Allergoids for Allergy Treatment

BACKGROUND

Chemically modified allergen extracts, known as allergoids, are commonly used for treating allergic patients. In general terms, the concept of allergoids implies allergen extracts with a reduction of their allergenicity maintaining their immunogenicity. Different methods to obtain allergoids have been developed in the past years, opening attractive lines of research.

OBJECTIVE

To review the different approaches to allergoid development as well as their characterization, mechanism of action and efficacy and safety issues.

METHODS

A revision and analysis of the different types of allergoids has been performed, with special attention to patents submitted and granted in the last years. Additionally, updated information about the mechanism of action and clinical evidence and safety of allergoids has been discussed.

RESULTS

Principally, allergoids are obtained by the polymerization of native allergen extracts with aldehydes, including formaldehyde or glutaraldehyde. However, recent patents and publications about different chemical modifications have been presented, as well as about the use of new adjuvants with allergoids. Regarding the characterization, allergoids require more sophisticated analytical methods than native extracts, as a consequence of their properties and characteristics.

CONCLUSION

In the last years, the partial understanding of the mechanism of action and the generation of clinical evidence of different types of allergoids, linked to their excellent safety profile and their convenience for a quick build up phase, have made of allergoids an excellent product for allergy treatment.

Preclinical safety and immunological efficacy of Alternaria alternata polymerized extracts

Introduction

Alternaria alternata is a widespread fungi whose allergy is a risk factor for asthma development. The use of a polymerized allergen extract (allergoid) may be safer than native extract based treatments while maintaining efficacy. The objective of this study was to characterize biochemically and immunochemically a new Alternaria alternata allergoid.

Methods

Characterization of native and allergoid extracts was performed by determination of protein content, protein and allergenic profile, biological potency, identification of Alternaria allergens, and Alt a 1 quantification. Safety was evaluated in toxicological assays (Ames test, limit test, and fish embryo acute toxicity test in zebrafish, and maximum tolerated dose and Dose‐range finding study in rats). Efficacy was evaluated as the capacity to induce IgG antibodies that block IgE‐binding to the allergen and cytokine induction (IFN‐γ, IL‐4, IL‐6, IL‐10, and TNF‐α) in PBMC from atopic donors.

Results

Protein and antigenic profiles showed significant modification of the depigmented allergoid with respect to the native extract, inducing a lower IgE binding capacity. Alt a 1, Alt a 3, Alt a 6, and Alt a 8 allergen sequences were identified in the polymer. No toxicological nor genotoxicity effects were observed. The polymer induced IgG antibodies that blocked human IgE binding epitopes, and it induced higher IL‐10 levels and similar levels of the other cytokines than native extract in PBMC.

Conclusions

This new A. alternata allergoid could be an effective immunotherapy treatment leading to cytokine stimulation and inducing synthesis of IgG antibodies able to block IgE binding to the allergen. In addition, no toxicological effect was observed, and it may be safer than native extract due to its lower IgE binding capacity and cytokine induction that suggest tolerance induction via T cell shift to Treg (IL‐10).

In vitro evidence of efficacy and safety of a polymerized cat dander extract for allergen immunotherapy

Background

Allergy to cat epithelia is highly prevalent, being the major recommendation for allergy sufferers its avoidance. However, this is not always feasible. Allergen specific immunotherapy is therefore recommended for these patients. The use of polymerized allergen extracts, allergoids, would allow to achieve the high allergen doses suggested to be effective while maintaining safety.

Results

Cat native extract and its depigmented allergoid were manufactured and biochemically and immunochemically characterized. Protein and chromatographic profiles showed significant modification of the depigmented allergoid with respect to its corresponding native extract. However, the presence of different allergens (Fel d 1, Fel d 2, Fel d 3, Fel d 4 and Fel d 7) was confirmed in the allergoid. Differences in IgE-binding capacity were observed as loss of biological potency and lower stability of the IgE-allergen complex on surface plasmon resonance. The allergoid induced production of IgG antibodies able to block IgE-binding to native extract. Finally, studies carried out with peripheral-blood mononuclear cells from cat allergic patients showed that the allergoid induced IFN-γ and IL-10 production similar to that induced by native extract.

Conclusions

Cat depigmented allergoid induced production of cytokines involved in a Th1 and Treg response, was able to induce production of IgG-antibodies that blocks IgE-binding to cat native extract, and showed reduced interaction with IgE, suggesting greater safety than native extract while maintaining in vitro efficacy.

Allergological characterisation of the storage mite Acarus gracilis (Acari: Acaridae)

BACKGROUND

Storage mites of the genus Acarus can be responsible for allergic sensitisation in domestic environments. Acarus gracilis is a frequent species in some geographical regions of the Iberian Peninsula. Since the allergenicity of this mite has not been described before, the objectives of this study were to characterise it immunologically, and to compare it with the closely related and more extensively studied species Acarus siro.

METHODS

Extracts from A. gracilis and A. siro cultures were characterised by Lowry, 1D and 2D-SDS and IEF. Zymogram, and determination of different enzymatic activities were performed. Skin prick solution of A. gracilis was tested in consecutive patients attending the Hospital of Mérida (Extremadura, Spain). Serum samples from eight individuals with positive skin prick test were collected. IgE determination, immunoblot and immunoblot-inhibition studies were performed.

RESULTS

Extracts of both species showed a very similar protein and allergenic profile. Allergens at 14 and 17 kDa were clearly recognised in both extracts by serum samples. Immunoblot-inhibition studies demonstrated that both extracts were totally inhibited by the opposite one. Enzymatic activity was similar in both cases with the most important differences being in kallikrein, serine protease and collagenase activities.

CONCLUSION

The storage mite A. gracilis has a similar protein and allergen profile to A. siro and can induce allergic sensitisation. Due to the higher prevalence of this species respect to A. siro in some regions, more studies are needed to determine the clinical significance of sensitisation to this storage mite species.

Different sensitization to storage mites depending on the co-exposure to house dust mites

BACKGROUND

Co-sensitization to house dust mites (HDMs) and storage mites (SMs) is very frequent, although the clinical relevance is not well established.

OBJECTIVE

To describe the pattern of sensitization and immunologic characterization of patients with positive skin prick test reactions to HDMs and SMs in 4 areas of Spain, selected according to high exposure to HDMs and variable exposure to SMs.

METHODS

One hundred sixty-nine individuals with positive skin prick test reactions to HDMs and SMs were included. Specific IgE levels to different mite species and to Der p 1, Der p 2, and Der p 10 were determined. Immunoblots to Dermatophagoides pteronyssinus, Lepidoglyphus destructor, and Tyrophagus putrescentiae extracts were carried out, and allergograms were obtained. Results of different areas were compared.

RESULTS

A high rate of polysensitization to SMs was observed, although 12% of participants did not have specific IgE to any SM species. Sensitization to Dermatophagoides species, Der p 2, and L destructor were predominant, although significant differences were observed among areas depending on the grade of exposure to SMs. In areas with high exposure, the SM allergogram showed greater recognition of group 2 allergen.

CONCLUSION

Sensitization patterns to SMs in patients sensitized to HDMs and SMs differ depending on the exposure to SMs. Sensitization, mainly to L destructor, seems to exist in areas with high exposure, possibly with group 2 allergens mainly involved. However, in areas with low SM populations, sensitizations observed by skin prick testing appear to be related to HDM exposure.

Tetranychus urticae allergy in a population without occupational exposure

BACKGROUND

Tetranychus urticae is a phytophagus mite found in the leaves of numerous plants. High sensitization rates have been demonstrated, however, provocation tests have only been performed in an occupational setting.

OBJECTIVE

To assess accuracy of skin prick tests and clinical relevance of T. urticae sensitization by means of conjunctival provocation tests (CPT) in a population without occupational exposure and to evaluate possible environmental risk factors for T. urticae allergy.

METHODS

Patients ≥ 18 years old sensitized to T. urticae (n = 12) and a non-sensitized control group (n = 12) were invited to perform CPT with T. urticae and fulfill a questionnaire including demographic data, questions on environmental exposure to T. urticae and allergy symptoms/diagnosis. A single-blinded placebo-controlled CPT with T. urticae (Leti®) was performed with increasing concentrations (0.002, 0.02, 0.2 and 2 mg/mL) and considered positive if conjunctival hyperemia, palpebral edema or lacrimation were observed in the tested eye.

RESULTS

Of T. urticae sensitized patients (mean wheal 4.4 ± 1.5 mm), 9 had a positive CPT, including 3 monosensitized. A good diagnostic accuracy was found for skin prick tests: AUC = 0.952, sensitivity = 100%, specificity = 80%, positive likelihood ratio = 5 and negative likelihood ratio = 0 for a 3 mm wheal. No differences were found between allergic and non-allergic subjects regarding atopy, allergic disease or farming activities.

CONCLUSIONS

A high prevalence of allergy to Tetranychus urticae was found in the north of Portugal. Future studies with a larger number of patients are needed to evaluate its relation to clinical symptoms and the impact of environmental factors.

Occupational allergy to aquarium fish food: red midge larva, freshwater shrimp, and earthworm. A clinical and immunological study

BACKGROUND

Chironomids seem to be the main cause of occupational allergy to aquarium fish food.

OBJECTIVE

The aim of this study was to investigate the pattern of occupational sensitization to 3 different arthropod species used as components of aquarium fish food.

METHODS

The study sample comprised 8 workers from a fish food packing department. The control group comprised 40 atopic patients (20 of whom were allergic to mites). We performed prick tests with extracts of red midge larva (Chironomus thummi), freshwater shrimp (Gammarus species), earthworm (Tubifex species), and other arthropod species and a battery of common inhalant allergens. We measured peak expiratory flow rate (PEFR) and specific immunoglobulin (Ig) E and performed a methacholine challenge test, nasal challenge test, and immunoblotting. Cross-reactivity analyses were completed using immunoblotting and CAP inhibition.

RESULTS

Prick test results were positive to red midge larvae in 7 patients (87.5%), Gammarus in 5 (62.5%), Tubifex in 3 (37.5%), and mites in 6 (75%). In the mite-allergic controls, 30% had positive prick test results to red midge larvae. PEFR decreased > or = 20% during the packing process in all patients, and in 1 patient it indicated a dual asthmatic response. Methacholine challenge test results were positive in all participants. Nasal challenge tests were performed in 4 patients, and the results were positive. Specific IgE to red midge larvae was detected in 62.5%, Gammarus in 50%, and Tubifex in 16%. Bands of approximately 14-15 kDa and 31 kDa were observed in Gammarus and red midge larvae extracts. Cross-reactivity assays demonstrated that Gammarus totally inhibited red midge larvae, while Tubifex did so partially. Dermatophagoides pteronyssinus showed very low inhibitory capacity.

CONCLUSIONS

Aquarium fish food arthropods are potent allergens with an elevated prevalence of sensitization and variable degree of crossreactivity. This is the first report of occupational allergy to Tubifex. More data are necessary to identify and characterize the responsible allergens.

Mite exposure in a Spanish Mediterranean region

BACKGROUND

Knowledge of the domestic mite fauna and allergen levels is important for a correct diagnosis and treatment of mite allergy. Our objectives were to describe the domestic mite fauna in the region of Murcia, Spain, to quantify mite allergens in dust samples obtained from mattresses of this area and to assess the influence of geographical, climatic and dwelling factors.

METHODS

Dust samples were collected in a transversal descriptive study from mattresses of 51 patients who went to the Allergology Service, and from mattress of 81 neighbours or family members of these patients. A questionnaire about home environment was filled in and obtained by all participants. Mite identification was done by light microscopy and allergen determinations (Der p 1 and Der f 1) by monoclonal antibodies.

RESULTS

Sixteen mite species were identified in the 132 dust samples collected. The most frequent species were Dermatophagoides farinae (36% of the samples), Dermatophagoides pteronyssinus (32%) and Tyrophagus putrescentiae (5.3%). There were significant differences among climatic regions. The coastal sector had greater mite abundance, being D. pteronyssinus more frequent and abundant than D. farinae. In inland areas D. farinae was the predominant mite species. Allergen levels correlated with the concentration of Dermatophagoides, with higher levels detected in coastal regions. Average annual temperature was the main outdoor factor that correlated with higher mite concentrations. Indoor main predictor of higher levels of mites was the presence of obvious signs of humidity in the home.

CONCLUSION

This study demonstrates the existence of a mite fauna dominated by D. pteronyssinus and D. farinae with a strong influence of climatic factors and residential characteristics.

Immunogenicity of Phleum pratense depigmented allergoid vaccines: experimental study in rabbits

BACKGROUND

Immunogenicity studies are based on accurate preclinical and clinical assessment of pharmaceutical products. The immunogenicity of modified allergen vaccines has not been fully elucidated, and the mechanisms involved are not well understood. Animal and human models have recently shown that depigmented allergoids induce specific immunoglobulin (Ig) G against individual allergens, thus supporting the clinical efficacy of these vaccines.

OBJECTIVE

The aim of this study was to investigate the production of specific IgG against individual antigens and their isoforms in rabbits injected with depigmented allergoid extracts of Phleum pratense pollen.

METHODS

Two New Zealand rabbits were immunized with depigmented-polymerized extracts adsorbed onto aluminum hydroxide (Depigoid) of P pratense. Rabbits were injected 3 times (35 microg Phl p 5). Specific IgG titers against native, depigmented, and depigmented-polymerized extracts and individual allergens (rPhl p 1 and rPhl p 5a) were analyzed by direct enzyme-linked immunosorbent assay. The capacity of these synthesized antibodies to recognize individual native and depigmented allergens and different isoforms was evaluated by immunoblot and 2-D analysis.

RESULTS

All rabbits produced high titers of specific IgG against the 3 extracts. Rabbits injected with depigmented allergoids produced similar specific antibody titers against native, depigmented, and depigmented-polymerized extracts. Serum samples recognized individual allergens and their isoforms in the nonmodified extracts.

CONCLUSION

Vaccines containing depigmented allergoid extracts of P pratense induce immunogenicity in vivo. The antibodies produced after injection of these extracts clearly recognized allergens and different isoforms in their native configuration.

Searching the soil: forensic importance of edaphic fauna after the removal of a corpse

Arthropods at different stages of development collected from human remains in an advanced stage of decomposition (following autopsy) and from the soil at the scene are reported. The corpse was found in a mixed deciduous forest of Biscay (northern Spain). Soil fauna was extracted by sieving the soil where the corpse lay and placing the remains in Berlese-Tullgren funnels. Necrophagous fauna on the human remains was dominated by the fly Piophilidae: Stearibia nigriceps (Meigen, 1826), mites Ascidae: Proctolaelaps epuraeae (Hirschmann, 1963), Laelapidae: Hypoaspis (Gaeolaelaps) aculeifer (Canestrini, 1884), and the beetle Cleridae: Necrobia rufipes (de Geer, 1775). We confirm the importance of edaphic fauna, especially if the deceased is discovered in natural environs. Related fauna may remain for days after corpse removal and reveal information related to the circumstances of death. The species Nitidulidae: Omosita depressa (Linnaeus, 1758), Acaridae: Sancassania berlesei (Michael, 1903), Ascidae: Zerconopsis remiger (Kramer, 1876) and P. epuraeae, Urodinychidae: Uroobovella pulchella (Berlese, 1904), and Macrochelidae: Glyptholaspis americana (Berlese, 1888) were recorded for the first time in the Iberian Peninsula.

Arginine kinase from the cellar spider (Holocnemus pluchei): a new asthma-causing allergen

BACKGROUND

We report a 31-year-old farmer whose work consists in handling cereal and vegetables, who consulted our clinic because of asthma symptoms after inhalation of dust during manipulation of the deposited material, usually inside the warehouse.

METHODS AND RESULTS

Skin prick tests and specific immunoglobulin E (IgE) determinations were negative with common aeroallergens. The patient noted the presence of many spiders in the warehouse, which were identified as the cellar spider Holocnemus pluchei and the common house spider, Tegenaria domestica. Extracts of spider bodies brought in by the patient were obtained and used to perform in vivo and in vitro studies. Molecular characterization of IgE-binding bands was performed by mass spectrometry. We obtained positive prick tests to the extracts of the bodies of both spiders. Immunoblotting displayed different bands in both spider extracts, in a range of 20-70 kDa. All were hemocyanins, except for a 17-kDa protein of Holocnemus identified as an arginine kinase (AK). Bronchial challenge was positive with the extract of the cellar spider and with the AK, but was negative with the domestic house spider.

CONCLUSION

We present the first case of respiratory allergy due to sensitization to AK from a common spider, confirmed by bronchial provocation tests.

Depigmented and polymerised house dust mite allergoid: allergen content, induction of IgG4 and clinical response

BACKGROUND

Polymerised allergenic extracts (allergoids) are commonly used in allergen immunotherapy. Clinical efficacy and safety of these extracts have been demonstrated. Recently, allergen sequences have been identified by mass spectrometry in depigmented and polymerised (Dpg-Pol) extracts. The objectives of this study were to investigate the presence of allergens in Dpg-Pol extracts of house dust mite and to analyze the immunological changes induced by these extracts in asthmatic patients enrolled in a double-blind, placebo-controlled study.

METHODS

Dpg-Pol extracts were manufactured and vaccines with a composition of 50% Dermatophagoides pteronyssinus and 50% D. farinae (100 HEPL/ml) were prepared. Allergen composition was analyzed by mass spectrometry. Patients with asthma and rhinoconjunctivitis were treated in a 1-year, double-blind, placebo-controlled, parallel-group study with 6 up-dosing and monthly maintenance injections. Specific IgE and IgG4 titres to D. pteronyssinus, Der p 1 and Der p 2 were measured in patients' sera using the CAP system and direct ELISA experiments.

RESULTS

Sequences from the major allergens Der p 1 and Der p 2 and from other allergens were identified in native and Dpg-Pol extracts. There was a statistically significant increase in specific IgG4, a decrease in the ratio of IgE/IgG4 to D. pteronyssinus and a significant increase in specific IgG4 to Der p 1 and Der p 2 in the patients allotted to active treatment.

CONCLUSIONS

The detection of allergen sequences suggests preservation of major and minor allergens in Dpg-Pol allergoids from house dust mites. Efficacy in asthma treatment and the increase in specific IgG4 seem to be associated with the presence of major allergens in Dpg-Pol allergen extracts.

Pancake syndrome (oral mite anaphylaxis)

Oral mite anaphylaxis is a new syndrome characterized by severe allergic manifestations occurring in atopic patients shortly after the intake of foods made with mite-contaminated wheat flour. This clinical entity, observed more frequently in tropical/subtropical environments, is more often triggered by pancakes and for that reason it has been designated "pancake syndrome". Because cooked foods are able to induce the symptoms, it has been proposed that thermoresistant allergens are involved in its production. A novel variety of this syndrome occurs during physical exercise and therefore has been named dust mite ingestion-associated exercise-induced anaphylaxis. To prevent mite proliferation and the production of anaphylaxis, it has been recommended that wheat flour be stored at low temperatures in the refrigerator.

Gregarines in Dermatophagoides spp. (Acari: Pyroglyphidae): light microscopy observation

Recently there has been an increasing interest in studying arthropods that live close to humans, such as cockroaches and mites, for their potential as vectors. Gregarines observed under light microscopy in intestinal extracts of house dust mites (Dermatophagoides spp.) are described for the first time in scientific literature.

Allergic sensitization to domestic mites in Corpus Christi, Texas

Corpus Christi, TX, is a Gulf Coast city with high humidity levels year-round. There is little available data on mite species in mattress dust, allergen levels, and sensitization to different mite species in allergic patients. This study was designed to determine skin sensitization and specific serum IgE to Dermatophagoides spp. and Blomia tropicalis in patients attending an allergy clinic and to explore the mite fauna and allergen content of their mattresses. Skin-prick tests to Dermatophagoides spp. and B. tropicalis along with mite-specific IgE in the serum by enzyme-linked immunosorbent assay (ELISA) and ImmunoCAP tests were performed in allergic patients attending an outpatient allergy clinic in Corpus Christi, TX. Mite species and allergen levels were determined in mattress dust. Forty-five consecutive patients were evaluated; 10 patients had positive skin tests to Dermatophagoides pteronyssinus and B. tropicalis, 32 patients reacted only to D. pteronyssinus, and 3 patients reacted exclusively to B. tropicalis. Increased titers of D. pteronyssinus- and D. farinae-specific IgE were present and B. tropicalis-specific IgE titers were lower. Significant amounts of mites were observed in 79.5% of dust samples, with a predominance of D. pteronyssinus and D. farinae. Other mite species, such as B. tropicalis, Euroglyphus maynei, Tarsonemus spp., Tyrophagus putrescientiae, Cheyletus spp., and Oribatidae were also observed. Greater levels of Der p and Der f 1 than of Blo t 5 were present in the mattresses. D. pteronyssinus and D. farinae are the prevalent mite species in houses of allergic patients from Corpus Christi, TX. Other mite species are also found.

Detection of allergen composition and in vivo immunogenicity of depigmented allergoids of Betula alba

BACKGROUND

Chemical modification of allergen vaccines to reduce IgE binding improves safety while maintaining clinical efficacy. However, this also complicates the characterization of allergoids using techniques as for native allergen extracts.

OBJECTIVES

The objective of this study was to analyse the molecular size of Betula alba depigmented allergoids, conservation of major allergens in the allergoids and in vivo antibody response to immunization.

METHODS

The molecular size of depigmented allergoids was evaluated by high performance-size exclusion chromatography and light scattering techniques. Protein composition was compared with native extracts by capillary liquid chromatography-tandem mass spectrometry based peptide mapping. Rabbits were immunized with depigmented allergoid of Betula pollen adsorbed onto aluminium hydroxide (Depigoid). IgG antibodies against individual allergens were determined by ELISA and immunoblot.

RESULTS

Depigmented allergoids contained a range of high molecular weight particles, approximately 60% of which had a molecular weight of 1-3 MDa. Peptide sequencing confirmed the preservation of five isoforms of Bet v 1, as well as Bet v 2, Bet v 6 and Bet v 7. Sera from immunized rabbits showed high levels of specific IgG to rBet v 1.0101 and rBet v 2.

CONCLUSIONS

The mean protein content was 544+/-106 microg per mg of freeze-dried material for depigmented allergoids and 434+/-71 for native extracts. They retain the capacity to induce specific IgG antibodies against individual allergens present in the native extract. These findings confirm the immunogenicity of depigmented allergoids and may explain why patients treated with these vaccines are protected against the native allergens. Analysis of molecular size and allergen content may be useful techniques for characterization and standardization of allergoid products.

Enzymatic activity of Dermatophagoides pteronyssinus extracts after acidic treatment

BACKGROUND

Mite extracts contain potent enzymes. These enzymes, especially Der p 1, may affect the bronchial homeostasis and the amplification of the allergic response. The objectives of this study were to determine how depigmentation affects the enzymatic activity of allergen extracts of Dermatophagoides pteronyssinus and to verify if these depigmented extracts retain their in vitro allergenic properties.

METHODS

Four native extracts were manufactured from 4 different batches of raw material of D. pteronyssinus. Once extracted, native extracts were reconstituted and modified by adding increasing quantities of 2 M HCl to the solution and dialyzed against double-distilled water. The enzymatic activity of these 8 extracts (4 native and 4 depigmented) was evaluated using in vitro methods. The allergenic potency was evaluated by human specific IgE and IgG ELISA inhibition experiments. The major allergen content (Der p 1 and Der p 2) was measured with monoclonal antibodies.

RESULTS

Protease, phosphatase, lipase and glycosidase activity was detected in native extracts. After depigmentation, all the enzymatic activities showed a significant decrease. SDS-PAGE reveals the same protein profile in both types of extracts. The results of ELISA inhibition confirmed that depigmented extracts preserved their antigenic and allergenic capacity. Der p 2 levels increased in depigmented extracts, while the detection capacity of Der p 1 decreased.

CONCLUSIONS

The depigmentation process significantly reduced the enzymatic activity of these mite extracts, while preserving their allergenicity and antigenicity. No significant differences were observed in the antigenic profile of native and depigmented extracts.

Enzymatic Activity in Body and Fecal Extracts of the Storage Mite Chortoglyphus arcuatus

BACKGROUND

Chortoglyphus arcuatus has been described in many countries. Many allergens are potent enzymes, which may promote a Th2 immune response. The aim of this study was to evaluate the enzymatic activity of body and fecal extracts of C. arcuatus.

MATERIAL AND METHODS

Feces and bodies of full-grown C. arcuatus cultures were separated by sieving, extracted in PBS, dialyzed and lyophilized. The antigenic profile of both extracts was determined by SDS-PAGE. Immunoblot experiments were conducted using a pool of sera from allergic individuals residing in Galicia, a region of Spain, where this species is abundant. The enzymatic activity of the extracts was evaluated by the zymogram technique. Serine and cysteine protease activity was measured using in vitro methods. The API Zym system was used to determine the enzymatic properties of the extracts.

RESULTS

The antigenic profile showed that the body extract contained more and better defined bands than the fecal extract. Allergens were detected in both extracts in a molecular weight range between 14 and 100 kDa. Gelatinolytic gels confirmed that fecal extracts contain more hydrolytic enzymatic activity than body extracts. Serine protease activity in fecal extracts was higher than in body extracts (5.98 vs. 2.701 IU of trypsin/mg of freeze-dried material). No cysteine protease activity was detected.

CONCLUSION

C. arcuatus extracts contain several allergens and proteins with high enzymatic activity, especially in the feces. Some of these allergens may be enzymes. Fecal extracts have more enzymatic activity than body extracts.

Mite immunotherapy

Dermatophagoides pteronyssinus and D. farinae are the most common house dust mites and are among the most common sources of indoor allergens worldwide. These species are very common in humid regions, where most allergic individuals are sensitized to house dust mites. Specific immunotherapy with mite extracts has demonstrated clinical benefits in several double-blind, placebo-controlled trials that are included in recent reviews of subcutaneous immunotherapy, including pediatric and adult patients with rhinoconjunctivitis and or asthma. Most successful studies of mite immunotherapy have used native allergen extracts adsorbed onto aluminum hydroxide, or chemically modified mite-allergen extracts. Several studies have also shown efficacy using sublingual immunotherapy in pediatric and adult patients with asthma and/or rhinitis. Additionally, the efficacy of subcutaneous immunotherapy has been demonstrated in patients with atopic dermatitis, although more double-blind, placebo-controlled studies are needed. Based on several studies, it cannot be concluded that mite immunotherapy is more dangerous or safer than immunotherapy with grasses, epithelia, or animal epithelia. Because the delivery of high doses of allergen carries with it the risk for immunoglobulin E (IgE)-mediated events, several methods have been developed to reduce specific IgE binding to mite-allergen extracts. An important challenge for future mite immunotherapy modalities is the delivery of relatively high doses without a significant risk for severe reactions.

Sensitization and exposure to house dust and storage mites in high-altitude areas of ecuador

BACKGROUND

Few studies have addressed exposure and sensitization to mite allergens in Andean countries.

OBJECTIVES

To identify the main mite species in 3 locations at different altitudes in Ecuador and to verify skin test reactivity to various mite species in allergic individuals in Quito, Ecuador.

METHODS

Mattress dust samples were collected in Quito (2,800 m above sea level), Cuenca (2,500 m above sea level), and Guayaquil (sea level). Mite species present in the samples were isolated, identified, and counted. Der p 1 and Der f 1 levels were measured using monoclonal antibody-based enzyme immunoassays. Four hundred thirty-five patients in Quito diagnosed as having allergic rhinitis or asthma underwent skin testing with commercial extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Tyrophagus putrescentiae, and Lepidoglyphus destructor. In addition, Glycyphagus domesticus, Acarus siro, and Aleuroglyphus ovatus were tested in 362, 262, and 279 patients, respectively.

RESULTS

Twenty-one mite species were identified. Large populations of mites were detected above 2,500 m of altitude. All the dust samples contained detectable levels of Der p 1 or Der f 1. Positive skin prick test reactions to D. pteronyssinus, D. farinae, B. tropicalis, L. destructor, T. putrescentiae, A. ovatus, A. siro, and G. domesticus were obtained in 60.9%, 56.8%, 17.0%, 19.3%, 10.6%, 15.8%, 8.8%, and 11.0% of the patients, respectively.

CONCLUSIONS

Most analyzed mattresses contained several species of mites. Mite allergen levels were high. This study confirms the importance of house dust and storage mite allergens in Ecuador in areas above 2,500 m of altitude, where humidity remains high year round.

House dust mite species and allergen levels in Galicia, Spain: a cross-sectional, multicenter, comparative study

BACKGROUND AND OBJECTIVES

Mites are important sources of allergens in Galicia, Spain. The objective of this study were to identify the main mite species and to determine allergen levels in mattresses from different locations in Galicia.

MATERIAL AND METHODS

Dust samples were collected with a portable vacuum cleaner for 2 minutes from 2 m2 of the surface of the mattress used by mite allergic patients and controls. After collection, samples were immediatel frozen. Mite species were collected, identified, and counted, and the results expressed as mites per gram of dust. Mite allergen levels (Der p 1 and Der f 1) were measured using monoclonal antibodies. All individuals answered a questionnaire about the characteristics of their homes.

RESULTS

A total of 332 dust samples were collected (112 from mite allergic patients and 220 from controls). Thirty-two species were identified. The mean age +/-SD of all the participants was 32.4 +/- 20.8 years and of the mattresses 7.6 +/- 5.9 years. The geometric mean of the total mite counts was 910.2 mites per gram (896.2 mites per gram in the mattresses of mite allergic patients and 917.3 in the mattresses of control subjects; P > .05). The main species was Dermatophagoides pteronyssinus, which was present in 97.6% of the samples (geometric mean, 584.7 mites per gram). The geometric mean level of Der p 1 was 13.1 microg/g of dust: 11.9 in the mattresses of mite allergic patients and 13.8 in the mattresses of control subjects. The geometric mean level of Der f1 was 1.1 microg/g: 1.5 in the mattresses of mite allergic patients and 0.8 in the mattresses of control subjects. Environmental risk factors associated with high mite counts included obvious signs of humidity in the bedroom and the age of the mattress.

CONCLUSIONS

The mite fauna in Galicia is comprised of many species, several of which are known to be of allergologic importance. The total population is exposed to very high levels of mite allergens.