Blomia tropicalis Blo t 5 and Blo t 21 recombinant allergens might confer higher specificity to serodiagnostic assays than whole mite extract

Identification of rBlo t 41 with a chitin-binding type-2 domain: A novel major allergen from Blomia tropicalis

BACKGROUND

Blomia tropicalis (B. tropicalis) has been reported to impose an increased risk of allergic diseases. However, few characteristics of the unknown allergen components responsible for B. tropicalis allergy and clinical relevance have been fully identified.

METHODS

We synthesized and characterized the physicochemical properties and cross-reactivity of the newly discovered recombinant B. tropicalis group 41 allergen (rBlo t 41). Subsequently, sera were collected from 107 B. tropicalis allergic subjects to evaluate the prevalence of the rBlo t 41. Lastly, its allergenicity was tested in humans by basophil activation assays, and in mice by a model of allergic asthma.

RESULTS

The mature protein of rBlo t 41 was described as 104 amino acids long and 15.8 kDa, and its limited cross-reactivity was observed between allergens of house dust mites (HDM). Sensitization rate of rBlo t 41 (56.07 %) was lower than rBlo t 2 (76.29 %) and rBlo t 5 (69.07 %) in our study. Besides, rBlo t 41 elicited CD63 upregulation in basophils, whereas rBlo t 41-sensitized mice generated rBlo t 41-IgE and developed allergic airway inflammation after allergen exposure. Of note, component-based tests showed a high area under curve value (AUC = 0.75) of rBlo t 41, displaying its favorable diagnostic potential in B. tropicalis allergy.

CONCLUSIONS

rBlo t 41 was identified as a candidate novel major allergen with good diagnostic potential in B. tropicalis sensitization. Additionally, we provided strong evidence about rBlo t 41 on the clinically relevant manifestations in B. tropicalis allergies, conducive to facilitating the development of component-resolved diagnosis.

Immunobiological properties and structure analysis of group 13 allergen from Blomia tropicalis and its IgE-mediated cross-reactivity

Blomia tropicalis is an important species of allergenic mite. Structurally related cross-reactive allergens are involved in pathogenesis of clinical symptoms. The present study focused on recombinant allergen rBlo t 13 from B. tropicalis, including investigation of its structure, immunological properties, IgE-mediated cross-reactivity. In this work, the prokaryotic expression plasmids pET-28(a)-Blo t 13, pET-28(a)-Der f 13, and pET-28(a)-Tyr p 13 were constructed, transformed into E. coli Rosetta (DE3) pLysS, and purified by nickel affinity chromatography, respectively. By using ELISA, the IgE-binding rates were detected for rBlo t 13 and its epitope peptides, as well as the cross-reactivity among rBlo t 13, rDer f 13, and rTyr p 13. The tertiary structure of rBlo t 13 was resolved using X-ray diffraction at 2.0 Å resolution. Using IgE-ELISA, the IgE binding rate of rBlo t 13 was 60 % with Blomia tropicalis-positive sera. In the experiments of ELISA for cross-reactivity with rBlo t 13 on solid phase, the inhibition rates were 65 %, 57 % and 63 % for rBlo t 13, rDer f 13, and rTyr p 13, respectively. The structure of Blo t 13 protein contains a β-barrel structure which is composed of 10 β strands and has 2 α helices at the end of the barrel. Comparison of the tertiary structures of rBlo t 13, rDer f 13, and rTyr p 13 revealed that the β-barrel structure is highly conserved, consistent with the alignment of amino acid sequences. We obtained the recombinant protein rBlo t 13, demonstrated its cross-reactivity with Der f 13 and Tyr p 13 due to their structural similarity.

House dust mite allergy in Malaysia: review of research gaps in the current scenario and the way forward

The prevalence of house dust mite (HDM) allergy, especially in Asian countries with rapid urbanization, has been increasing. House dust mites thrive in places with relatively high humidity. With the combination of climate change, naturally high humidity, and urbanization, tropical countries like Malaysia are becoming a hotspot for HDM allergy fast. With a previously reported sensitization rate of between 60 and 80%, it is a worrying trend for Malaysia. However, due to incomplete and out-of-date data, as seen by the limited study coverage in the past, these numbers do not paint a complete picture of the true HDM allergy scene in Malaysia. This review briefly discusses the HDM fauna, the HDM sensitization rate, the common diagnosis and therapeutic tools for HDM allergy in Malaysia, and makes suggestions for possible improvements in the future. This review also highlights the need of more comprehensive population-based prevalence studies to be done in Malaysia, encompassing the three main HDMs-Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis-as the lack of up-to-date studies failed to give a clearer picture on the current scenario of HDM allergy in Malaysia. Future studies will be beneficial to the nation in preparing a better blueprint for the management and treatment of HDM allergy.

House dust mite allergy: The importance of house dust mite allergens for diagnosis and immunotherapy

House dust mite (HDM) allergy belongs to the most important allergies and affects approximately 65-130 million people worldwide. Additionally, untreated HDM allergy may lead to the development of severe disease manifestations such as atopic dermatitis or asthma. Diagnosis and immunotherapy of HDM allergic patients are well established but are often hampered by the use of mite extracts that are of bad quality and lack important allergens. The use of individual allergens seems to be a promising alternative to natural allergen extracts, since they represent well-defined components that can easily be produced and quantified. However, a thorough characterization of the individual allergens is required to determine their clinical relevance and to identify those allergens that are required for correct diagnosis of HDM allergy and for successful immunotherapy. This review gives an update on the individual HDM allergens and their benefits for diagnosis and immunotherapy of HDM allergic patients.

EAACI Molecular Allergology User's Guide 2.0

Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.

Conjunctival Provocation Test With Blomia tropicalis

Background: Conjunctival provocation test (CPT) is used to demonstrate clinical relevance to a specific allergen. Blomia tropicalis (Bt) is a prevalent allergen in tropical regions. Its major allergen Blo t 5 is commonly detected in house dust in Brazil. Patients with allergic rhinoconjunctivitis (ARC) have IgE antibodies to Bt although it may not indicate clinical allergy. Objective: The purpose of this study is to demonstrate the role of CPT in clinical allergy to Bt in allergic conjunctivitis (AC). Methods: CPT was performed in asymptomatic subjects with ARC (n = 26) outside the grass pollen season. They had positive skin prick tests (SPT) to Bt and other common inhalant allergens and they were off topical or systemic antihistamines. Standardized allergens were used for CPT (Blo t 5 462.5 ng/mL in 1:1 solution, Alk Abelló). CPT was conducted on a control group of subjects (n = 29) without symptoms of ARC and with negative SPT. CPT was performed with progressive doses of allergen solutions in normal saline (1:32, 1:16, 1:8, 1:4, 1:2). CPT with the same allergen dose that elicited a positive reaction was repeated one week later. The protocol was approved by the local Ethics Board and signed informed consent was obtained from all participants. Results: There were 92% (24/26) of positive CPT in subjects sensitized to Bt. Significant association was found between SPT and CPT results with Bt (p < 0.0001). CPT had 92% sensitivity and 100% specificity when compared to SPT results. Positive reactions with the same dose or one immediately higher occurred in 21 out of 22 subjects who repeated TPC 1 week later. Mild transient nasal symptoms (21/24) were the major side effects of positive CPT followed by moderate periorbital edema which occurred in 41% (10/24). One controlled asthmatic BT-sensitized subject developed wheezing and dyspnea during a positive CPT with Bt that cleared with inhaled albuterol (400 mcg). There were no reactions whatsoever of CPT in non-allergic subjects. Conclusion: This study demonstrated that Bt may cause allergic conjunctivitis in our population. In addition, CPT is a safe and reproducible test if standardized allergens are used.

Analysis of Results of Specific IgE in 100 Atopic Dermatitis Patients with the Use of Multiplex Examination ALEX2-Allergy Explorer

Background and aim: Progress in laboratory diagnostics of IgE-mediated allergy is the use of component-resolved diagnosis. Our study analyses the results of specific IgE to 295 allergen reagents (117 allergenic extracts and 178 molecular components) in patients suffering from atopic dermatitis (AD) with the use of ALEX2 Allergy Explorer. Method: The complete dermatological and allergological examination, including the examination of the sensitization to molecular components with ALEX2 Allergy Explorer testing, was performed. The statistical analysis of results was performed with these methods: TURF (total unduplicated reach and frequency), best reach and frequency by group size, two-sided tests, Fisher’s exact test, and chi-square test (at an expected minimum frequency of at least 5). Results: Altogether, 100 atopic dermatitis patients were examined: 48 men, 52 women, the average age 40.9 years, min. age 14 years, max. age 67 years. The high and very high level of specific IgE was reached in 75.0% of patients to 18 molecular components: from PR-10 proteins (Aln g 1, Bet v 1, Cor a1.0103, Cor a1.0401, Fag s 1), lipocalin (Can f 1), NPC2 family (Der f 2, Der p 2), uteroglobin (Fel d 1), from Alternaria alternata (Alt a 1), Beta expansin (Lol p 1, Phl p 1), molecular components from Timothy, cultivated rye (Secc pollen) and peritrophin-like protein domain Der p 23. The high and very high level of specific IgE to other lipocalins (Fel d 7, Can f 4), to arginine kinase (Bla g 9, German cockroach), and to allergen extracts Art v (mugwort), and Cyn d (Bermuda grass) reached 52.0% of patients. The severity of AD is in significant relation to the sensitization to molecular components of storage mites (Gly d 2, Lep d 2—NPC2 family), lipocalins (Can f 1, Can f 2, Can f 4, and Can f 6), arginine kinase (Asp f 6, Bla g 9, Der p 20, Pen m 2), uteroglobin (Fel d 1, Ory c 3), Mn superoxide dismutase (Mala s 11), PR-10 proteins (Fag s 1, Mal d 1, Cor a 1.0401, Cor a 1.0103), molecular components of the peritrophin-like domain (Der p 21, Der p 23), and to Secc pollen. In the subgroup of patients suffering from bronchial asthma, the significant role play molecular components from house dust mites and storage mites (Lep d 2, Der p 2, Der f 2—NPC2 family), cysteine protease (Der p 1), peritrophin-like protein domain (Der p 21, Der p 23), enolase from Alternaria alternata (Alt a 6), and Beta expansin Phl p 1. Conclusion: The results of our study demonstrate the detailed profile of sensitization to allergens reagents (allergen extract and molecular components) in patients with atopic dermatitis. We show the significance of disturbed epidermal barrier, resulting in increased penetration of allergens. We confirmed the significant relationship between the severity of AD, the occurrence of bronchial asthma and allergic rhinitis, and high levels of specific IgE to allergen reagents. Our results may be important for regime measures and immunotherapy; Der p 23 shall be considered as an essential component for the diagnosis and specific immunotherapy of house dust mite allergy.

Purification and characterisation of the dimeric group 12 allergen from Blomia tropicalis heterologously expressed by Escherichia coli Top10F´

Successful research in the wide-ranging field of allergy is usually achieved by definition not only of physicochemical and immunological properties of natural, but also recombinant allergens. Blomia tropicalis mite is a well-known source for various groups of hypersensitivity-causing proteins. The goal of the present work was to produce, purify and characterise by in silico, biochemical and immunological methods the recombinant group-12 allergen of B. tropicalis. The recombinant Blo t 12 aggregation capacity as well as the affinity to antibodies from BALB/c immunised mice and B. tropicalis-sensitised human donors were investigated through in silico analyses, dynamic light scattering, SDS-PAGE, ELISA and Western blot. The presence of Blo t 12 within B. tropicalis extracts was also determined by ELISA and Western blot. High concentrations of dimeric rBlo t 12 were detected through SDS-PAGE next to other aggregates and the results were confirmed by data from DLS and Western blot. The YITVM peptide was predicted to be the most aggregation-prone region. The IgE-reactivity of rBlo t 12 was not completely abolished by aggregate formation but it was significantly decreased compared to rBlo t 5, or B. tropicalis extracts. Natural Blo t 12 may naturally dimerises, but it was detected in non-delipidified B. tropicalis extracts in low amounts. Given that this allergen may be a specific marker for B. tropicalis allergy, the recombinant Blo t 12 herein obtained is characterised as a mid-tier allergen in Brazilian atopic patients and may be useful for the improvement in precision allergy molecular diagnostic applications.

En route to personalized medicine: uncovering distinct IgE reactivity pattern to house dust mite components in Brazilian and Austrian allergic patients

AIM

Molecular sensitization profile analyses of allergic individuals to the house dust mites (HDM) Blomia tropicalis and Dermatophagoides pteronyssinus from Brazil and Austria, in the attempt to comprehend the individual contribution of the molecular components in the diagnosis of HDM allergy.

METHODOLOGY

These analyses were made using a new in vitro multiplex allergen assay which allows simultaneous measurement of specific IgE against the whole allergen extract as well its components.

RESULTS AND CONCLUSION

The data showed that in Brazil the inclusion of the molecular components Blo t 5 and/or Blo t 21 major allergens and Blo t 2 can increase the sensitivity and specificity of the assay for the diagnosis of allergy to B. tropicalis, using matrix-based methodologies. Also we highlighted, for the first time, the importance of Blo t 2 analysis for a sensitive diagnosis, since some individuals were sensitized only to this molecular component. Regarding the sensitization profile of individuals sensitized to D. pteronyssinus, we point out the importance of analyzing the molecular components Der p23 and Der p 7, in addition to Der p 1 and Der p 2 for an accurate diagnosis based on matrices.

A hybrid of two major Blomia tropicalis allergens as an allergy vaccine candidate

Introduction

Allergen‐specific immunotherapy (AIT) represents a curative approach for treating allergies. In the tropical and subtropical regions of the world, Blomia tropicalis (Blo t 5 and Blo t 21) is the likely dominant source of indoor allergens.

Aim

To generate a hypoallergenic Blo t 5/Blo t 21 hybrid molecule that can treat allergies caused by B tropicalis.

Methods

Using in silico design of B tropicalis hybrid proteins, we chose two hybrid proteins for heterologous expression. Wild‐type Blo t 5/Blo t 21 hybrid molecule and a hypoallergenic version, termed BTH1 and BTH2, respectively, were purified by ion exchange and size exclusion chromatography and characterized by physicochemical, as well as in vitro and in vivo immunological, experiments.

Results

BTH1, BTH2 and the parental allergens were purified to homogeneity and characterized in detail. BTH2 displayed the lowest IgE reactivity that induced basophil degranulation using sera from allergic rhinitis and asthmatic patients. BTH2 essentially presented the same endolysosomal degradation pattern as the shortened rBlo t 5 and showed a higher resistance towards degradation than the full‐length Blo t 5. In vivo immunization of mice with BTH2 led to the production of IgG antibodies that competed with human IgE for allergen binding. Stimulation of splenocytes from BTH2‐immunized mice produced higher levels of IL‐10 and decreased secretion of IL‐4 and IL‐5. In addition, BTH2 stimulated T‐cell proliferation in PBMCs isolated from allergic patients, with secretion of higher levels of IL‐10 and lower levels of IL‐5 and IL‐13, when compared to parental allergens.

Conclusions and Clinical Relevance

BTH2 is a promising hybrid vaccine candidate for immunotherapy of Blomia allergy. However, further pre‐clinical studies addressing its efficacy and safety are needed.

Subcutaneous allergen immunotherapy for asthma: A randomized, double-blind, placebo-controlled study with a standardized Blomia tropicalis vaccine

BACKGROUND

Sensitization to Blomia tropicalis (Bt) is very frequent in the tropics, and particularly in Cuba, being a significant cause of allergic asthma. Allergen immunotherapy (AIT) with Bt can be a therapeutic option, however, placebo-controlled clinical trials have not been reported.

OBJECTIVE

To assess the therapeutic effect and safety of AIT for asthma using a standardized allergen vaccine of B. tropicalis by subcutaneous route, in allergic asthmatic patients exposed and sensitized to this mite species.

METHODS

A double-blind, placebo-controlled Phase II trial was conducted in 35 adults (18 with treatment and 17 with placebo), with mild to moderate asthma, predominantly sensitized to Bt. AIT was administered subcutaneously in increasing doses from 4 to 6000 Biological Units using a locally manufactured standardized extract (BIOCEN, Cuba). Patient assessment was performed using symptom-medication score (SMS), peak expiratory flow and skin reactivity relative to Histamine as measured by skin prick test (SPT).

RESULTS

The 12-month treatment achieved a significant (p < 0.001) decrease of SMS. Symptom score showed only 41% (CI: 26-61) of placebo values, whereas medication was 34.5% (22.4%-63.3%). Treatment was regarded clinically effective in 67% of patients (OR 32; 95%CI: 17 to 102). The effect size on symptoms and medication was higher than has been reported with equivalent allergen dosages of D. pteronyssinus and D. siboney in Cuban asthmatic patients. Skin reactivity to Bt was also significantly reduced (p = 0.0001), increasing 148-fold the allergen threshold to elicit a positive skin test. This desensitization effect was specific to Bt and did not modify the reactivity to Dermatophagoides. The change of specific skin reactivity was significantly (p < 0.05) correlated to clinical improvement. All adverse events were local with a frequency of 2.4% of injections.

CONCLUSIONS

Subcutaneous AIT with Blomia tropicalis was effective and safe in asthmatic adults exposed and sensitized to this mite species in a tropical environment.

TRIAL REGISTRATION

Cuban Public Registry of Clinical Trials: RPCEC00000026 (WHO International Clinical Trial Registry Platform ICTRP).

Identifying Potential Co-Sensitization and Cross-Reactivity Patterns Based on Component-Resolved Diagnosis

BACKGROUND

Component-Resolved diagnosis (CRD) can help to establish immunoglobulin E (IgE) sensitization profiles and potential risks and determines whether specific IgE is the result of primary sensitization or cross-reactivity, especially for those who are polysensitized.

METHODS

We recruited 432 patients with mite-sensitized respiratory allergic diseases to study the co-sensitization and cross-reactivity of the 17 allergen components in Guangdong Province, China, using the CRD method and to describe the potential association between allergen components.

RESULTS

Among the 432 patients, serum specific immunoglobulin E of the 17 components were tested by EUROIMMUN system. Der p 1 (81.48%), Der f 2 (77.78%), Der f 1 (74.07%), Der p 2 (66.20%) and Der p 23 (54.63%) were the main sensitized components in patients with mite-sensitized respiratory allergy, while the components of cockroach, crab, and shrimp had a lower positive rate. In the crude extract allergen-positive samples, Der f 2 (91.06%) and Der f 1 (86.72%) were the major sensitized components of Der f, while Der p 1 (94.52%), Der p 2 (78.36%), Der p 23 (63.29%) were the major sensitized components of Der p, And other components of Der p such as Der p 7 (34.25%), Der p 5 (17.81%), Der p 10 (12.05%), Der p 3 (1.92%) were all below 50.00%. Blo t 5 (54.55%) was one of the major components of Blo t. The positive rates of all Bla g components were as follows, rBla g 2 (15.56%) >rBla g 5 (8.89%) >rBla g 4 (4.44%) >rBla g 1 (1.11%). The positive rate of the only available pen a 1 component was 9.43%. Using hierarchical cluster and optimal scale analysis, 17 components can be roughly divided into 5 different sensitization clusters. Also, from the results of the Venn diagram, the allergen component in each cluster has a high proportion of co-sensitization and cross-reactivity. Regardless of age, total IgE levels, and disease type factors, similar sensitization profiles were observed for each component in the same category based on hierarchical clustering analysis.

CONCLUSIONS

Epidemiological data on allergen components causing allergic symptoms can be further understood using CRD. Der p 1, Der p 2, Der p 23, Der f 1, Der f 2 as the primary sensitizing component of the study cohort. The positive rate for Blo t 5 was 28.01% for all populations and 54.45% for Blo t-positive samples. In addition, CRD allows us to identify more potential allergen associations such as common sensitivities and cross-reactions between component proteins. Based on these results, we suggest that when patients are identified as sensitized to a particular allergen, clinicians can pay more attention to other allergy components that are closely related to it.

Proteomic Analysis Reveals Allergen Variability among Breeds of the Dust Mite Blomia tropicalis

BACKGROUND

The dawn of the "omics" technologies has changed allergy research, increasing the knowledge and identification of new allergens. However, these studies have been almost restricted to Dermatophagoides spp. Although Blomia tropicalis has long been established as a clinically important source of allergens, a thorough proteomic characterization is still lacking for this dust mite.

OBJECTIVE

To increase knowledge of B. tropicalis allergens through proteomic analysis.

METHODS

Eleven in-bred lineages of B. tropicalis were obtained from 11 unique different pregnant females. Their somatic extracts were analyzed and compared with a commercially available extract by liquid chromatography tandem mass spectrometry (LC-MS/MS).

RESULTS

Considerable differences in the protein expression profiles were found among the breeds, and most of them displayed higher expression levels of major allergens than the commercially available extract. Blo t 2 was the most prominent allergenic protein in the analyzed extracts. Six identified allergens and 14 isoforms have not yet been recognized by IUIS. Conversely, 3 previously recognized B. tropicalis allergens were not found.

CONCLUSIONS

The clear impact of inbreeding on allergen content shown by our study leads us to conclude that the quantification and/or identification of allergens from in-bred lines should be routinely considered for mite cultivation in order to select breeds with higher amounts of major allergens. In this sense, LC-MS/MS may be a useful method to achieve this quality control for research and commercial purposes.

Blo t 2: Group 2 allergen from the dust mite Blomia tropicalis

Blomia tropicalis has been recognized as a cause of allergic diseases in the tropical and subtropical regions. Here we report the immuno-characterization of its group 2 allergen, Blo t 2. Allergen Blo t 2 was amplified from the cDNA of B. tropicalis using degenerate primers, expressed in Escherichia coli as a recombinant protein and purified to homogeneity. The mature protein of Blo t 2 was 126 amino acids long with 52% sequence identity to Der p 2 and apparent molecular mass of 15 kDa. Circular dichroism spectroscopy showed that Blo t 2 is mainly a beta-sheeted protein. We confirmed the presence of three disulfide bonds in recombinant (r) Blo t 2 protein using electrospray mass spectrometry. Thirty-four percent of dust-mite allergic individuals from the Singapore showed specific IgE binding to rBlo t 2 as tested using immuno dot-blots. IgE-cross reactivity assays showed that Blo t 2 had between 20-50% of unique IgE-epitopes compared to Der p 2. IgE binding of native and recombinant forms of Blo t 2 were highly concordant (r2 = 0.77, p < 0.0001) to rBlo t 2. Dose-dependent in vitro histamine was observed when rBlo t 2 was incubated with whole blood of Blo t 2 sensitized individuals, demonstrating that it is a functional allergen. Nine naturally occurring isoforms of Blo t 2 were identified in this study, each having between 1-3 amino acid variations compared to the reference clone. Blo t 2 is a clinically relevant allergen of B. tropicalis as it has unique IgE epitopes compared to major group 2 allergens from Dermatophagoides spp.

Hygienic conditions influence sensitization to Blomia tropicalis allergenic components: Results from the FRAAT birth cohort

BACKGROUND

In tropical zones, perennial exposure to house dust mite (HDM) allergens and helminth infections is present. Studying the impact of these conditions on the inception and evolution of allergic diseases is necessary to have an accurate view of their natural history. We aimed to evaluate the dynamics of genuine sensitization to Blomia tropicalis and Ascaris in children from the FRAAT birth cohort and the effects of helminth infection, environmental HDM allergen levels, and sociodemographic factors.

METHODS

Children were followed up to 6 years old. Specific IgE to recombinant allergens from B. tropicalis (Blo t 5 and Blo t 12) and Ascaris spp (Asc l 3, Asc l 13 and Asc s 1) was measured by ELISA at different time points. Allergen levels were measured in dust when children were 6 months old.

RESULTS

IgE sensitization increased over time up to 3 years old. Correlation among the specific IgE levels to B. tropicalis and Ascaris components is poor at year 1, but coefficients are high and significant (Spearman's rho coefficients >0.70) at year 6. Unhygienic conditions increased the odds of sensitization to B. tropicalis allergenic components. Blo t 5 levels were lower in the poorest. IgE response to Blo t 5 and Blo t 12 was less intense in children with high exposure to Blo t 5 (levels >80th percentile).

CONCLUSION

In this tropical community, the pattern of childhood IgE sensitization is different from that in developing countries and is influenced by the hygienic conditions.

Clinical Response to Subcutaneous Dermatophagoides pteronyssinus Immunotherapy in Children with Allergic Rhinitis and Asthma Is Independent of Sensitization to Blomia tropicalis Allergens

BACKGROUND

Dermatophagoides pteronyssinus (DP) and Blomia tropicalis (BT) are the dominant house dust mites inducing allergic diseases in tropical climates. It is not known whether the efficacy of DP subcutaneous immunotherapy (SCIT) is similar in patients sensitized to DP alone or to both DP and BT.

METHOD

Ninety-five children (5-17 years old) affected by asthma with rhinitis and sensitized to both DP and BT received 3 years of DP-SCIT. Clinical symptom and medication scores, serum-specific IgE and IgG4 were evaluated during DP-SCIT. Patients were grouped based on DP and BT co-sensitization or cross-reactivity, according to positive or negative IgE to BT major allergen (BTMA).

RESULTS

After 3 years of DP-SCIT, all patients had significant reductions in symptoms and medication use. In all, 65% of the patients were free of asthma symptoms and medication use; in addition, 3% was free of rhinitis symptoms. FEV1 in all patients were greater than 95% of predicted. DP-SCIT induced significant increases in DP- and BT-specific IgG4. In 50% of patients, DP-specific IgG4 increased more than 67-fold. BT-specific IgG4 increased more than 2.5 fold. A moderate correlation (r = 0.48-0.61, p < 0.01) was found between specific IgE against DP and BT in the BTMA- group (n = 34) before and after DP-SCIT, whereas no correlation was found in the BTMA+ group (n = 61). The 2 BTMA groups responded similarly with regard to clinical improvement and increase in specific IgG4 to both DP and BT. No safety finding of concern were reported in either group.

CONCLUSION

DP-SCIT may be of clinical benefit to patients with IgE sensitizations to both DP and BT. DP-SCIT induces IgG4 that cross-react with BT allergens.

Ascariasis as a model to study the helminth/allergy relationships

Ascariasis is the most frequent soil transmitted helminthiasis and, as well as other helminth infections, is expected to influence the clinical presentation of allergic diseases such as asthma. Indeed, several clinical and experimental works have shown an important impact either increasing or suppressing symptoms, and the same effects have been detected on the underlying immune responses. In this review we analyze the work on this field performed in Colombia, a Latin American tropical country, including aspects such as the molecular genetics of the IgE response to Ascaris; the allergenic activity of Ascaris IgE-binding molecular components and the immunological and clinical influences of ascariasis on asthma. The analysis allows us to conclude that the impact of ascariasis on the inception and evolution of allergic diseases such as asthma deserves more investigation, but advances have been made during the last years. The concurrent parasite-induced immunostimulatory and immunosuppressive effects during this helminthiasis do modify the natural history of asthma and some aspects of the practice of allergology in the tropics. Theoretically it can also influence the epidemiological trends of allergic diseases either by its absence or presence in different regions and countries.

Parasites and allergy: Observations from Brazil

Brazil is a middle-income country undergoing the epidemiological transition. Effects of changes in daily life habits and access to clean water, sanitation and urban services on a growing urban population have contributed to a double burden of both infectious and noncommunicable chronic diseases. Studies have indicated that parasite infections may modulate the human immune system and influence the development of allergic conditions such as asthma. However, there is no consensus in the published literature on the effects of parasitic infections on allergy, perhaps as a consequence of factors determining the epidemiology of these infections that vary between populations such as age of first infection, duration and chronicity of infections, parasite burden and species, and host genetic susceptibility. In this review, we discuss the observations from Brazil concerning the relationship between parasite infections and allergy.

The Blomia tropicalis allergen Blo t 7 stimulates innate immune signalling pathways through TLR2

BACKGROUND

Although the house dust mite species Blomia tropicalis is a leading cause of allergic diseases in tropical and subtropical regions, the identification and characterization of the allergenic proteins remain incomplete.

OBJECTIVE

We aimed to characterize a recombinant form of Blo t 7 (rBlo t 7) in terms of IgE reactivity, lipid-binding activity and ability to stimulate innate immunity.

METHODS

The mature Blo t 7 cDNA was cloned by PCR methods for the expression of a secreted form of the allergen in P. pastoris. The IgE reactivity to purified rBlo t 7 as well as the potential cross-reactivity with Der p 7 was determined by ELISA. The lipid-binding capacity of rBlo t 7 was assayed using fluorescent lipid probes. The stimulation of TLR2 signalling pathway by rBlo t 7 was examined in cell activation and reporter assays.

RESULTS

The amplified mature Blo t 7 cDNA revealed the presence of a 60 base pair insertion compared with the reference sequence registered in the GenBank database. Multiple protein sequence alignments of group 7 mite allergens confirmed that this longer deduced amino acid sequence was the authentic Blo t 7 polypeptide chain. Analysis of IgE reactivity can classify rBlo t 7 as an intermediate B. tropicalis allergen which displayed weak cross-reactivity with Der p 7. Purified rBlo t 7 was shown to bind selectively the naturally fluorescent lipid probe cis-parinaric (cPNA) with a dissociation constant of 2 μmol/L. The group 7 Blomia allergen stimulated the TLR2-, NF-kB- and MAPK-dependent production of IL-8 and GM-CSF in respiratory epithelial cells.

CONCLUSIONS & CLINICAL RELEVANCE

Through its propensity to transport fatty acids/lipids and to stimulate TLR2 signalling pathways in airway epithelial cells, Blo t 7 can represent a key allergen for the initiation of the B. tropicalis-induced airway inflammation.

Characterization of a hybrid protein designed with segments of allergens from Blomia tropicalis and Dermatophagoides pteronyssinus

BACKGROUND

Sensitization to allergens of the house dust mites Dermatophagoides pteronyssinnus and Blomia tropicalis is an important risk factor for asthma and allergic diseases. Allergen-specific immunotherapy is currently based on natural allergen extracts, however, in the last years recombinant allergens with different modifications have shown promising immunological properties that may be advantageously applied for developing novel allergy vaccines.

METHODS

A hybrid molecule (MAVAC-BD-2) containing epitopes of B. tropicalis (Blo t 5, Blo t 8 and Blo t 10) and D. pteronyssinus (Der p 1, Der p 2, Der p 7 and Der p 8) allergens was constructed, expressed in Escherichia coli and purified by affinity chromatography. Its folding was analyzed by circular dichroism. Antibody reactivities were evaluated by ELISA and non-denaturing dot blot assays using a battery of sera from mite allergic patients and non-allergic subjects. ELISA inhibition and dot blot assays with monoclonal antibodies were used to detect B-cell epitopes. Human basophil activation and induction of IgG-blocking antibodies in mice immunized with the hybrid protein were also evaluated.

RESULTS

MAVAC-BD-2, expressed as a 22.8 kDa protein, showed a lower frequency and strength of IgE reactivity compared to Blo t 5, Der p 1, Der p 2 and the extracts of B. tropicalis and D. pteronyssinus. MAVAC-BD-2 inhibited 26% of IgE reactivity to Der p 2 and Blo t 5, reacted with anti-Der p 1 and anti-Der p 2 monoclonal antibodies and did not induce relevant basophil activation. MAVAC-BD-2 immunized mice produced specific antibodies that reacted against mite extracts and the purified allergens, as well as IgG antibodies that blocked the human IgE reactivity to mite extracts.

CONCLUSION

MAVAC-BD-2 has hypoallergenic characteristics and in mice induces IgG antibodies that block the human IgE reactivity to mite extracts.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

BACKGROUND

Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).

METHODS

Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.

RESULTS

The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.

CONCLUSION

This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

Molecular diagnosis and immunotherapy

PURPOSE OF REVIEW

To describe recent insights into how molecular diagnosis can improve indication and selection of suitable allergens for specific immunotherapy and increase the safety of this therapy.

RECENT FINDINGS

As specific allergen immunotherapy targets specific allergens, identification of the disease-eliciting allergen is a prerequisite for accurate prescription of treatment. In areas of complex sensitization to aeroallergens or in cases of hymenoptera venom allergy, the use of molecular diagnosis has demonstrated that it may lead to a change in indication and selection of allergens for immunotherapy in a large proportion of patients when compared with diagnosis based on skin prick testing and/or specific IgE determination with commercial extracts. These changes in immunotherapy prescription aided by molecular diagnosis have been demonstrated to be cost-effective in some scenarios. Certain patterns of sensitization to grass or olive pollen and bee allergens may identify patients with higher risk of adverse reaction during immunotherapy.

SUMMARY

Molecular diagnosis, when used with other tools and patients' clinical records, can help clinicians better to select the most appropriate patients and allergens for specific immunotherapy and, in some cases, predict the risk of adverse reactions. The pattern of sensitization to allergens could potentially predict the efficacy of allergen immunotherapy provided that these immunotherapy products contain a sufficient amount of these allergens. Nevertheless, multiplex assay remains a third-level approach, not to be used as screening method in current practice.

House Dust Mite Allergens: New Discoveries and Relevance to the Allergic Patient

PURPOSE OF REVIEW

Recent findings on house dust allergens and their contribution to knowledge that will significantly impact on current and future allergy treatments are appraised.

RECENT FINDINGS

Quantitation of IgE binding to a spectrum of allergen components in several independent studies in varying locations has largely affirmed the main components as the groups 1 and 2 and possibly 23 allergens with mid-tier contributions from the groups 4, 5, 7, and 21. Prevalent binding to Der p 23 has been recapitulated sometimes with low titers. The IgE of non-asthmatic atopic subjects binds at lower titer and to fewer components than that of asthmatics, and their IgG binding relative to IgE is higher especially for children hospitalized for exacerbation. The higher IgG ratios were associated with increased IL-10 a cytokine more readily induced from T cells of allergic subjects. Peptides representing the groups 1 and 2 allergens can be used to stimulate ex vivo T cells showing responses correlating with IgE binding and providing a valuable tool for ascertaining the contribution of IgE and T cells to disease. Also, the induction of Th2 and follicular helper T cells are shown to make different contributions in mice. Cross-reactivity of IgE binding assays with high-titer cross-reactive antibodies induced by scabies is a problem in the many areas of the world where scabies is highly prevalent and endemic and from recent increases in immigration. In the last few years, allergen research has produced results that warrant rapid translation into diagnostic tools and the formulation of allergen components for immunotherapy.

Blomia tropicalis allergen 5 (Blo t 5) T-cell epitopes and their ability to suppress the allergic immune response

Blomia tropicalis is the major asthma allergen in the tropics comparable to Dermatophagoides pteronyssinus. However, little is known about the B. tropicalis epitopes recognized by T cells. Our aim was to identify the T-cell epitopes in the major B. tropicalis allergen, Blo t 5, and investigate the potential of the corresponding peptides to inhibit the allergic inflammatory lung response. C57BL/6 mice were immunized with plasmid DNA encoding Blo t 5 and T-cell epitopes identified using the interferon-γ ELISPOT assay with 15-mer overlapping peptides. C57BL/6 mice were sensitized with bone-marrow-derived dendritic cells (BMDC) pulsed with Blo t 5 allergen followed by intranasal Blo t 5 challenge. Two H-2^b restricted epitopes (Bt5_76-90 and Bt5_106-115 ) were recognized by CD4 T cells specific for Blo t 5, but no CD8 epitopes were identified. In mice sensitized with Blo t 5-pulsed BMDC and challenged with intranasal Blo t 5 Bt5_76-90 and Bt5_106-115 , peptide-specific CD4 T cells were found to secrete the T helper type 2 cytokines interleukin-5 and interleukin-13. Intradermal administration of synthetic peptides encoding the identified T-cell epitopes suppressed allergic airway inflammation to further allergen challenges. Hence, we have identified novel CD4 T-cell epitopes specific for Blo t 5 and demonstrated that these peptides could be employed therapeutically to suppress the T-cell response in a murine model of allergic airway inflammation.

Allergens of Blomia tropicalis: An Overview of Recombinant Molecules

Allergic diseases are considered a major problem for healthcare systems in both developed and developing countries. House dust mites are well-known triggers of allergic manifestations. While the Dermatophagoides genus is widely distributed globally, Blomia tropicalis is the most prominent mite species in the tropical and subtropical regions of the world. Over the last decades, an increase in sensitization rates to B. tropicalis has been reported, leading to increased research efforts on Blomia allergens. In fact, 8 new allergens have been identified and characterized to different degrees. Here, we provide an overview of recent developments concerning the identification and production of recombinant Blomia allergens, as well as their structural and immunological characterization. Although considerable progress has been achieved, detailed molecule-based studies are still needed to better define the clinical relevance of Blomia allergens. Thus, the establishment of a well-standardized and fully characterized panel of allergens remains a challenge for the development of better diagnosis and therapy of allergic diseases induced by B. tropicalis.

Particularities of allergy in the Tropics

Allergic diseases are distributed worldwide and their risk factors and triggers vary according to geographical and socioeconomic conditions. Allergies are frequent in the Tropics but aspects of their prevalence, natural history, risk factors, sensitizers and triggers are not well defined and some are expected to be different from those in temperate zone countries. The aim of this review is to investigate if allergic diseases in the Tropics have particularities that deserve special attention for research and clinical practice. Such information will help to form a better understanding of the pathogenesis, diagnosis and management of allergic diseases in the Tropics. As expected, we found particularities in the Tropics that merit further study because they strongly affect the natural history of common allergic diseases; most of them related to climate conditions that favor permanent exposure to mite allergens, helminth infections and stinging insects. In addition, we detected several unmet needs in important areas which should be investigated and solved by collaborative efforts led by the emergent research groups on allergy from tropical countries.

Diagnostic use of recombinant Tha p 2 in the allergy to Thaumetopoea pityocampa

Thaumetopoea pityocampa causes allergies and skin and ocular lesions. No commercial tools are currently available for the clinical diagnosis of this allergy. We aimed to develop an in vitro method for the diagnosis of this allergy to avoid patients undergoing in vivo tests with insect extracts. Recombinant Tha p 2 was produced and used in an ELISA validated with 15 allergic patients. Subsequently, 42 subjects recruited from a random sampling cross-sectional study were analysed. The ELISA sensitivity and specificity were 93.3% and 100%, respectively, for the allergic patients and 71.4% and 95.3%, respectively, for the epidemiological study. The positive ELISA results correlated with the skin prick test areas with the whole body and the setae extracts. Professional exposure and short latency of symptoms onset were risk factors for a positive result in the ELISA. In conclusion, our ELISA is very useful for T. pityocampa allergy diagnosis and for epidemiologic testing.

Quantitation of Blomia tropicalis allergen Blo t 5 in cereal and cereal-based foods consumed in the Nile Delta, Egypt

The mite Blomia tropicalis has significant prevalence worldwide. Blo t 5 is a major B. tropicalis allergen that has been associated with sensitization and allergic symptoms in many asthmatic patients. Besides house dust, contaminated foodstuffs are an important source of exposure to B. tropicalis allergens. In this study, a double sandwich enzyme-linked immunosorbent assay (ELISA) using mAb 4D4 and biotinylated mAb 4G9 was done to detect Blo t 5 allergen in different types of raw and processed foods, including wheat, corn, rice, bean, wheat and corn flour, cake, and rusk, which were collected from retail stores in the Nile Delta of Egypt. Out of 88 samples, 38 (43.2%) were positive for Blo t 5 allergen with no significant statistical difference in positivity according to food type. In positive samples, the Blo t 5 concentration ranged from 10 ng/g to 790 ng/g. This study showed that Blo t 5 should be considered as an important allergen that presents a risk to the Egyptian population and should become a routine allergen in the skin prick test to improve the management of allergic disease.

The IgE response to Ascaris molecular components is associated with clinical indicators of asthma severity

Background

Asthma is a common chronic disease worldwide and Ascaris lumbricoides infection (ascariasis) is frequent in tropical regions. However, the effect of ascariasis on asthma severity has not been sufficiently explored. We sought to evaluate the influence of the IgE immune response to Ascaris extract and purified house dust mites (HDM) and Ascaris allergens on indicators of asthma severity in patients living in the tropics.

Methods

Asthmatic patients from Cartagena, Colombia were recruited. Clinical assessment included questionnaires, physical examination, allergy skin tests, spirometry, parasite stool examination and IgE antibody measurements. Asthma was diagnosed by a physician according to validated criteria. Indicators of severity were occurrence of severe dyspnea episodes, night awakenings events, > 4 emergency room (ER) visits and hospitalizations during the last year. Specific IgE to Der p 2, Ascaris spp., Blomia tropicalis and Dermatophagoides pteronyssinus extracts was determined by ImmunoCap. IgE to tropomyosins (Asc l 3, Blo t 10 and Der p 10), Blo t 5 and Asc s 1 was detected by ELISA. Logistic regression analyses were used to explore the relationships between sensitization and indicators of asthma severity.

Results

After adjustment for HDM sensitization, Ascaris sensitization remained associated with severe dyspnea (aOR: 1.90, 95% CI: 1.08 - 3.34, p = 0.03) and > 4 ER visits (aOR: 2.23, 95% CI: 1.15 - 4.30, p = 0.02). We also found that sensitization to the species specific markers Blo t 5 and Asc s 1, as well as the cross-reactive tropomyosins of D. pteronyssinus and Ascaris were associated with > 4 ER visits. Der p 2 sensitization was associated with bronchodilator responsiveness (aOR: 2.24: 1.25-4.02, p = 0.01). Remarkably, significantly higher IgE levels to HDM species specific allergens were found in Ascaris sensitized patients.

Conclusions

In this tropical population, IgE sensitization to Ascaris and the cross-reactive tropomyosins was frequent and associated with clinical indicators of asthma severity. The significant relationship between sensitization to the nematode-specific marker Asc s 1 and ER attendance supports these findings. Moreover, ascariasis increases the human IgE responses to HDM specific allergens.

Parasitic worms and allergies in childhood: insights from population studies 2008-2013

The last few decades have seen a marked increase in the global prevalence of allergic diseases particularly among children. Among the factors attributed to this rise has been reduced exposure to pathogens during childhood leading to insufficient maturation of the regulatory arm of developing immune systems. Over the years, a number of epidemiological studies have observed an inverse relationship between parasitic worm (helminth) infections and allergies. The purpose of this review is to highlight insights from population studies conducted among children published between 2008 and 2013 that explore the complex dynamics between helminth infections and allergies. These insights include the effect of anthelmintic treatment on allergic responses, an elucidation of immune mechanisms and an examination of helminth-induced immunoglobulin E cross-reactivity. A better understanding of the relationship between helminths and allergies is imperative as research directions move toward harnessing the therapeutic potential of helminths and their products in the treatment of allergic disorders.