Mite hypersensitivity in patients with rhinitis and rhinosinusitis living in a tropical environment

Aeroallergen sensitization patterns among patients with chronic rhinitis with or without concomitant asthma

OBJECTIVES

The aim of this study was to explore the differences in the pattern of allergen sensitization in CR individuals without or with asthma, according to asthma severity.

METHODS

A total of 1066 adults were evaluated. Asthma and chronic⁄allergic rhinits were identified by specialists, questionnaries and skin-prick test. The phenotypic characterization was avaliable from skin-prick test to an aeroallergen extended panel, total IgE and pulmonary function. Using questionnaires and clinical evaluation, participants were classified into the groups: chronic rhinitis alone (CRA) and chronic rhinitis + asthma, the latter subdivided into CR + mild asthma (CRMA) and CR + moderate to severe asthma (CRMSA). Aerollergen sensitization was defined by a positive prick test to one or more allergens associated with nasal symptoms and/or asthma. The association between CR and asthma was evaluated by multivariable logistic regression. The evidence of effect modification of pattern of sensitization in CR on the association with asthma severity and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders.

RESULTS

Frequency of sensitization to aeroallergens was higher in association with asthma in comparison to CRA (CRMA 70.4%; CRMSA 65.0%; CRA 47.0%; p = 0.000). Similarly, the presence of asthma was associated to aeroallergen multiple sensitization (51.5%) (OR = 2.10, 95% CI 1.27-3.50). Additionally, the sensitization to mites, cockroaches, animal epithelium, grasses, and molds, were higher in asthma (56.8%, 24.3%, 12%, 7.13% and 10.3%, respectively). Sensitization to Alternaria alternata, Cladosporium herbarum and dog epithelium was exclusive in asthma groups. A concomitant asthma diagnosis was directly associated with a positive allergen sensitization at least one allergen (62.7%, OR = 2.45, 95% CI 1.80-3.34) and polissensitization (51.5%, OR = 2.10, 95% CI 1.27-3.50).

CONCLUSION

Asthma is associated with multiple allergen sensitization among patients with CR. Some unique profiles of aeroallergen sensitization were observed in patients with CR and asthma. Nevertheless, no difference was found in the sensitization in relation to asthma severity, which suggest atopy is not the main underlying mechanism for asthma severity among patients with CR.

LEVEL OF EVIDENCE

Level 3.

Oral mite anaphylaxis: who, when, and how?

PURPOSE OF REVIEW

To present an update on the recent advances in the understanding of the mechanisms and practical management of oral mite anaphylaxis (OMA, pancake syndrome).

RECENT FINDINGS

Among novel observations regarding OMA, this review highlights the increased prevalence of aspirin/NSAID hypersensitivity inpatients affected by OMA, the association of OMA with exercise-induced anaphylaxis, the presentation of OMA simulating acute asthma, the occurrence of OMA in childhood, the high severity and lethal potential of OMA, the contamination of other foods, such as oat and corn flour with mites, and the simultaneous induction of OMA symptoms in more than one individual exposed to the same food source.

SUMMARY

OMA is a severe, potentially lethal, acute allergic condition that should be suspected whenever symptoms begin soon after the intake of mite-contaminated foods. Physician awareness on this clinical picture is of paramount importance to establish a correct diagnosis and to implement adequate preventive measures to help patients at risk to avoid its occurrence.

Brunei Darussalam: country report on children's environmental health

This is the country report for Brunei Darussalam pertaining to children's environmental health. It covers the current landscape of environmental risk factors which affect children's health, existing local policies, as well as strategies for moving forward in alignment with the United Nation's Sustainable Development Goals (SDGs).

[Blomia tropicalis: A house dust mite in the tropics]

INTRODUCTION

Blomia tropicalis is a mite that belongs to the superfamily of Glycyphagidae. Initially described as a storage mite, it is now considered as a house dust mite of tropical and sub-tropical areas.

STATE OF THE ART

Sensitization to this mite is very common in South America and Southeast Asia. Epidemiological studies have also found sensitization to this mite in Africa and Central America. Blo t 5 is the major allergen of B. tropicalis. Co-sensitization to other house dust mites such as Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f) is very common. Cross-reactivity has been described but recombinant allergens revealed by molecular biology techniques do not explain this cross-reactivity. Sensitization to B. tropicalis seems to begin at the age of 36 months, the incidence increases until adulthood, and decreases from the age of 50. The involvement of B. tropicalis in allergic rhinitis and asthma is well described. It is also implicated in other allergic diseases. Few studies have assessed the therapeutic strategies available against this mite but immunotherapy is widely used.

PERSPECTIVES

Studies are needed to better understand the role of B. tropicalis in human diseases and to develop specific treatments.

Hidden allergens and oral mite anaphylaxis: the pancake syndrome revisited

PURPOSE OF REVIEW

To present currently available information on oral mite anaphylaxis.

RECENT FINDINGS

Oral mite anaphylaxis (pancake syndrome) is a new syndrome characterized by severe symptoms triggered by the intake of foods containing mites and their allergens. Breathlessness, face and/or laryngeal angioedema, wheezing, rhinorrhea, cough, dysphagia, and wheals are the most frequent clinical manifestations.

SUMMARY

Pancake syndrome can occur in individuals at any age and in any geographical location. Foods made with wheat and corn flour, especially pancakes, are the most common inducers of the clinical picture. Both, domestic and storage mites have been incriminated. Increased physician awareness is required for early diagnosis and treatment, and for the prevention of future episodes in predisposed individuals.

Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization

The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population.

Increased concentrations of greenhouse gases, and especially carbon dioxide (CO₂), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges.

This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand.