Cockroach

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Fig. 1. Summary of the relations between some common arthropods

Quantitative measurements of IgE antibodies
Specific IgE antibodies in serum were, unless otherwise stated, mesured with Pharmacia CAP System or UniCAP (36). Prototype ImmunoCAP reagents were made for Periplaneta fuliginosa, P. americana, Blatta orientalis, Forficula and Porcellio. Other insects, i6 Blattella germanica, and all other reagents were commercial material (Pharmacia & Upjohn Diagnostics AB, Uppsala, Sweden).

Allergenic similarities and differences between cockroach genera or species
Studying asthmatic subjects from two North American cities, Kang et al (22) found IgE antibodies to 2-12 allergen components of P. americana, B. germanica, and Blatta orientalis. Data suggested presence of at least one common allergen detected by most patients. Cockroach sensitivity seamed to be a more common cause of asthma in one of the cities (Chicago). Antibodies to P. americana were the least prevalent although all three species were considered common in both locations.

Similar results were obtained in a skin test study on 46 atopic asthmatics from the New Orleans area showing that 22/38 cockroach sensitive patients reacted to both P. americana and Blattella germanica. RAST inhibition confirmed presence of common allergens in bodies and feces of the two species (29).

Helm et al (17) found IgE antibodies to 8 allergens (18-92 kD) of B. germanica and demonstrated high degree of cross-reactivity to B. asahinai, a close relative to B. germanica, recently introduced into Florida. The allergenic relation between the two Blattella species was stronger than between the genera Blattella, Periplaneta, and Blatta.

Presence of common as well as species/genus -specific allergens in the three genera was also suggested by the results of immunoblotting studies on 16 patients showing heterogenous IgE reactivity to 20 components in the molecular weight range 15 – 260 kD (45).

An additional species of Periplaneta (P. fuliginosa) is commonly found in Japan. The prevalence of specific IgE antibodies (Pharmacia CAP System) in Japanese asthmatic children was 16%, the same as to B. germanica(35). The measured IgE antibody concentrations indicate a close relationship between the allergens of the two species (Fig 2).

Fig. 2. Specific IgE antibodies to Blattella and Periplaneta in Japanese asthmatic patients (Pharmacia CAP System). The prevalence was 25%. Specimens from Toyama Red Cross Hospital (Dr G Murakami), National Institute of Health (Dr M Sakaguchi), and National Sagamihara Hospital (Dr H Yasueda).

Antigenic relationship between cockroaches and other insects, like beetles, moths, chironomid midges and silverfish, have been proposed (6, 52, 2, 37). Cockroach allergens do not seem to cross-react with house dust mites (Dermatophagoides) to any significant extent (35, 21, 55). Tropomyosin, a muscle protein, has been shown to carry epitopes common to crustaceans, molusks, and insects (12, 28). However, an immunoassay for shrimp tropomyosin was unable to detect any counterpart in oyster, cockroach or house dust mite (20).

IgE antibodies to defined allergenic proteins
Cockroach allergens seem to emanate from the intestinal tract and other internal organs (55). The whole insect body is an adequate allergen source.

About half of an American patient group skin reactive with whole body extracts of American or German cockroach were skin test positive to a major cross-reactive allergen (44). Although the homologous proteins of the two species are very closely related they were shown to contain also epitopes that were not shared. The allergens, Per a 1 and Bla g 1, were recognized by 100% and 70%, respectively, of the patients.

Human IgE antibodies binding to Bla g 1 (25 kD) from Blattella germanica, considered as the major cockroach species in USA, were strongly reactive with allergens from the related species B. asahinai and did also show cross-reactivity to members of the genera Periplaneta, Supella, Leucophea, and Blatta (38).

Bla g 2, a digestive tract enzyme (36 kD) of Blattella, was much less cross-reactive (38) and was not detected in Periplaneta (3). IgE antibodies to Bla g 1 and Bla g 2 were detected in 30% and 58%, respectively of 106 asthmatic cockroach allergic patients living in different areas of North America. Skin test reactivity correlated with the serum IgE antibody.

Blattella-specific IgE antibodies were found in 37/37 asthmatic patients (USA) with positive skin test results to cockroach. Immunoblotting analysis of the sera showed binding to 23 allergens in the range 11kD to >100 kD. Four components with molecular weights higher than 40 kD showed reactivity with 50-80% of the subjects tested (34). Allergens prepared from whole body and feces showed equivalent patterns of IgE antibody reactivity.

Also Bla g 4 (21 kD) is a Blattella–specific allergen. The prevalence of serum IgE antibody in asthmatic cockroach allergic patients (USA) was about 50 % (4).

The same seems to be true for Bla g 5 (23 kD) which, despite its general function as a glutathion S- transferase (GST) and its sequence relations to GST of other insects, have not been found in Periplaneta (5). The prevalence of Bla g 5–specific IgE antibodies in cockroach-allergic patients (USA) was 70%.

Per a 3 (72-78 kD), isolated and cloned from Periplaneta americana, was found to be a major cockroach allergen in the central parts of Taiwan, and one of nine P. americana allergens, but did not have an IgE binding counterpart in Blattella (53, 54).

IgE antibody in allergic disease
Recent studies on the prevalence of IgE antibodies to cockroach (Table 1) confirm data generated by in vivo testing. The influence of climate and socioeconomic status of the patients is clear. The prevalence was 0 (zero)% in asthmatic patients in Los Alamos, New Mexico, USA, where the dry conditions at high altitude prevent cockroach and mite infestation and where asthma instead is caused by cats (62%) and dogs (67%) kept indoor (19). On the other hand, the prevalence was 68 % in New York City in an asthmatic inner-city population where the prevalence of IgE antibodies to mite, dog and cat was only 24%, 28%, and 38%, respectively (46). Despite the differences in selection criteria, allergen quality, and test techniques, the data summarized in Table 1 provide an overview of the situation in the areas represented.

Table 1.
Prevalence of cockroach sensitization

Observations on regional differences and similarities

IgE antibodies to cockroach and other insects in Japan
Already the very early studies suggested that insects as a group may play a role in asthma (30). Later investigations have confirmed that cockroach is a major sensitizer in asthma and that the majority of the patients studied react to Periplaneta as well as Blattella (Fig 2). However, they have also shown that IgE antibodies to silk worm wings and to chironomid midges are about twice as common as antibodies to cockroach in Japanese asthmatics (33). The results of a multicenter study on the role of insects in asthma (Fig 3) suggest species-specific sensitization by inhaled allergens from midges and moths but also cross-reactivity between these (25) as well as crossreactivity with cockroach detected by a subgroup of the patients. For this Japanese patient population the cockroach is an important allergen but does not seem to be the major sensitizer.

Fig. 3. Specific IgE antibodies to midge and moth wings compared to IgE antibodies to cockroach in Japanese asthma patients (Pharmacia CAP System). Specimens from Tokyo University (Dr K Ito), Toyama Red Cross Hospital (Dr G Murakami), and National Sagamihara Hospital (Dr H Yasueda).

IgE antibodies to cockroach and other arthropods in Italy
Preliminary data (UniCAP) from an investigation of a group of Italian patients (Fig. 4 and 5) confirmed the extensive cross-reactivity between three genera of cockroaches but did also indentify cases with species-specific sensitivity. Testing the same subjects with allergens prepared from earwig, a related insect widely spread around the world, and sowbug also called woodlouse, a common land living crustacean, supports the observations from Japan regarding the importance of additional insects and suggests very complex sensitization patterns involving also inhaled and possibly ingested crustacean allergens (15). In this group there is no obvious correlation between the IgE antibody concentrations measured with cockroach and house dust mite (Fig 5).

Fig. 4. IgE antibodies against selected cockroaches, another insect and a crustacean in 159 consecutive patients with suspected allergy visiting an allergy clinic in Rome, Italy (R Paganelli).

Fig. 5. Comparison of IgE antibody concentrations against cockroach and house dust mite in 159 consecutive patients with suspected allergy visiting an allergy clinic in Rome, Italy (R Paganelli)

Conclusions
Cockroach specific IgE antibodies are frequently found in patients with asthma and other allergic conditions all around the world. Data suggest good agreement between IgE antibody measurements, in vivo tests, and clinical sensitivity. Variations observed can be ascribed to variation of methods and allergen preparations. Clinical sensitivity to cockroach is not easy to define in a fully specific way with the overlap that exists in the form of cross-reactivity and multisensitization, probably also to insect sources not yet defined. The relative importance of cockroach is bound to vary between regions depending not only on the exposure to cockroaches but also on the exposure to other arthropod allergens. Conclusions from regional studies may not necessarily have global relevance and further studies on potential constituents of inhaled dusts and their contribution to allergic disease can be expected to give important information improving diagnosis and management of indoor allergy. 

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