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Early sensitisation and development of allergic airway disease - risk factors and predictors.

The development and phenotypic expression of allergic airway disease depends on a complex interaction between genetic and several environmental factors, such as exposure to food, inhalant allergens and non-specific adjuvant factors (e.g. tobacco smoke, air pollution and infections). The first months of life seem to be a particularly vulnerable period and there is evidence that sensitisation is related to the level of allergen exposure during early life. At present, the combination of atopic heredity and elevated cord-blood IgE seems to result in the best predictive discrimination as regards development of allergic disease at birth. Early sensitisation, cow's milk allergy and atopic eczema are predictors for later development of allergic airway disease. Exposure to indoor allergens, especially house dust mite allergens, is a risk factor for sensitisation and development of asthma later in childhood in high-risk infants and infants with early atopic manifestations.

Age Factors↗

Acaricidal activity of active constituent isolated in Chamaecyparis obtusa leaves against Dermatophagoides spp.

Acaricidal activities of materials derived from Chamaecyparis obtusa leaves against Dermatophagoides farinae and Dermatophagoides pteronyssinus were examined using the dry film method and compared with that of commercial benzyl benzoate and N,N-diethyl-m-toluamide (DEET). The active constituent of the C. obtusa leaves was identified as beta-thujaplicin (C10H12(O2)) by spectroscopic analyses. Responses varied with dose. On the basis of a 24 h LC50 value, acaricidal activity against D. farinaewas more pronounced with beta-thujaplicin (72.2 mg/m2) than benzyl benzoate (89.9 mg/m2) and DEET (377 mg/m2). Acaricidal activity against D. pteronyssinus was more pronounced in beta-thujaplicin (62.1 mg/m2) than benzyl benzoate (72.4 mg/m2) and DEET (193 mg/m2). These results indicate that acaricidal activity of C. obtusa leaves likely results from by beta-thujaplicin. Beta-thujaplicin merits further study as potential house dust mite control agents or lead compounds.

Benzoates↗

The effect of sub-floor heating on house-dust-mite populations on floors and in furniture.

It is well known that dehydrating conditions for house dust mites can be created by simply raising the temperature, causing loss of body water and eventually death. Thus, it can be expected that conditions for dust mites are less favourable on floors supplied with sub-floor heating. This was examined in a study of 16 houses with sub-floor heating and 21 without. The pattern of changes in air humidity and temperature on the floors was investigated and compared to known data of the tolerance of dust mites. Also the resident mite populations were compared. Floors with sub-floor heating had, on average, fewer mites, but the difference with unheated floors was small. It was remarkable that mite numbers were also lower in upholstered furniture. Another important observation was that some houses with sub-floor heating had high mite numbers, indicating that this type of heating is compatible with a thriving mite population. Temperature and humidity conditions of heated floors may allow mites not only to survive, but also to remain active in winter. A moderate increase in temperature, a moderate decrease in (absolute) air humidity, or a combination of both, will suffice to keep the humidity all winter below the Critical Equilibrium Humidity, the level of air humidity that is critical for mite growth and reproduction, hence for allergen production. However, it is argued that measures to suppress allergen production by house dust mites are likely to be far more effective if taken in summer rather than in winter.

Air Pollution, Indoor↗

[Allergy to house dust mites: allergy independent symptoms dominate].

A sensitisation to allergens has not always a clinical relevance. Therefore, the history has an uppermost importance for defining the relevance of a sensitisation. In contrast to the history in seasonal rhino-conjunctivitis, which causes typical complains in a restricted time period patients with house dust mite allergy seem to have less defined complaints. To define the most relevant symptoms of this frequent allergy, we evaluated 35 patients with clearly defined house dust mite allergy by a questionnaire and evaluated the same questionnaire also in a control group of 18 patients without sensitisation or asthma. The symptoms described in the patient group confirm that symptoms of house dust mite allergy are frequently not related to a direct allergen exposure. Some patients complained about itchy red eyes in the morning, but the majority of symptoms occurred independent from allergen exposure. These are blocked nose as well as exercise induced asthma. These symptoms are present all year around and are not only restricted to mite exposed areas. They are probably related to the underling eosinophilic inflammation. Thus exercise induced asthma and blocked nose are symptoms, which may indicate a mite allergy, particular in younger patients.

Adolescent↗

House-dust mites and mattresses.

BACKGROUND: Despite considerable efforts to develop anti dust mite strategies, surprisingly few studies have evaluated the allergen content in different types of mattresses in everyday use. This study investigated the presence of mite feces (an indicator of mite allergens) in foam and spring mattresses. METHODS: The homes of 152 schoolchildren in Northern Norway were investigated. Dust samples were collected in a standardized way from 24 foam mattresses without covers, 68 foam mattresses with covers, and 24 spring mattresses, and the presence of mite feces detected by a guanine colorimetric paper test (Acarex). RESULTS: We found mite feces in 15 (40.5%) of the dust samples from the foam mattresses without covers and 18 (26.3%) of the foam mattresses with covers. Only three (12.5%) of the spring mattresses contained detectable amounts of feces. Signs of dampness, age of mattress, cleaning of mattress, frequency of vacuuming the bedroom, mechanical ventilation, bedroom temperature and bedroom relative humidity were associated with the presence of mite feces. After adjustment for relevant confounders, the risk of finding mite feces was four times higher in foam compared to spring mattresses (odds ratio 4.0, 95% confidence interval (CI) 1.1-15.1), and eight times higher for the foam mattresses without cover (OR 8.1, 95% CI 1.8-36.9). CONCLUSION: A simple replacement of foam mattresses with spring mattresses may reduce the exposure to house-dust-mite allergens.

Air Pollution, Indoor↗

The unfavorable effects of concomitant asthma and sleeplessness due to the atopic eczema/dermatitis syndrome (AEDS) on quality of life in subjects allergic to house-dust mites.

BACKGROUND: Allergic rhinitis, asthma or the atopic eczema/dermatitis syndrome (AEDS) may independently impair quality of life in patients. However, although many allergic patients may suffer from more than one disorder, the effect of concomitant disease -- in particular, the impact of AEDS -- is largely unknown. As part of a large multicenter clinical trial on the efficacy of mattress casings in house-dust mite (HDM) allergy, generic quality of life in a mixed population of 224 subjects with rhinitis (n = 198) and/or asthma (n = 111) and/or AEDS (n = 64) was studied. The study aimed to estimate quality of life impairment in these atopic patients and to address the question/issue of whether one atopic disorder goes beyond other existing allergic diseases, thereby causing further impairment to quality of life. METHODS: Generic quality of life was assessed by SF-36. Quality of life in the atopic group was compared with a Dutch norm population. Multiple linear regression was used to determine the effects of disease (i.e. the presence of allergic rhinitis, asthma or AEDS) or disease severity, as assessed by visual analog scores (VAS) for asthma, rhinitis, VAS sleeplessness and VAS itching being considered as major symptoms in AEDS on SF-36 domains. RESULTS: Compared to the norm group, atopic patients were impaired in: physical functioning; role physical functioning; general health; vitality; and social functioning. The diagnosis of asthma was negatively associated with the SF-36 subscales for physical functioning (P = 0.02), and general health (P < 0.01). In line with these findings, asthma severity (VAS asthma) was negatively associated with physical functioning (P < 0.01), role physical functioning (P < 0.01), general health (P < 0.0.1), social functioning (P = 0.01), emotional functioning (P = 0.01), and vitality (P = 0.01). VAS sleeplessness had significant negative effect on role physical functioning (P < 0.01), bodily pain (P < 0.01), General health (P = 0.01), mental health (P < 0.01), social functioning (P < 0.01), and vitality (P < 0.01). In contrast, neither the diagnosis of allergic rhinitis or AEDS, nor VAS itching as an outcome parameter of AEDS, exerted additional effects on the SF-36 domains. CONCLUSIONS: Patients with atopic disease based on HDM allergy may have impaired quality of life. The majority of these patients have allergic rhinitis. The (co)existence of asthma, expressed in terms of diagnostic criteria or symptom severity, or the presence of sleep disorders as a consequence of AEDS, may further impair quality of life.

Adolescent↗

The 3 mm skin prick test (SPT) threshold criterion is not reliable for Tyrophagus putrescentiae: the re-evaluation of SPT criterion to dust mites.

BACKGROUND: The mean wheal diameter >/= 3 mm is the usual criterion for positive skin prick test (SPT) reaction to dust mites. The study assessed the accuracy of this SPT criterion with respect to specific IgE values of above 0.35 kUA/l (+ sIgE). METHODS: Specific IgE (ImmunoCAP, Pharmacia AB Diagnostics, Uppsala, Sweden) and standard SPT to Dermatophagoides pteronyssinus (DP) and farinae (DF), Lepidoglyphus destructor (LD) and Tyrophagus putrescentiae (TP) (ALK, Hørsholm, Denmark) were performed in a random sample of 457 subjects, of whom 273 men (mean age 35.3 +/- 11.0 years) and 184 women (mean age 37.9 +/- 9.5 years). Statistical analysis was performed using the chi-square test, regression analysis and discriminant analysis. RESULTS: When the mean wheal diameter of >/= 3 mm was considered positive (+ SPT), the correlation between + SPT and + sIgE was 0.47 for DP (P < 0.001), 0.43 for DF (P = 0.004), 0.35 for LD (P = 0.03) and 0.37 for TP (P = 0.014). Regarding + sIgE, this SPT criterion has a specificity of 92.2% for DP, 82.3% for DF, 80.8% for LD and 70.1% for TP. When the value 4.5 mm was taken as the threshold for the positive SPT reaction to TP, specificity increased significantly from 70.1% to 86.4% (chi2 = 32.04, P < 0.001). CONCLUSIONS: The 3 mm SPT threshold criterion is not reliable in evaluating sensitization to TP due to an insufficient specificity of the allergen extract to this mite. It is advisable either to re-evaluate the TP allergen extract or change the threshold criterion for positive SPT reaction to TP.

Adult↗

In allergic asthma experimental exposure to allergens is associated with depletion of blood eosinophils overexpressing LFA-1.

BACKGROUND: In atopic individuals, exposure to allergens is followed by recruitment of blood eosinophils in the target tissue. We investigated whether allergen inhalation challenge could result in depletion of blood eosinophils overexpressing adhesion molecules involved in eosinophil migration. METHODS: Blood eosinophils were isolated from seven atopic asthmatic patients and seven control subjects and the "at baseline" expression of lymphocyte function-associated antigen-1 (LFA-1), macrophage antigen-1 (Mac-1) and very late antigen-4 (VLA-4) was assessed by monoclonal antibody staining and flow cytometry analysis. Asthmatic patients underwent allergen challenge and the expression of LFA-1, Mac-1 and VLA-4 by blood eosinophils was again evaluated 3 h and 24 h after allergen challenge. RESULTS: As compared to controls, eosinophils from atopics showed at baseline enhanced LFA-1 expression (P=0.0012), but similar Mac-1 or VLA-4 expression (P > 0.1, each comparison). In atopics, the percentage and absolute number of blood eosinophils were significantly decreased 3 h after allergen challenge (P=0.001 and P=0.022, respectively) but returned to similar values to prechallenge values after an additional 21 h (P > 0.1). Allergen challenge was also followed by a significant decrease in LFA-1 expression by eosinophils, at 3 h (P=0.002) and at 24 h (P=0.038), while no changes in Mac-1 and VLA-4 were observed. A significant correlation between postchallenge decrease in LFA-1 expression and in blood eosinophilia, both expressed as percentage (r=0.88; P < 0.01) or absolute number (r=0.87; P < 0.01) was demonstrated at 3 h (r=0.88; P < 0.01) but not at 24 h (r=0.64, P > 0.05 and r=0.11; P > 0.05, respectively). CONCLUSION: In allergic asthma, an early recruitment of blood eosinophils overexpressing LFA-1 occurs in the first hours after allergen challenge.

Adolescent↗

The effect of storage on allergen and microbial agent levels in frozen house dust.

BACKGROUND: House dust samples collected for exposure studies are often stored for variable time periods until analysis. However, there is currently no information on the effects of dust storage on the content of biocontaminants. Therefore, associations were analysed between the levels of mite allergens (Der p 1, Der f 1), cat allergen (Fel d 1) and microbial components (endotoxin, beta(1-->3)-glucan) on the one hand and the storage duration of dust samples at -20 degrees C on the other hand. METHODS: Within the framework of a study on the influences of INdoor factors and Genetics on Asthma (INGA), dust samples were collected from living room floors between June 1995 and August 1998 and extracted according to a standardized protocol. The concentrations of Der p 1, Der f 1, Fel d 1 and beta(1-->3)-glucan were determined with specific enzyme immunoassays. Endotoxin content was quantified using a chromogenic kinetic Limulus amoebocyte lysate (LAL) test. All concentrations were expressed per gram of dust RESULTS: Dust samples (n = 1236) were obtained from 655 homes in Hamburg, Hettstedt, Zerbst and Bitterfeld. Storage duration (range 8-298 days) was grouped into four categories ( 120 d). After adjustment for city of residence and season of dust sampling, means ratios comparing categories 2-4 to the first category were not statistically significant for Der p 1, Der f 1, endotoxin and beta(1-->3 glucan). However, Fel d 1 concentrations significantly declined with increased storage times of dust samples. CONCLUSIONS: Storage of house dust at -20 degrees C for up to 10 months has no effect on mite allergen, endotoxin and beta(1-->3)-glucan levels. A potential loss of Fel d 1 during storage of frozen dust samples needs further investigations by repeated measurements of allergen in identical dust samples.

Air Pollution, Indoor↗

Similar levels of nitric oxide in exhaled air in non-asthmatic rhinitis and asthma after bronchial allergen challenge.

BACKGROUND: Nitric oxide in exhaled air (eNO) is elevated in allergic asthma compared with healthy subjects and has been proposed as a marker of bronchial inflammation. However, eNO is elevated to a lesser extent in allergic non-asthmatic rhinitis as well. Considering the distinctive clinical appearances of both allergic diseases, differences in eNO are expected to persist after allergen exposure. The aim of the study was to compare allergen-induced changes in eNO in house dust mite sensitized patients with asthma and patients with perennial rhinitis without asthma symptoms. METHODS: Bronchial allergen challenge was performed in 52 patients sensitized to house dust mite (Dermatophagoides pteronyssinus), of whom 26 had non-asthmatic rhinitis and 26 had asthma. Levels of eNO were measured before and 1 h, 1 day and 1 week after challenge. RESULTS: At baseline eNO was significantly lower in non-asthmatic rhinitis compared with asthma (geometric mean eNO (SEM): 121 (1.1) in non-asthmatic rhinitis vs 197 (1.1) nl/min in asthma, P < 0.006). However, the increase in eNO after bronchial allergen challenge in non-asthmatic rhinitis, in particular in those patients with a dual asthmatic response, significantly exceeded the increase in asthma resulting in similar levels of eNO after challenge (geometric mean eNO (SEM) at 24 h postchallenge 204 (1.1) in non-asthmatic rhinitis vs 244 (1.1)nl/min in asthma, P = 0.3). CONCLUSION: The difference in eNO between non-asthmatic rhinitis and asthma at baseline is abolished after allergen exposure due to a significantly greater increase in eNO in non-asthmatic rhinitis.

Administration, Inhalation↗

Laboratory assessment of the efficiency of encasing materials against house dust mites and their allergens.

BACKGROUND: The current recommendation to reduce mite allergen exposure for mite-sensitive individuals is to use allergen-impermeable bed coverings. As these covers are made of various kinds of materials, they vary in quality. The objective of this study was to investigate the efficiency of different covering materials against house dust mites and their allergens in vitro. METHODS: Four types of materials including (1) plastic cover, (2) polyurethane-coated cover, (3) non-woven covers, (4) tightly woven microfiber covers and a regular cotton bed sheet (as a control) were evaluated using three methods: (i) heat escape method, (ii) Siriraj chamber method and stereomicroscopy, scanning electron microscopy and (iii) enzyme-linked immunosorbent assay (ELISA). RESULTS: We found that there was a statistically significant difference in allergen permeability among four types of coverings (P < 0.001). In terms of the impermeability to mites and their allergens, plastic- and polyurethane-coated covers were observed to be the best, followed by non-woven, woven and cotton-based bed sheets. A regular cotton-based bed sheet allows a significant amount of leakage of mite allergens. Both woven and non-woven material are efficient barriers against mite allergen in terms of impermeability. However, with regard to mite colonization, non-woven covers have the drawback of mites being able to penetrate and colonize within the fabric fibers. Woven covers are therefore recommended because of their major advantages of not allowing the colonization of mites within the fabric, being easy to clean, and comfortable. CONCLUSION: The three assessment methods used in this study could be useful as a primary approach to evaluate the quality of covering materials in vitro using both pore size and ability to be colonized by mites on the materials as the key factors.

Allergens↗

Disodium octaborate tetrahydrate (DOT) application and vacuum cleaning, a combined strategy to control house dust mites.

BACKGROUND: The effectiveness of acaricides in homes is controversial. OBJECTIVE: To determine whether disodium octaborate tetrahydrate (DOT) combined with vacuuming lowers dust mite numbers and their allergens in carpets and sofas. METHODS: A 6-month study was carried out with 93 homes, which were randomized into three groups: (i). active, received DOT; (ii). placebo, received water; and (iii). control, received no application. Active and placebo homes were vacuumed weekly. Dust was collected from carpets and sofas at the start of the study and every 2 months thereafter and quantified for live, total mites, and mite allergen levels. RESULTS: At 2 months, live mite numbers in active carpets were 3 +/- 1, in placebo carpets 129 +/- 48, and in control carpets 177 +/- 39 mites/g. The corresponding numbers in sofas were 3 +/- 2, 81 +/- 31, and 134 +/- 45 mites/g, respectively (P < 0.001 active vs placebo and vs. control). Live mites in carpets and sofas remained lower in the active group at 6 months (P < 0.001). Total mites in active carpets decreased from 555 +/- 69 at baseline to 223 +/- 32 mites/g at 6 months (P < 0.001) and mite allergen levels from 1.36 +/- 0.13 to 0.85 +/- 0.16 microg/g (P < 0.001). Total mites in active sofas remained unchanged, but mite allergen levels decreased from 1.48 +/- 0.25 at baseline to 0.7 +/- 0.15 microg/g at month 6 (P < 0.05). CONCLUSION: DOT kills mites in carpets and sofas, and, combined with vacuuming, effectively reduces total mites in carpets and mite allergen levels in carpets and sofas.

Animals↗

Differences in mite fauna between the continental and Mediterranean climates of Croatia: microscopy and Dustscreen test findings.

BACKGROUND: The aim of this study was to evaluate the difference between the mite fauna in the inland and coastal Croatia. METHODS: Ninety-nine floor house dust samples were collected: 28 from the coastal area, 31 from the inland rural and 40 from the inland urban area. Data on basic household characteristics were collected for 81 of 99 households. The mites were separated from the dust using the floatation method and then microscopically identified. The levels of Dermatophagoides pteronyssinus (Der p) 1, Dermatophagoides farinae (Der f) 1 and Der 2 were measured using the Dustscreen test. Ordinal descriptive statistics and nonparametric tests were used for data analysis, assuming statistical significance at P < 0.05. RESULTS: More than 70% of mites identified in all areas were pyroglyphids. Nonpyroglyphid mites accounted for 20-25% of all identified mites in the coastal areas (Blomia, Lepidoglyphus and Glycyphagus) and with 15% in the inland areas (Lepidoglyphus and Acarus). The highest Der p 1 median levels were found in the coastal area, with significantly lower levels in the inland rural and inland urban areas (4.5; 2; 0.85 microg/g of dust; P = 0.0001). The highest Der f 1 median levels were found in the inland urban area, with significantly lower levels in the inland rural and coastal areas (0.88; 0.75; 0 microg/g of dust; P = 0.0013). The levels of Der f 1 were significantly higher in samples taken from households with central heating than from those with traditional heating (1; 0.25 microg/g of dust; P < 0.01). CONCLUSIONS: Separate diagnostic dust mite lists for the coastal and inland areas because of climatic and dwelling differences required to be implemented. Compared with traditional heating, central heating significantly increases the risk of exposure to Der f 1 levels >2 microg/g of dust (odds ratio, 7.35; 95% confidence interval, 1.43-37.87; P = 0.01).

Animals↗

Nasal inflammation and bronchial reactivity to methacholine in atopic children with respiratory symptoms.

BACKGROUND: In atopic subjects, dysfunctions of the upper and lower airways frequently coexist and allergic rhinitis seems to constitute a risk factor for the occurrence of asthma in predisposed individuals. AIM OF THE STUDY: To evaluate whether in atopic subjects nasal inflammation could reflect changes in respiratory functions, 11 allergic children, sensitized to house dust mites (HDM), with rhinoconjunctivitis and asthma and 10 nonatopic controls (ctrs) were studied. METHODS: All subjects underwent nasal brushing to detect percentages of nasal eosinophils (Eos %) and intercellular adhesion molecule-1 (ICAM-1) expression by nasal epithelial cells. In the same day pulmonary function tests, i.e. forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flows at 25-75% of the vital capacity (FEF25-75%) and methacholine (MCh) bronchial inhalation challenge were also evaluated. RESULTS: Pulmonary function parameters were not significantly different in allergic children and in ctrs (P > 0.05), while a significant increase in bronchial reactivity to MCh, expressed as Pd20 MCh, was detected in the former population (P < 0.05). As compared with ctrs, allergic children showed elevated Eos % and ICAM-1 expression (P < 0.05). When nasal inflammation and pulmonary function parameters were compared, a significant correlation was found between nasal Eos % and bronchial reactivity to MCh (P = 0.002). CONCLUSIONS: These data support the concept of significant links between upper and lower respiratory tract involvement in atopic children sensitized to HDM.

Adolescent↗

Maternal smoking in pregnancy alters neonatal cytokine responses.

BACKGROUND: Maternal cigarette smoking in pregnancy is an important, common and avoidable exposure that has been linked with elevated cord blood (CB) immunoglobulin E levels and subsequent asthma and allergic disease in childhood. Despite this, there is still very little information about the immunological effects of maternal smoking on the fetus. METHODS: This aim of this study was to compare cord blood mononuclear cell (CBMC) cytokine responses to allergens [ovalbumin (OVA) or house dust mite (HDM)] and mitogens [concanavalin A (ConA) or phytohemaglutinen (PHA)] in neonates whose mothers smoked throughout pregnancy (n = 17) with responses of neonates whose mothers never smoked (n = 40). Cell cultures were stimulated for 24 h and supernatants collected for cytokine detection by enzyme-linked immunosorbent assay [interleukin (IL)-13, IL-6, interferon (IFN)gamma and IL-10]. Cell pellets were also collected for cytokine mRNA detection (IL-5, IL-9, IFNgamma). RESULTS: Maternal smoking in pregnancy was associated with significantly higher neonatal T helper type 2 (IL-13 protein) responses to both HDM (P = 0.01) and OVA (P = 0.035). These effects remained statistically significant after allowing for confounding factors, including the effects of maternal atopy. Similar trends were also seen for IL-9mRNA, IL-5mRNA and IL-6 responses, although these were not statistically significant. Although IFNgamma mRNA responses to PHA (P = 0.015) and ConA (P = 0.025) were lower if mothers smoked in pregnancy, there were no differences in neonatal (Th1) IFNgamma protein responses to allergens or mitogens. CONCLUSIONS: These findings indicate that maternal cigarette smoking can modify aspects of fetal immune function and highlight the need for further studies in this area.

Adult↗