Mite

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Jan Hed, Clin Immunologist, MD, PhD
Karolinska Institutet, IMPI, Div of Clin Immunology
Huddinge University Hospital, Sweden
 
The statements below are based on conclusions from selected publications. Their intention is to highlight recent research and information that could be beneficial in allergy in vitro testing. They can include seemingly contradictory statements due to differences in selecting patient populations as well as in the study design.
  • About 50,000 species of mites have been described (for review, see 1).
     
  • The name “house-dust mite” has been used to include those members of the family Pyroglyphidae that live permanently in house dust. Six of them, Dermatophagoides pteronyssinus, D. farinae, Hirstia domicola, Malayoglyphus intermedius, and Euroglyphus maynei have been recorded in house dust repeatedly and throughout the world (for review, see 1). 
     
  • Mites belonging to the superfamilies Acaroidea and Glycophagoidea have been referred to as “storage mites” or “stored-products mites”. The most important genera of the superfamily Acaroidea found in house dust are Acarus and Tyrophagus. The most important genera of the superfamily Glycophagoidea are Lepidoglyphys, Blomia, Austroglyphagus, Chortoglyphus, Glycophagus, and Gohieria (for review, see 1).
     
  • Blomia tropicalis is the most prominent mite (62% of total mites) followed by D. pteronyssinus (16% of total mites) in Singaporean homes (2).
     
  • Dermatophagoides pteronyssinus and Blomia tropicalis are the dominating mites of the domestic mite fauna of Puerto Rico (3).
     
  • Der p 2, Der p 5 and Der p 7 produce immediate hypersensitive skin-test reaction in 70%, 60%, and 52% respectively of mite-sensitive patients strongly sensitive to whole mite extract (4).
     
  • False-positive skin prick tests to commercial animal dander extracts can be caused by contaminating mite allergens (5).
     
  • Specific IgE levels to D. pteronyssinus and D. farinae are highly correlated (6,7,8) and testing of both has been described as redundant (7, 8).
     
  • Patients sensitized to mites often show reactivity to most tested mite species (6, 9, 10) indicating a high degree of cross-reactivity (9, 10).
     
  • RAST inhibition studies demonstrate significant cross-reactivity among Dermatophagoides and Euroglyphus species but little to Blomia kulagini, indicating little immunological cross-reactivity between Pyroglyphidae and non-Pyroglyphidae mites (10). 
     
  • There seems to be limited allergenic cross-reactivity between storage and house dust mites (11, 12, for review, see 13) but cross-reactivity between storage mites is high (11, 12, 14).
     
  • The amino acid sequence of the m1 and m2 allergens of Euroglyphus maynei had 84-86% sequence identity with corresponding allergens from D. pteronyssinus and D. farinae mites (15).
     
  • Increased serum IgE to storage mites was found in 46% of patients sensitized to house dust mites and prevalence rates were associated with increased IgE levels to D. pteronyssinus (14).
     
  • It has been possible to verify storage mite allergy in perennial rhinitis patients not sensitized to house dust mites (16).
     
  • The proteolytic activity of the major allergen of house dust mite, Der p 1, has been shown to enhance both total IgE and specific IgE in experimental models (17,18), activate the complement system to produce anaphylatoxins (19) and inactivate alpha 1-antitrypsin (20).
     
  • The proteolytic house-dust mite allergens Der p 1 and Der p 9 exert profound effects on bronchial epithelial cells (21) and stimulate the release of proinflammatory cytokines (22).
     
  • Red/spider mites are more common sensitizing mite allergens than house dust mites in occupational asthma of apple-cultivating farmers (23) and citrus farmers (24,25) in Korea.
     
  • In a Spanish rural population, 36% of workers were found to be sensitized to spider mites and 10% had symptoms associated with occupational exposure. All patients were also sensitized to D. pteronyssinus and a significant cross-reactivity was shown between the species (26).
     
  • There is a strong association between sensitization to house dust mite and moderate-to-severe atopic dermatitis (27, 28, 29).
     
  • Bronchial challenge with house dust mite allergens can evoke skin symptoms in patients with atopic dermatitis (30).
     
  • The serum concentration of specific IgE to house dust mite is correlated to airway hyperresponsiveness to methacholine in young adults (31).
     
  • There is a dose-response relation between the level of exposure to house dust mite allergen and the risk of acquiring sensitization (32) to this allergen, as well as the severity and risk of developing asthma (33, 34, 35, 36, 37, 38, for review, see 39).
     
  • Sensitization to house dust mites is a dominant risk factor for asthma among adolescents (40).
     
  • Seasonal changes in the natural exposure to house dust mite allergen lead to concurrent changes in serum-levels of specific IgE antibodies to housedust mite (32).
     
  • Seasonal differences in house dust mite allergen exposure were the single parameter explaining seasonal differences in PEF amplitudes in mite allergic asthma patients (33). 
     
  • Specific IgE antibodies against egg white in infants at 6 months of age proved to be a significant predictor of the future sensitization to house dust mite (41). 
     
  • Early sensitization to house dust mite at low concentrations (0.23-0.35 U/ml) can be shown at 6 months of age and predict active allergic disease at 5 years of age (41).
     
  • A mite-allergen level of >2microg/g dust is considered a risk level for sensitization and symptoms of asthma (42, 43, for review, see 44, 45). However, in one study, 34% of mite-sensitized asthmatic children were exposed to mite allergen below this limit (46). 
     
  • In a geographical area with high house dust mite allergen exposure (>10 microg/g), (39), asthma prevalence was not linked with mite allergen levels (39) but to the number of sensitizing allergens (47).
     
  • Indoor allergen sensitization, including house dust mite, in contrast to pollen allergen sensitization, was related to increased bronchial responsiveness in adults (48).
     
  • In another study, there was no such relationship among adult asthmatic patients and mite exposure (36).
     
  • The domestic reservoir concentration of mite and cockroach allergen was closely related to prevalence of sensitization in atopic children but not to prevalence of asthma (49).
     
  • In asthmatic patients, peak expiration flow increased or decreased in accordance with weekly changes in the concentration of mites (50).
     
  • Only 4+ skin test positivity was closely associated with increased nasal reactivity to Der p allergen among patients with perennial rhinitis (51).
     
  • In The Netherlands, approximately 30% of mite allergic patients have cross-reacting IgE antibodies to silverfish, cockroach and/or chironomid compared to less than 5% of allergic patients not sensitized to mites (52).
     
  • Recombinant tropomyosin from cockroach shows a high degree of homology with tropomyosins from house dust mites and shrimp (53).
     
  • Cross-reactivity between mites, snails (54, 55, 56) and shrimps (57) involves more than a single allergen (54,56) and potential candidates include the thermostable minor allergens of D. pteronyssinus, tropomyosin and hemocyanin (54).
     
  • Induction of IgE against foods such as shrimps and snails, including tropomyosin-reactive IgE, has been shown after house-dust mite immunotherapy (58).
     
  • Systemic anaphylaxis can occur after the ingestion of heated or unheated mite-contaminated foods (59, 60, 61, for review, see 62).

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