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A 23-year-old medical student showed a positive reaction on a skin test for Paragonimus westermani, and two Tarsonemus floricolus mites were subsequently found by sputum examination and identified morphologically. Our report is the first human case of Tarsonemus floricolus in Korea.
We evaluated the efficacy of health education in reducing indoor arthropod allergens in Seoul. The mite control measures comprised the use of mite-proof mattress and pillow coverings, regular washing of potentially infested materials, maintenance of a low humidity, removal of carpets, and frequent vacuum cleaning. Cockroach control measures included trapping, application of insecticides, and protecting food. Of 201 homes enrolled in October 1999, 63 volunteers were included in a 2-year follow-up survey between April 2000 and January 2002. Before intervention, the density of mites/g of dust varied greatly; 27.1/g in childrenos bedding, 20/g in adult bedding, 7.2/g on the floors of childrenos bedrooms, 6.8/g in sofas, 5.9/g on the floors of adultos bedrooms, 3.9/g on living room floors, 3.7/g in carpets, and 1.9 mites/g on kitchen floors. The predominant mite species and house percentages infested were; Dermatophagoides farinae 93%, D. pteronyssinus 9%, and Tyrophagus putrescentiae 8%. Comparing 1999 and 2001 infestations, before and after 25 mo of education, mite abundance was reduced by 98%, from 23.7 to 0.57 mites/g of dust. In 1999, cockroaches were detected in 62% homes: 36% Blattella germanica and 35% Periplaneta spp., including 9% double infestations of B. germanica and P. americana. Following intervention, cockroach infestation rates decreased to 22% of houses in 2000 and 23% in 2001. We conclude that continuous and repetitive health education resulted in the effective control of domestic arthropods.
Housing hazards contribute to considerable morbidity and mortality among millions of children each year in the US, but few interventions are proven to control asthma and lead poisoning. Moreover, there is little evidence that many of the current recommendations to control residential hazards are safe and efficacious. The only interventions that have been found to work consistently are home visitation programs and home modification, such as installment of window guards and carpet removal. Altering the environment to protect the health of children requires pediatrician intervention. New models of cooperation between pediatricians and public health agencies must deal with residential hazards in an integrated manner and cannot be focused on one disease process or one method at a time. With research in more effective environmental interventions and pediatric-public-health partnerships, primary and secondary prevention of diseases from residential hazards may become a reality in the future.
PURPOSE: This study was designed to examine the effect of asthma management education program applied to allergic asthma patients receiving immunotherapy due to house dust mite on their stress and compliance with health care regimens. METHODS: A quasi experimental design with non-equivalent control group and non-synchronized design was used. The subjects of this study were 61 patients who were receiving immunotherapy at intervals of a week after their symptoms were diagnosed as house dust mite allergic asthma at the pulmonary department of a university hospital in Seoul. They were divided into an experimental group of 29 patients who received asthma management education and a control group of 32 patients. The asthma management education program was composed of group education (once) and reinforcement education (three times) with environmental therapy and immunotherapy to house dust mite. RESULTS: Stress significantly decreased in the experimental group compared to that in the control group. Compliance with health care regimens significantly increased in the experimental group compared to that in the control group. CONCLUSIONS: The results suggested that the asthma management education program is effective for the management of stress and the improvement of compliance in patients with allergic asthma to house dust mite.
Allergy to house dust mite is among the most prevalent allergic diseases worldwide. Most house dust mite allergic patients react to Der p 1 from Dermatophagoides pteronyssinus, which is a cysteine protease. To avoid heterogeneity in the sample used for crystallization, a modified recombinant molecule was produced. The sequence of the proDer p 1 allergen was modified to reduce glycosylation and to abolish enzymatic activity. The resulting rproDer p 1 preparation was homogenous and stable and yielded crystals diffracting to a resolution of 1.61 A. The active site is located in a large cleft on the surface of the molecule. The 80-aa pro-peptide adopts a unique fold that interacts with the active site cleft and a substantial adjacent area on the mature region, excluding access to the cleft and the active site. Studies performed using crossed-line immunoelectrophoresis and IgE inhibition experiments indicated that several epitopes are covered by the pro-peptide and that the epitopes on the recombinant mature molecule are indistinguishable from those on the natural one. The structure confirms previous results suggesting a preference for aliphatic residues in the important P2 position in substrates. Sequence variations in related species are concentrated on the surface, which explains the existence of cross-reacting and species-specific antibodies. This study describes the first crystal structure of one of the clinically most important house dust mite allergens, the cysteine protease Der p 1.
Allergic asthma is associated with a pulmonary recruitment of Th type 2 cells, basophils, and eosinophils, mainly linked to chemokine production. CCL18 is a chemokine preferentially expressed in the lung, secreted by APCs, induced by Th2-type cytokines, and only present in humans. Therefore, CCL18 may be involved in allergic asthma. PBMC from asthmatics allergic to house dust mite cultured in the presence of Dermatophagoides pteronyssinus 1 (Der p 1) allergen secreted CCL18, 48 and 72 h after stimulation, whereas those from healthy donors did not. Part of CCL18 was directly derived from Der p 1-stimulated plasmacytoid dendritic cells, whereas the other part was linked to monocyte activation by IL-4 and IL-13 produced by Der p 1-stimulated T cells. In bronchoalveolar lavages from untreated asthmatic allergic patients, CCL18 was highly increased compared with controls. Functionally, CCL18 preferentially attracted in vitro-polarized Th2 cells and basophils, but not eosinophils and Th1 cells, and induced basophil histamine and intracellular calcium release. These data show a new function for CCL18, i.e., the recruitment of Th2 cells and basophils, and suggest that CCL18 may play a predominant role in allergic asthma.
BACKGROUND: Chronic urticaria is one of the perplexing problems faced by clinicians. There are a few reports associating house dust mite sensitivity with chronic urticaria, based upon the patient's history as well as intradermal skin testing and in vitro analysis. AIMS: To investigate the possible association between house dust mite sensitivity and chronic urticaria. METHODS: In this case control study three groups of patients were enrolled. Group I: Chronic urticaria (73 subjects). Group II: Chronic urticaria with collateral allergic disorders (49 subjects). Group III: Normal subjects without chronic urticaria or other allergies (25 subjects). All the patients underwent skin prick testing with antigens of the house dust mite, Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF), with positive and negative controls. RESULTS: Among the patients with chronic urticaria, 78/122 (64%) patients had skin sensitivity to house dust mites. Out of these, 39/73 (53%) had chronic urticaria alone and 39/49 (79%) had chronic urticaria with other associated allergies. Among the normal control subjects, 7/25(28%) reacted positively to house dust mites. CONCLUSION: This study suggests a possible association of house dust mite sensitivity with chronic urticaria.
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A family history of allergy and asthma identifies children at high risk of allergic disease. Dietary restrictions in pregnancy are not recommended. Avoiding inhalant allergens during pregnancy has not been shown to reduce allergic disease, and is not recommended. Breastfeeding should be recommended because of other beneficial effects, but if breast feeding is not possible, a hydrolysed formula is recommended (rather than conventional cow's milk formulas) in high-risk infants only. Maternal dietary restrictions during breastfeeding are not recommended. Soy formulas and other formulas (eg, goat's milk) are not recommended for reducing food allergy risk. Complementary foods (including normal cow's milk formulas) should be delayed until a child is aged at least 4-6 months, but a preventive effect from this measure has only been demonstrated in high-risk infants. There is no evidence that an elimination diet after age 4-6 months has a protective effect, although this needs additional investigation. Further research is needed to determine the relationship between house dust mite exposure at an early age and the development of sensitisation and disease; no recommendation can yet be made about avoidance measures for preventing allergic disease. No recommendations can be made about exposure to pets in early life and the development of allergic disease. If a family already has pets it is not necessary to remove them, unless the child develops evidence of pet allergy (as assessed by an allergy specialist). Women should be advised not to smoke while pregnant, and parents should be advised not to smoke. No recommendations can be made on the use of probiotic supplements (or other microbial agents) for preventing allergic disease at this time. Immunotherapy may be considered as a treatment option for children with allergic rhinitis, and may prevent the subsequent development of asthma.
Dynamics of the number and biomass of D. pteronyssinus and D. farinae and the concentration of major significant mite allergens of groups 1 and 2 were studied in simple periodic cultures. The experiments provided evidence for that there is a positive relationship between the concentration of mite allergens Der p I, Der p II, Der f I, Der f II and the number of mites D. pteronyssinus and D. farinae, as evidenced by both correlation coefficients and curves. The same relationship was seen while examining the number of mites and the exposure of mite allergens in house dust. The findings suggest that the concentration of major mite allergens of Groups 1 and 2 in addition to the number/biomass of mites are one of the most important criteria for the maturity of the culture. The cultures of D. pteronyssinus and D. farinae mature no later than on day 29 of the onset of cultivation, as shown by the maximum concentrations of Der p I, Der p II, Der f I, Der f II and mite biomass, achieved in this period.
Disodium cromoglycate (DSCG), budesonide, and cyclosporin A (CsA) were the well-known immunomodulators for the allergic and immunologic diseases clinically. In this study, we evaluated the characteristics of inhibition on cytokine synthesis of Der p I-stimulated T cells by the same inhibiting concentrations of DSCG, budesonide, and CsA in house-dust mite antigen (Der p I)-specific atopic and nonatopic healthy individuals. Seven house dust mite allergen specific patients were recruited for this study. Seven healthy volunteers were included on the basis of negative allergic manifestations and low serum immunoglobulin E values. Peripheral blood mononuclear cells (PBMCs) were cultured in the presence of recombinant interleukin (rIL)-2 with or without budesonide, DSCG, CsA, and Der p I for 48 hours. Cells were stained with anti-CD4 fluorescein isothiocyanate-conjugated monoclonal antibody, and then anti-human IL-4 phycoerythrin, IL-5, or IL-13 monoclonal antibody, respectively, was added to both blocked and stained samples. Incubation of PBMC from atopics with each immunomodulator and Der p I resulted in the reduction of IL-4 secretion compared with Der p I alone stimulation. However, IL-4 secretion in PBMC from nonatopics was not reduced with DSCG and Der p I stimulation. IL-4, IL-5, and IL-13 secretions of PBMC from atopics were significantly decreased after incubation with each immunomodulator and Der p I, compared with after incubation with Der p I alone. These results might be considered to show either that DSCG has a selective inhibiting effect on cytokine production in T cells from atopics or is a weak inhibitor of cytokine secretions compared with budesonide and CsA at even strength for the inhibition of lymphocyte proliferation in normal, healthy individuals.
The present work aimed at evaluating the efficacy and tolerance of an alternative schedule of local nasal immunotherapy for the treatment of mite dust allergic rhinitis. The authors suggest the nasal administration of the maximum tolerated dosage chosen on the basis of nasal provocation test threshold, comparing allergen extracts in micronized powder and watery solution. Forty-five patients (25 men and 20 women), aged 18 to 66 years, affected by allergic rhinitis to Dermatophagoides (Dpt) were selected and treated either by local immunotherapy in watery solution (15) or in powder form (15) or by parenteral specific hyposensitizing treatment (15). Before and one year after the beginning of the study, the clinical diaries and the total and specific IgE variation were evaluated. The monthly symptoms and drugs use are comparable among the three treatment groups. No significant difference was found, with the exception of local symptomatology, which improved more in patients undergoing local immunotherapy (p > 0.05); and oral antihistamines use, which was lower in patients treated with the watery solution (p < 0.05). Thus, local simplified hyposensitizing treatment is able to combine the absence of symptomatological worsening with the decrease of both local and systemic drugs use. The advantages of the LNIT protocol proposed herein are as follows: simplified schedule for self-administration; improved patient compliance; reduction of local side effects; clinical efficacy comparable with subcutaneous specific immunotherapy.
Ethnic origin has been reported to affect the prevalence of atopic diseases in several studies in different parts of the world. The aim of this study was to determine the current and cumulative prevalence of asthma, allergic rhinitis, atopic dermatitis and reactivities to allergen skin prick tests (SPT) among secondary school students in Afyon, Turkey. The data of the first stage were collated through the application of the European Community Respiratory Health Survey Questionnaire on 1,400 students (1,366 were properly completed) registering at various schools in Afyon-Turkey, in the academic year 2000-2001. At the second stage, a physical examination and SPT were performed on 121 students. Of the students within the study group, 53 (3.9%) had experienced an asthma attack within the previous 12 months, 49 (3.6%) had a past history of asthma attacks and 167 (12.2%) reported wheezing attacks within the previous 12 months. The cumulative prevalence of asthma, rhinoconjunctivitis and dermatitis were found to be 7.46%, 8.10% and 3.5%, respectively. A positive SPT reaction to at least one allergen was found in 15.7% of the students. SPT positivity was 11.13% in symptomless students and 20.3% in asthmatic students. In analysis of logistic regression, a history of atopy, as determined in the questionnaire, was seen to be significantly correlated with SPT positivity. The prevalence of self-reported asthma and/or asthma-like symptoms was shown to be lower in students living in Afyon than other countries. Asthma and asthma-like symptoms were found to be significantly more prevalent among students who smoked.
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Epidemiologic studies suggest an inverse correlation between infection and development of allergy. The purpose of this study was to test the hypothesis whether a preexisting T helper 1 (Th1)-type immune response elicited by Mycobacterium bovis-bacillus Calmette-Guerin (BCG) immunization could suppress allergic airway inflammation induced by the mite allergen Dermatophagoides pteronyssinus group 2 (Der p2) in an animal model. C57BL/6 mice were immunized with subcutaneous injection of BCG, then intraperitoneal Der p2 emulsified in alum. Der p2-specific immunoglobulin G1 and cytokine production from splenocytes were measured after Der p2 sensitization, and pulmonary function and airway inflammation were determined after inhalation challenge with Der p2. The intraperitoneal Der p2 with alum injection was able to induce Der p2-specific immunoglobulin G1 production, which could be downregulated by the pretreatment with BCG + Der p2. The inoculation of BCG + Der p2 caused splenocytes to produce more interferon-gamma, and this level was higher than that elicited by Der p2 or buffer alone. The positive interferon-gamma-staining CD4 cells were also increased after activation by phorbol myristate acetate and ionomycin. Lung pathology examination found decreased airway inflammation (associated with the best pulmonary function and least airway desquamation) in the mice inoculated with BCG + Der p2. In this Der p2-induced allergy model, BCG inoculation with Der p2 can cause a Th1-type immune response that hinders Der p2-induced allergic sensitization and the development of airway inflammation.
Formaldehyde (FA) irritates the skin, eyes, and respiratory system and is considered to be a typical air pollutant. We investigated the effects of FA on the manifestations of airway inflammation caused by a house-dust mite allergen (Der f). ICR mice were exposed to 0.5% FA mist once a week for 4 weeks. The mice were sensitized intraperitoneally with Der f and ALUM prior to FA exposure. After the last FA exposure, theywere instilled intratracheally with Der f. The airway inflammation was subsequently examined. The Der f-specific IgG1 and IgE in plasma as well as the asthma-relevant cytokines in the lungs were measured. We found an increase in the plasma IgG1 production of and in the expression of interleukin-5 (IL-5) and regulated on activation, normal T cell expressed, and presumably secreted (RANTES) in the lungs of mice treated with Der f. The FA exposure enhanced the manifestation ofthe histopathological changes caused by Der f. This observation corresponded to the enhancement of IL-5 and RANTES production. However, the antigen-specific IgG1 antibody did not increase. The IL-4 cytokine level induced by Der fwith or without FA was the same as that of the control. IL-2, granulocyte macrophage-colony stimulating factor (GM-CSF), and antigen-specific IgE were not detected. FA exposure enhanced the eosinophilic airway inflammation and the proliferation of goblet cells, which were induced by a mite allergen responsible for the increased local expression of IL-5 and RANTES.
In epidemiological studies, increased indoor temperature--producing a lower relative humidity--is associated with low house dust mite (HDM) load. Twenty-eight dwellings were allocated for either intervention (12/15 completed) or control (11/13 completed). In the intervention group, participants were asked to increase the bedroom temperature by at least 3 degrees C compared to the self-assessed temperature of the previous winter. Dust samples were repeatedly collected from mattress and floor, and bedroom temperature and relative humidity were recorded hourly throughout one year. Dust was analysed for allergen (Der f 1 + Der p 1 + Der m 1 = Der 1) by ELISA and HDMs were counted. Changes in mite and in mite allergen concentration were the same in the control and intervention groups, and measured temperatures did not differ during intervention period in the groups (18 degrees C and 19 degrees C). Groups turned out not to be comparable with respect to initial (self-assessed) bedroom temperature (lowest in the intervention group). There was a significant seasonal variation, with doubled Der 1 concentrations in dust collected in July-November compared to January-May samples. No effect was obtained on mites or mite allergens, but this may be due either to a general lack of effect of increase in bedroom temperature, or to an insufficient increase in temperature in our intervention group. Seasonal variations in HDM and HDM allergens must be accounted for when data on exposure are interpreted.
Sarcoptes scabiei ("itch mite") causes scabies, a disease of considerable human and veterinary significance. Little work has been done at the molecular level because of the difficulty of obtaining mites. We have used mites in skin from the bedding of crusted scabies patients for the construction of a library of 10(5) cDNAs from S. scabiei var. hominis cloned in the vector pGEX4T-2. We describe the isolation by immunoscreening of 2 clones, one of which (Ssagl) is homologous to and cross-reactive with the house dust mite Euroglyphus maynei allergen M-177, an apolipoprotein from hemolymph. Immunohistochemistry revealed that it is located around the internal organs and cuticle of the mite and in eggs. Although it was not found to be protective in a challenge trial, the rabbits did not exhibit typical crust characteristics. This work shows that it is now possible to conduct such challenge trials with cloned scabies antigens.