing cockroach allergen sensitization, it showed low sensitivity (12%). Moreover, the SSIgE test showed high specificity (89%) but low sensitivity (3%) for diagnosing dog dander sensitization and high specificity (88%) but low sensitivity (10%) for diagnosing cat dander sensitization. CONCLUSION: The SSIgE test using microfluidic array ELISA shows moderate accuracy for diagnosing house dust mite sensitization and low accuracy for diagnosing cockroach allergen and dog and cat dander sensitization.

Reações adversas locais e sistêmicas à imunoterapia alérgeno-específica para ácaros em pacientes de ambulatório especializado de Hospital Universitário em São Paulo / Local and systemic adverse reactions to allergen-specific immunotherapy for mites among patients seen at a university hospital's specialty outpatient clinic in São Paulo

Objetivo: Relatar e classificar as reações adversas à imunoterapia subcutânea (ITSC) com extratos de ácaros no tratamento de alergias. Método: Foram incluídos 38 pacientes que receberam ITSC com extratos de Dermatophagoides pteronyssinus (Der p) isolado ou associado a Blomia tropicalis (Blo t). As reações adversas sistêmicas que ocorreram durante o tratamento foram registradas e classificadas de acordo com a WAO ­ World Allergy Organization. Também foram registrados o tratamento instituído e a evolução do quadro. Resultados: A média de idade dos pacientes do estudo foi 36 anos. Foram administradas 1.127 doses de ITSC com extrato de Der p. Destas, 87,3% (984) provocaram reação. De acordo com a classificação proposta pela WAO, 35,49% das reações foram Grau 1; 46,85% Grau 2; e 17,6% Grau 3. O tratamento utilizado foi: anti-histamínico em 81,3% das reações, corticosteroide em 81,3%, e beta-agonista inalatório em 70% dos casos. A adrenalina foi administrada em 41% das reações. No grupo que recebeu extrato associado de Der p e Blo t foram administradas 435 doses, das quais 155 (37,47%) resultaram em reações, sendo 78% de Grau 1, e 21,9% de Grau 2. O tratamento utilizado foi: anti-histamínico em 77,2% das reações, corticosteroide em 77,2% e beta-agonista inalatório em 58% dos casos. Conclusão: Na população estudada, as reações sistêmicas para Der p de acordo com a classificação da WAO, foram na sua maioria reações Grau 2. Já na imunoterapia para Der p e Blo t associados, as reações de Grau 1 prevaleceram. Embora seja um tratamento seguro, a imunoterapia pode levar ao aparecimento de reações sistêmicas, e deve ser realizada pelo médico especialista, em ambiente adequado e equipado para tratamento de reações sistêmicas.

Objective: To report and classify adverse reactions to subcutaneous immunotherapy (SCIT) to house dust mites in the treatment of allergies. Method: We included 38 patients undergoing treatment with SCIT using Dermatophagoides pteronyssinus (Der p) extracts isolated or combined with Blomia tropicalis (Blo t). Systemic adverse reactions to SCIT were reported and classified according to World Allergy Organization (WAO) criteria. Treatment details and reaction evolution were also recorded. Results: Mean age of patients was 36 years. A total of 1,127 doses of SCIT with Der p extract were administered. Of these, 87.3% (984) caused reactions. The classification of reactions according to WAO criteria was as follows: 35.49% Grade 1, 46.85% Grade 2, 17.6% Grade 3. Treatment consisted of antihistamine in 81.3% of the cases, corticosteroid in 81.3%, and inhaled beta-agonist in 70%. Epinephrine was used in 41% of the reactions. In the group that received Der p and Blo t extracts combined, 435 doses were administered, of which 155 (37.47%) resulted in reactions: 78% Grade 1 and 21.9% Grade 2. Treatment consisted of antihistamine in 77.2% of the reactions, corticosteroids in 77.2%, and inhaled beta-agonist in 58%. Conclusion: In the studied population, systemic reactions to Der p were mostly Grade 2 according to the WAO classification. Conversely, reactions to SCIT with Der p and Blo t extracts combined were mostly Grade 1. Even though immunotherapy is considered a safe therapy, it may cause systemic adverse reactions, and should therefore be performed by a specialist physician in an adequate, well-equipped setting for the treatment of systemic reactions.

Perfil de sensibilização a alérgenos prevalentes em clínica especializada de Catalão, Goiás / Sensitization profile to prevailing allergens in a specialty clinic in Catalão, state of Goiás

Objetivo: Investigar o perfil de sensibilização a alérgenos e a frequência de reatividade ao teste cutâneo de puntura com aeroalérgenos mais comuns em uma clínica especializada de Catalão, GO. Métodos: Neste estudo retrospectivo, foram analisados 400 prontuários de pacientes atendidos no período de 2008 a 2010, que realizaram teste cutâneo de puntura para avaliar sensibilidade a aeroalérgenos. Resultados: A prevalência de sensibilização alérgica foi de 70,7% entre os pacientes avaliados. Entre os aeroalérgenos analisados, houve frequência elevada de positividade a ácaros da poeira domiciliar em todos os meses, principalmente em julho e dezembro, seguidos por fungos. Sensibilização alérgica foi predominante para Dermatophagoides pteronyssinus (62%), entre os ácaros da poeira domiciliar. Em relação à frequência de pacientes atendidos com sintomas de doenças atópicas, observou-se que rinite foi a principal causa de atendimento (48,2%), seguida de asma, com 23,2% dos atendimentos. Houve um aumento de 24% no número de pacientes que procuraram atendimento, refletindo possível aumento na prevalência de doenças alérgicas durante os anos avaliados. Conclusões: Os resultados obtidos no presente trabalho mostraram que os ácaros são os agentes causadores mais frequentes de alergia, e que a rinite foi a doença atópica mais frequente entre os pacientes de uma clínica especializada. Foi verificado aumento no número de atendimentos por doenças alérgicas nos anos avaliados.

Objective: To investigate the profile of sensitization to allergens and the frequency of reactivity to skin prick tests with the most common aeroallergens at a specialty clinic in the municipality of Catalão, state of Goiás. Methods: In this retrospective study, 400 charts of patients seen between 2008 and 2010 and who underwent skin prick testing for evaluation of sensitivity to aeroallergens were analyzed. Results: The prevalence of allergic sensitization was 70.7%. Among the aeroallergens analyzed, there was a high frequency of sensitization to house dust mites in all months, especially in July and December, followed by molds. Among house dust mites, allergic sensitization to Dermatophagoides pteronyssinus was predominant (62%). In relation to the frequency of patients with symptoms of atopic diseases, rhinitis was the main cause for seeking treatment (48.2%), followed by asthma (23.2%). There was an increase of 24% in the number of patients who sought care, reflecting a possible increase in the prevalence of allergic diseases over the years evaluated. Conclusions: The results obtained in the present study showed that house dust mites were the most common causal agents of allergy and that rhinitis was the most common atopic disease among patients seen at a specialty clinic. There was an increase of 24% in the number of consults for allergic diseases over the years evaluated.

Vacina de Bordetella pertussis reduz IgE específica, inflamação e remodelamento num modelo animal de alergia respiratória induzida por ácaro / Bordetella pertussis vaccine reduces specific IgE, inflammation, and remodeling in an animal model of respiratory allergy caused by house dust mites

Objetivo: Adjuvantes, como lipopolissacárides bacterianos, vêm sendo estudados para melhorar a eficácia da imunoterapia alérgeno-específica. A vacina de Bordetella pertussis (Pw) mostrou ter papel protetor em modelos de asma induzida por ovalbumina. Porém, seu papel na alergia a ácaros é desconhecido. Avaliamos os efeitos da vacina difteria-tétano-coqueluche (DTPw) em um modelo murino de alergia respiratória induzida por Dermatophagoides pteronyssinus (Derp). Métodos: Num protocolo de 30 dias, camundongos BALB/c foram imunizados por via subcutânea com salina ou Derp, isoladamente ou associados às vacinas de difteria-tétano (DT) ou DTPw (dias 0, 7 e 14). Posteriormente, os animais sofreram desafio intranasal diariamente com salina ou Derp (dias 22 a 28) e foram sacrificados (dia 29). Avaliamos imunoglobulinas séricas específicas, celularidade no lavado bronco-alveolar (BAL), remodelamento das vias aéreas inferiores, densidade de leucócitos polimorfonucleares (PMN) e área de muco ácido no epitélio nasal. Resultados: Os animais sensibilizados com Derp produziram altos níveis de imunoglobulinas específicas, apresentaram aumento da densidade de PMN e da área de muco ácido nasal, elevação da celularidade no BAL e remodelamento. As vacinas levaram à redução dos níveis de IgE, sendo o grupo Derp-DTPw similar aos grupos salina. Os grupos vacinados tiveram redução da celularidade no BAL e do remodelamento, com resultados mais expressivos no grupo Derp-DTPw em relação ao Derp-DT. As vacinas DT e DTPw inibiram o infiltrado PMN nasal e DTPw modulou a produção do muco ácido. Conclusões: A vacina DTPw diminuiu a IgE específica sérica, inflamação nasal e pulmonar e o remodelamento das vias respiratórias inferiores.

Objective: Adjuvant therapies, such as the use of bacterial lipopolysaccharides, have been evaluated as tools to improve the effectiveness of allergen-specific immunotherapy. Bordetella pertussis vaccine (Pw) has been shown to have a protective role in asthma models induced by ovalbumin. Conversely, its role in allergy to dust mites is unknown. We evaluated the effects of diphtheria-tetanus-pertussis vaccine (DTPw) in a murine model of respiratory allergy induced by Dermatophagoides pteronyssinus (Derp). Methods: Over a 30-day protocol, BALB/c mice were immunized subcutaneously with saline or Derp, alone or combined with diphtheria-tetanus vaccine (DT) or DTPw (days 0, 7, and 14). Then, they were subjected to intranasal challenge with saline or Derp daily (days 22 to 28), and sacrificed on day 29. We evaluated serum specific immunoglobulins, bronchoalveolar lavage (BAL) cellularity, lower airway remodeling, density of polymorphonuclear leukocytes (PMN), and acidic mucus area in the nasal epithelium. Results: Animals sensitized to Derp produced high levels of specific immunoglobulins, showed increased PMN density and acidic mucus in the nasal mucosa, and elevated BAL cellularity and remodeling. Vaccines led to the reduction of IgE levels, with the Derp-DTPw group showing similar results to those of the saline groups. Vaccinated groups showed reduced BAL cellularity and airway remodeling, with more expressive results in the Derp-DTPw group compared to Derp-DT. DT and DTPw vaccines inhibited PMN infiltration in nasal mucosa, and DTPw modulated the production of acidic nasal mucus. Conclusions: DTPw vaccine decreased serum specific IgE, nasal and pulmonary inflammation, and lower airway remodeling.

Efficacy of Nasal Cellulose Powder in the Symptomatic Treatment of Allergic Rhinitis: A Randomized, Double-Blind, Placebo-Controlled Trial

PURPOSE: Nasal Cellulose Powder (NCP), which can prevent from binding an allergen to nasal mucosa, may reduce allergic rhinitis (AR) symptoms in dust mite-sensitized children. This study was conducted to assess the efficacy of NCP in improving clinical symptoms of a nasal airflow limitation and the response of nasal inflammatory cells. METHODS: Children with dust mite-sensitized AR aged 6–18 years were recruited. After a 4-week run-in period, NCP or a placebo was administered, 1 puff per nostril 3 times daily for 4 weeks. The nasal provocation test (NPT) with Dermatophagoides pteronyssinus (Der p) was performed before and after treatment. The daily symptom scores (DSS), daily medication scores (DMS), the peak nasal inspiratory flows (PNIF), nasal airway resistance (NAR), as well as the maximum tolerated dose of NPT and eosinophil counts in nasal scraping, were evaluated. RESULTS: Sixty children (30 NCP and 30 placebos) were enrolled. Before treatment, there were no significant differences in age, dust mite control measures, DSS, DMS, PNIF, NAR, the maximum tolerated dose of NPT, or nasal eosinophil scores between children receiving NCP and placebos. After treatment, there were no significant differences between the NCP and placebo groups in the median (range) of the outcomes—DSS: 2.06 (0.18–3.77) vs. 1.79 (0.08–7.79), P=0.756; DMS: 1.60 (0–5.13) vs. 0.56 (0–4.84), P=0.239; PNIF (L/min): 110 (60–160) vs. 100 (50–180), P=0.870; NAR (Pa/cm³/s): 0.40 (0.20–0.97) vs. 0.39 (0.24–1.32), P=0.690; the maximum tolerated dose of NPT and the nasal eosinophil scores: 1 (0–4) vs. 1 (0–4), P=0.861. CONCLUSIONS: NCP treatment may not be more effective than placebo treatment in dust mite-sensitized AR children.