Skin prick tests and IgE determinations with common inhalant allergens, inhalant insect allergens and shrimp. Relationships to indoor environment. Concomitant sensitization to different allergens.

(Published in Lithuanian in: VAIKU PULMONOLOGIJA IR ALERGOLOGIJA, n.o 3, 2000)

 Nils E Eriksson, Christian Möller, Jan Åke Wihl, Marius Zolubas

Lung & Allergy Clinic, County  Hospital, Halmstad, Sweden, Dept Paediatrics , Norrland´s university hosptial, Umeå, Sweden and  Dept. Otorinolaryngology, MAS University hospital, Malmö, Sweden, Seamen’s Hospital, Klaipeda, Lithuania

               Besides the authors, the following clinicians participated in the study:

Roald Bolle	Dept. Paediatrics, Tromsö, Norway
Ronald Dahl	Dept. Pulmonology, Aarhus, Denmark
David Gisslason	Dept. Pulmonology,  Gardabaer, Iceland
Hugo Hagstad	Dept. Pulmonology, Boden, Sweden
Kent-Åke Henricson	Dept. Paediatrics, Halmstad, Sweden
Natalja Ilina, Ludmilla Luss and Vera Fedeseva	Dept Therapy, Institute of Immunology, Moscow, Russia
Jaak Kiviloog	Dept. Pulmonology, Örebro, Sweden
Hans Matsols	Dept. Medicine, Falun, Sweden
Kerstin Norrlind	Dept. Medicine, Danderyd, Sweden
Maria Petrova, Elena Bobrova and  Tatiana Guembitskaia	State Scientific Centre of Pulmonology, St. Petersburg, Russia
Peter Plaschke	Division of Asthma and Allergy, Gothenburg, Sweden  (present address: Dept. Med. Roskilde Amts Hospital, Roskilde, Denmark)
Lea Praks	Dept. Pulmonology, University of Tartu, Tartu, Estonia
Ljudmilla Raudla and Elga Mesimaa	Inst. Exp. Medicine, Tallinn, Estonia
Brita Stenius- Aarniala	Dept. Pulmonology, Helsinki, Finland
Inga-Lisa Strannegård	Dept. Paediatrics, Gothenburg, Sweden
Gunnemar Stålenheim	Dept. Pulmonology, Uppsala, Sweden
Margareta Söderberg	Lung & Allergy Clinic, Umeå, Sweden
Eleonora Tananko and Vera Nepomniastich	Institute of Clinical Immunology, Novosibirsk, Russia
Julia Tananko	Primary Health Clinic, Nizhne-Kamenka, Altai, Russia
Galina  Tsyvkina	Clin Immun & Allergy Centre, Vladivostok, Russia

Abstract

                 The aims of this multi centre study were to find the prevalence of sensitization with two insects - RML and cockroach - in atopic patients in Nordic countries and relate indoor environmental factors to the sensitization with these and other allergens. Furthermore, we wanted to evaluate the cross-sensitization patterns among inhalant allergens and crustaceans.

                 Skin prick tests (SPTs) with common inhalant allergens as well as cockroach, red mosquito larvae (RML) and shrimp were performed on 2113 atopic patients from eight countries. Allergen specific IgE in the sera of 550 patients was determined, using CLA with 16 different inhalant and food allergen extracts. CAP RAST was used for determination of allergen specific IgE against cockroach on the sera of 50 individuals having positive SPT but negative CLA with cockroach. On sera from 16 selected patients, having strongly positive SPT with the insects, RAST was performed with nine commercially available insect allergens.

                 Positive SPT with cockroach was found in 19% of the atopic patients and with RML in 9%. Positive CLA with cockroach was obtained in only 12% of those having positive SPT. Among 50 patients, however, who had strongly positive SPT and negative CLA with cockroach, 28 (56%) had positive CAP RAST with cockroach. The figure for positive CLA with RML among those having positive SPT with RML was 20%.

                 Positive relationships were found between reports of cockroaches at home and sensitization to cockroaches and between contacts with RML used as aquarium fish foods and specific serum IgE against RML as well as with IgE against cockroaches. Correlation was also found between symptoms on exposure to house dust and positive SPTs with DP and DF. Strongly positive correlations were seen between test results (with SPT as well as with IgE) within (but not between) the allergen groups insects/crustaceans/mites, moulds, mammalians and pollens.

                 A practical conclusion for clinical work is that a positive test result with one insect allergen does not necessarily mean that this unique insect is of clinical importance for the patient. Furthermore, positive test results with crustaceans in a patient sensitized to insects do not necessarily indicate clinically relevant crustacean allergy, and vice versa.

Key words

Allergy, allergic rhinitis, asthma, CLA, chironomids, cockroach, cross reactions, hypersensitivity, IgE, insects, skin test, RAST

Introduction

House dust mites (HDM), animals and pollen constitute common sources of inhalant allergens. Inhalant allergy against insects has been reported to be common in some countries, for example against chironomids (non-biting midges) in the Sudan (1) and Japan (2), and against cockroaches in for example the USA (3) and Spain (4). No studies have earlier been performed regarding the prevalence of sensitization against insects in Northern Europe and Northern Asia.

                 Chironomid larvae are used as aquarium fish food, called "red mosquito larvae" (RML). In Halmstad, Sweden, one of us found that about 25% of adult atopic patients with asthma and/or rhinitis had a positive skin prick test (SPT) with RML  (5, 6) The sensitization rate with RML was higher among atopic farmers than among atopic urban patients (7). Positive SPTs with crustaceans and molluscs (5) as well as house dust mites and a storage mite (6) were more common in RML allergic patients than in other atopic patients. Allergen specific IgE with various crustaceans were found in the sera of the majority of the RML-sensitized patients (6). Inhibition studies, performed on the sera from some of the patients, showed that true IgE cross-reactivity occurs between Chironomid, crustaceans and cockroach (5, 6). Other studies have also shown cross-reactions among insects (8) and between insects and crustaceans (9, 10).

                 The aims of the present study were to

·       find the prevalence of sensitization with two insects (RML and cockroach) in atopic patients in Nordic countries and

·       relate indoor environmental factors to the sensitization with inhalant and crustacean allergens

·       evaluate the cross-sensitization patterns among inhalant allergens and crustaceans and

·       link symptoms elicited by house dust and crustaceans to sensitization against mites, insects and crustaceans

Patients and methods

Patients

Out of 3423 consecutive patients referred for routine allergy evaluation because of asthma and/or rhinitis, the atopic patients (that is patients having one or more positive skin prick test reactions) were included in this study. Twenty-four allergy clinics took part in the study (see Table 1). There were 2113 atopic patients, 1001 males and 1112 females; 407 children and 1706 adults. The mean age of the patients was 28 years (range 4-60 years).  Their diagnoses were asthma in 696, rhinitis in 1064 and asthma + rhinitis in 492 cases.

Patients´ histories

All patients were questioned about the existence (present or earlier) of dog, cat, cockroach or aquarium in their homes. Furthermore, they were asked if they had any contact with RML used as fish food. They were also asked if they got airways symptoms on exposure to house dust or symptoms on eating or handling crustaceans. The questions could be answered ”yes”, ”no” or ”I do not know”.

Skin test

Skin prick tests (SPTs) were performed on the volar sides of the forearms in accordance with international recommendations (11). A drop of allergen was placed on the skin, and a prick test lancet with a 1 mm point was inserted through the drop. The wheal reactions were read after 12-15 minutes. The contours of the reactions were outlined with a pen and transferred to records via a transparent tape and the diameters of the wheals were measured. The reactions were recorded in accordance with the recommendation of the Standardization Committee of the Northern Society of Allergology (12, 13). Thus, a wheal reaction of the same size as that of a histamine reference was recorded as three plus (3+). A wheal with an area double that of 3+ was recorded as 4+ and a wheal double the size of 4+ was recorded as 5+. A wheal half the size of 3+ was recorded 2+. As a positive reference histamine HCI 10 g/l was used

Allergen extracts used in skin tests

In the skin testings, extracts of 12 different inhalant allergens and one food allergen (shrimp) were used. The shrimp extract was included because of our interests in a cross-reaction between insects and crustaceans (5).

                 Standardized glycerinated allergen extracts (Soluprick SQ, 10 HEP) from Allergy Laboratory, Copenhagen, Denmark (ALK), were used with Dermatophagoides pteronyssinus (DP), Dermatophagoides farinae  (DF), horse, dog, cat, birch, timothy and mugwort. Unstandardized extracts were used with Cladosporium and Alternaria (Soluprick 1/20 w/v from ALK), cockroach (whole body extract of German and American cockroach) and shrimp (genus Peneus) (1/10 w/v) from Bayer, Spokane, USA and red mosquito larvae (RML), 1/100 w/v, produced by Allergy Laboratory, Sahlgrenska Hospital, Gothenburg, Sweden, as earlier described (5).

                 A purified Chironomid-allergen extract (Chi t I), produced by Prof. X Baur, Bochum, Germany, was used for testing only on a selected group of patients having a positive SPT with the crude Chironomid extract or with HDM, cockroach or shrimp.

                 At the centres in Tromsö and Boden, DF and Alternaria were, for practical reasons,  not included in the allergen  panel. At Boden, furthermore, mugwort was excluded.

                 Patients having one or several SPT reactions >2+ were regarded as atopics.

In vitro analyses

Sera from 550 patients having positive SPTs with RML, cockroach, shrimp, DP or DF were analysed using CLA (MAST Immunosystems, Spokane, USA), regarding IgE antibodies against 16 different allergens (DP, DF, cat, dog, horse, birch, timothy, mugwort, Cladosporium, RML, cockroach, shrimp, crab, clam, cod and feathers). The CLA pipettes were coated with the standard allergens from MAST Immuno Systems, Spokane, USA, with the exception of the RML allergen, which was produced from red mosquito larvae, purchased at a Zoo Shop in  Gothenburg.

                 The CLA tests were performed at the Allergy Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden, in accordance with the manufacturer’s instructions. CLA classes 1 and higher were regarded as positive.

                 Sera from 50 patients having positive SPT but negative CLA with cockroach were analysed with CAP RAST  (Pharmacia, Uppsala, Sweden) for IgE antibodies against cockroach and RML).Results are given in RAST classes. RAST classes >1 were regarded as positive.

                      On the sera of 16 Scandinavian patients (not reporting exposure to cockroach at home), who according to SPTs had a clear-cut insect allergy (SPT with cockroach >3+ or SPT with cockroach >2+ in combination with SPT RML >2+), IgE determinations were performed with commercially available insect RAST CUP: Horse botfly (Gastrophilus intestinalis) (Ri201), Berlin beetle (Trogoderma augustum (i76), Cockroach (Blatella germanica) (i 6), Flour moth (Ephestia kuehniella) (Ri203), Grain weevil (Sitophilus granarius) (Ri202), Horsefly (Gadfly)(Tabanaus spp) (Ri204), Mosquito (Aedes communis) (i71), RML (Chironomus Thummi Th) (i73), Silk moth (Bombyx mori) (i8)

Statistical methods

SPSS Statistical Software was utilised in the statistical analysis. The Spearman´s correlation coefficient was used for analysis of linear relationship. For comparison between groups the Chi square test and the Mann-Whitney test were used. Values of p<0.01 were considered significant. All tests used were two-tailed.

 

The study was approved by the Ethic´s Committee, Lund, Sweden

Results

Results of skin tests and IgE determinations

The allergens most often giving rise to positive SPTs were cat, timothy, birch and dog  (Figure 1). SPT with cockroach was positive in 18% of the patients. Among the participating centres, St Petersburg had the highest figure (41%) and Nizhne-Kamenka the lowest figure (8%). SPT with RML was positive in 8% of the patients, with the highest prevalence in Helsinki (18%) and the lowest (2%) in Reykjavik. Sensitization against shrimp was found in 12% of the patients, most frequently in Klaipeda (24%) and least often in Tallinn (2%).  Results of the STPs have been reported in detail elsewhere (12).

                 The allergens most often giving rise to positive results with the CLA (performed on sera from 550 patients having positive SPTs with HDM, insects or shrimp) were cat, timothy, horse, birch and DF (Figure 2).

                 Among the patients, whose sera were analysed with CLA, cockroach gave positive SPTs in 39% and CLA positive in 9%. Of those with positive SPTs with cockroach, 12% had positive CLA with cockroach. The corresponding relationships between SPTs and CLA with RML and shrimp are shown in Table 2. The correlation between SPTs and CLA with HDM, mammalians and pollen was much better than with the insects and shrimp (details will be presented elsewhere.

                 SPT with Chi t I, which was performed on a selected group of patients, was positive in 7 out of 19 (37%) patients having positive SPT with RML and furthermore positive in 49 out of 309 patients (16%) having a negative SPT with RML.

                 Of the 50 patients having positive SPT but negative CLA with cockroach, whose sera were analysed with RAST, 28 showed positive RAST with cockroach and 9 with RML. Details are given in Table 3.

                 Sera from 16 patients with clear-cut sensitization to cockroach were analysed with CAP RAST, using seven different insect allergens, besides cockroach and RML. All the sera showed positive RAST results with some of the additional insect allergens (most often with silk moth), and three were positive with all the nine allergens (Table 4).

Sensitization in relation to contacts with pets aquarium and insects at home

                 The existence of a cat in their home was reported by 21% of the patients (from 2% of children in Gothenburg to 100% of the patients in Nizhne-Kamenka), and dog by 22 % (from 8% of adult patients in Gothenburg to 92% in Nizhne-Kamenka). Furthermore, 25% of the individuals had earlier had a cat and 23% had earlier had a dog at home (Table 5).

                 Of patients currently having a cat at home, 42% had positive SPTs with cats. A higher figure was found for those having had cats earlier (53% positive SPTs with cats) and patients who never had a cat at home (50% positive SPTs) (p<0.01). With dog allergen no significant differences were found between patients with or without a dog at home.

                 Cockroaches were reported to occur in many homes in Russia, Estonia and Lithuania but only in a few of the homes of patients in the West European countries (Table 6). Positive SPTs with cockroach were found in 28% of those having cockroach at home, in 23% of those having had cockroach earlier and in 17% of those never having had cockroach at home (p<0.001). Of patients having positive SPTs with cockroach, only 28 % reported present or earlier contacts with cockroaches. Positive CLA with cockroach was found in the sera of 29% of the patients reporting cockroach at home and in 6% of those without cockroaches (p<0.001). There was also a significant relationship between cockroaches at home and CLA with shrimp. Of patients with cockroach at home, 60% had IgE antibodies against shrimp in their sera, vs. only 26% of patients without cockroaches (p<0.001).

                 Aquariums occurred in the homes of 11% of the patients and 27% had earlier had an aquarium. Present contacts with RML were reported by 4% and earlier contacts by 13% of the patients. Positive SPTs with RML occurred in 12% of the patients having an aquarium at home, in 9% of those having had an aquarium earlier and in 8% of those with no contacts with an aquarium (n.s.). Of patients having contact with RML as fish food, 13% had positive SPTs with RML vs. 12% of those without such contacts (n.s.).

                  Regarding CLA results, neither RML nor cockroach or crustaceans showed any significant relationship to the presence of an aquarium at home. Of the patients having contacts with RML as fish food, however, 25% had positive CLA with RML vs. 3% of patients without RML contacts (p<0.001). CLA with cockroaches was more often positive in patients with RML contacts (14%) than in patients without such contacts (6%)  (p<0.01)

Relationship between history (symptoms elicited by house dust and crustaceans) and test results

Allergic symptoms on exposure to house dust were reported by 44% of the patients. Positive SPTs with HDM (DP or DF) were found in 34% (DP 31%, DF 25%) of those reporting symptoms and in 17% (DP 15%, DF 12%) of those without symptoms on exposure to house dust (p<0.001). Positive SPTs with cockroach were found in 10% of the patients having symptoms from house dust and in 7% of those without such symptoms (n.s.). The corresponding figures for positive SPTs with dog were 35% and 28% (n.s.) and for cat 56% and 50% (n.s.). When the patients´ histories of symptoms on exposure to house dust were compared with the SPTs with cats and dogs in patients having a cat or dog at home, no significant relationships were found.

                 The CLA results with DP, DF, cat and dog did not show any significant relationship to symptoms on exposure to house dust.

                 Patients having been exposed to RML reported symptoms more often on exposure to house dust (52%) than those without such contacts (43%) (p<0.01).

                 Symptoms on eating or handling crustaceans were reported by 9% of the patients, and positive SPTs with shrimp were found in 24% of these patients, vs. 12% in patients without symptoms from crustaceans (p<0.001). Among 271 patients having a positive SPT with shrimp, 16% reported symptoms from crustaceans and of 1564 individuals with negative SPTs, 8% had symptoms (p<0.001). The incidence of symptoms increased with the increasing size of the shrimp SPT reaction. The correlation between symptoms and SPTs was, however, poor. Only 38% of patients having a strong (4+) SPT reaction with shrimp reported crustacean hypersensitivity. A correlation was found between reports of hypersensitivity against crustaceans and the SPT results with cockroach. Of patients with a negative SPT with cockroach, 8% reported symptoms from crustaceans vs. 13% of those with positive SPTs (p<0.01).

                                  No significant relationship was found between CLA with crab or shrimp and patients´ reports of symptoms induced by crustaceans.

 

Cross-sensitization

With SPTs as well as with CLA a concomitant sensitization was often seen with allergens within certain groups: HDM, animals, pollen and insects/crustaceans/cod/HDM. As examples, Figure 4 shows the relationship between SPTs with RML and cockroach and Figure 5 the relation between SPTs with cockroach and shrimp. Relationships between CLA results with cat and dog are shown in Figure 6 and with birch and timothy in Figure 7.

                 When the SPT results obtained with each of the 13 allergens were compared with those of each of the others, 91 cross-tables of SPT results were constructed. The corresponding correlation coefficients (Spearman´s R) are given in Table 7. As seen from the table, the strongest positive correlations were found for the combinations DP/DF  (R=0.8) followed by cat/dog and cockroach/RML(R=0.6) and Alternaria/Cladosporium (R=0.5). Also the combinations of shrimp/insects (R=0.4), cockroach/HDM (R=0.3) and timothy/birch/mugwort (R=0.3) show rather pronounced correlations. As a numeric example of the correlation between HDM and cockroach: 34% of those having positive SPT with cockroach had positive SPT with DP whereas only 30% of those with negative cockroach test had positive SPT with DP. Of patients with positive STP with DP, 29% had positive STP with cockroach and of those with negative STP with DP 16% were positive with cockroach.

                 When the CLA results obtained with each of the 15 allergens were compared in a corresponding way, 120 cross-tables of CLA results were constructed. The corresponding correlation coefficients (Spearman´s R) are given in Table 8. As seen from the table, the strongest positive correlations were found for the combinations with  DP/DF (R=0.9), dog/cat/horse (R=0.5-0.8), shrimp/HDM (R=0.7) and clam/cockroach/crustaceans/cod (R=0.5). Furthermore, DP and DF showed a high degree of correlation with crab, cod  and clam (R=0.3-0.5). Only small or non-significant positive correlations (or even negative correlations) were found between HDM, insects and crustaceans on the one hand and animals and pollen on the other hand..

                 When the test results of groups of allergens (mammalian animals, pollen, HDM, insects) were compared pair-wise, a weak correlation was found between insects and HDM (R=0.15), no significant correlation between mammalian allergens and HDM or insects, and significant negative correlations between pollens and insects (R=-0.14) and between pollens and HDM (R= -0.22) (p<0.001).

RAST was performed with nine different insect allergens on 16 patients having strongly positive SPTs with cockroach. When the RAST results of the different insect allergens were compared, significant correlations  (p<0.01) were obtained with 23 of the 36 combinations. Highest correlation coefficients (R=0.9) were obtained with the combinations of  flour moth with grain weevil, mosquito, cockroach and silk moth and the combination of  horse botfly with grain weevil (Table 9).

Discussion

The main results of the present study, performed on 2113 atopic patients from eight countries, are

·         a negative correlation between cats in the homes of the patients and sensitization to cat,

·         a positive relationship between cockroaches at home and sensitization to cockroaches,

·         correlations between contacts with RML used as aquarium fish foods and specific serum IgE with RML and cockroach,

·         correlation between SPTs with cockroach and symptoms from crustaceans,

·         correlations between symptoms on exposure to HDM and positive SPTs with DP and DF,

·         positive allergen specific IgE results with several different insect allergens in cockroach-positive sera,

·         positive correlations between test results within (but not between) the allergen groups HDM, insects/crustaceans/HDM, moulds, mammalians and pollens.

                 For some allergens, e.g. mites, it has been shown that the degree of exposure correlates to the risk for sensitization (14,15). Patients sensitised against cats and dogs, are prone to eliminate the pet from their homes resulting in fewer cat and dog allergic patients among those who keep their pets. Thus a negative correlation between exposure to cats and cat allergy could be expected. Most people try to eliminate cockroaches from their homes whether they are allergic or not. When they fail with this elimination the risk for cockroach allergy is increased. This is in agreement with our finding of a positive correlation between exposure and sensitization for cockroaches. Thus if the patient can influence the exposure there is a negative correlation, but if the patient does not have this possibility, there is a positive correlation.

                 A positive feature with the study is the possibility to compare results from many patients from 24 centres in eight countries using a standardized method. However, conditions were different in the participating clinics,  somewhat hampering the results. Thus for example in one of the centres, Nizhne-Kamenka in Siberia, few patients were sensitized, few had aquariums but all had pets at home. In a more homogeneous patient material perhaps it would have been possible to corroborate earlier reports e.g. of a positive correlation between contacts with aquarium and RML used as fish food and sensitization to RML (16, 17). (I have to check the ref no)

                 The finding of concomitant sensitization within groups of allergens, i.e. mammalian animals, pollens, insects/crustaceans/cod/HDM  is in accordance with an earlier study from one of the participating clinics (18) as well as with other studies. Thus Witteman et al. (19) found that IgE antibodies reactive with silverfish, cockroach and chironomid were frequently found in mite-positive patients. A true cross-reactivity exists not only between DP and DF but also between RML, crustaceans and cockroaches  (5, 20) and a cross-reactive allergen (presumably tropomyosin) has been identified in shrimp, mite and insects (21). The positive correlation in SPTs between mites and cockroaches in homes with as well as homes without cockroaches is another proof of this cross-reactivity (22). The other covariances  found in our study might to some degree, although unproved, also be due to cross-reaction between allergens. Another possibility is a genetic determination. There is evidence that variants at both HLA and TCR-alfa complexes may to some degree influence allergen-specific IgE responses (23, 24) It is possible that the allergenic epitops within the groups, although not the same, are similar in their possibility to trigger an IgE response in genetically susceptible individuals.

                 An interesting finding is the high frequency of positive SPTs with cockroaches and RML. Cockroaches occur in  homes in many parts of the world, e.g. the USA  (26) but not in Scandinavia (27). Nevertheless, positive test results were found also in our Scandinavian patients (12). The sensitization against RML was found in many patients who never, to their knowledge, had been exposed to RML, which is in accordance with an earlier study from one of the participating clinics, Halmstad (18).  Thus it is  highly probable that many of the patients with positive test results with RML and cockroach had been sensitized by some cross-reacting allergen such as other environmental insects or by eating crustaceans. In Northern Scandinavia, due to the dry indoor climate, mites are more rare than in the southern parts (15) and thus cockroach allergy in these centres could not be due to mite exposure.

                 Relationships with food allergy have earlier been documented for some inhalant allergens, for example birch pollen (28), ragweed pollen (29), mugwort pollen (30) and latex (31). The cross-reactions among arthropods include those between insects and crustaceans and molluscs (5, 10, 21). A clinically important aspect of these cross-reactions is the possibility that immunotherapy with an inhalant allergen may induce sensitization against a food. It has been reported that mite immunotherapy induced a clear IgE response to snail in some patients (32).

                 The results of the present study, showing positive RAST results with several different insect allergens,  are in accordance with other studies that indicate that concomitant sensitization to several different insects is common. Baldo & Panzani (8) analysed IgE antibodies against seven different insects in the sera from subjects who according to skin tests had inhalant allergies to insects. Approximately one third of their sera reacted with extracts from all seven species and  more than half the sera reacted with four of the  extracts. Twenty-six of the sera also reacted with DF. Their conclusion was that 'Pan allergy' to insects may occur in subjects who have been sensitized to one or a few insects and allergenic similarities may extend to at least some other non-insect members of the phylum Arthropoda.

                 A practical conclusion for clinical work is that a positive test result with one insect allergen does not necessarily mean that this unique insect is of clinical importance for the patient. Furthermore, positive test results with crustaceans in a patient sensitized to insects do not necessarily indicate clinically relevant crustacean allergy, and vice versa. .

Acknowledgements

This study was supported by The Swedish Heart Lung Foundation, The Swedish Association against Asthma and Allergy,  The County of Halland,  Halmstad Hospital, and Herman Krefting´s Foundation

                    

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20. Nagano T, Ohta N, Okano M, Ono T, Masuda Y. Analysis of antigenic determinants shared by two different allergens recognized by human T cells: house dust mite (Dermatophagoides pteronyssinus) and chironomid midge (Chironomus yoshimatsui). Allergy 1992;47:554-559.

21. Witteman AM, Akkerdaas JH, van Leeuwen J, van der Zee JS, Aalberse RC Identification of a cross-reactive allergen (presumably tropomyosin) in shrimp, mite and insects. Int Arch Allergy Immunol. 1994;105: 56-61

22. Eriksson NE, Möller C. Cockroach and Dermatophagoides pteronyssinus cross-react. J Allergy Clin Immunol 1996;98:471-473.

23. Ansari AA, Friedhoff LR, Meyers DA, Bias WB, Marsh DG. Human immune response to Lolium perenne pollen allergen Lol p III (Rye III) is associated with HLA-DR3 and DR-5. Human Immunol 1989;25:59-71.

24. Moffat MF, Hill MR, Cornelis F et al. Genetic linkage to T-cell receptor / complex to specific IgE responses. Lancet 1994;343:1697-1600

25. Pollart-SM, Smith-TF, Morris-EC, Gelber-LE, Platts-Mills-TA, Chapman-MD. Environmental exposure to cockroach allergens: analysis with monoclonal antibody-based enzyme immunoassays. J-Allergy-Clin-Immunol. 1991 Feb; 87(2): 505-10

26. Galeazzo Riario-Sforza G, Della Torre F, Antonicelli L, Bonifazi F, Giordano T, D’Amato D, Liccardi G, Bettini P, Incorvaia C. Sensitization to Cockroach in Italy: A multicentric study. Allergy and Asthma Proc. 1997;18:23-28.

27. Munir AK, Bjorksten B, Einarsson R, Schou C, Ekstrand-Tobin A, Warner A, Kjellman NI. Cat (Fel d I), dog (Can f I), and cockroach allergens in homes of asthmatic children from three climatic zones in Sweden. Allergy. 1994 Aug; 49(7): 508-16

28. Eriksson N, Formgren H, Svenonius E: Food hypersensitivity in patients with pollen allergy in Sweden. Allergy 1982; 37: 437-443.

29. Andersen LB, Dreyfuss EM, Logan J, Johnstone DE, Glaser J. Melon and banana sensitivity coincident with ragweed poloinosis. J allergy 1970;45:310-319.

30. Wütrich B, Dietschi R: Das "Sellerie-Karotten-Beifuss-Gewürz-Syndrom": Hauttest- und RAST-Ergebnisse. Schweiz Med Wochenschr 1985; 115: 358-364.

31. Rodriguez, M., Vega F., Garcia M., Panizo C., Laffon E., Montalvo A., Cuevas M. Hypersensitivity to latex, chestnut, and banana. Ann allergy 1993;70:31-34

32. von Ree R, Antonicelli L, Akkerdaas JH, Geritani MS, Aalberse RC, Bonifazi F. Possible induction of food allergy during mite immunotherapy. Allergy 1996; 51:108-113.

 

Other articles which might be included in the discussion: see included file

 

 

Table 1 Number of atopic patients included in the study from each of 24 allergy centres

 

Clinic	Total
Reykjavik (I)	91
Aarhus (D)	83
Tromsö (N)	71
Gothenburg, ch (S)	51
Gothenburg, ad. (S)	136
Halmstad, ad. (S)	107
Halmstad, ch. (S)	92
Malmö (S)	97
Örebro (S)	106
Falun (S)	57
Uppsala (S)	89
Stockholm (S)	117
Umeå, ad. (S)	80
Umeå, ch. (S)	122
Boden (S)	80
Helsinki (F)	49
Tallinn (E)	102
Tartu (E)	89
St Petersburg (R)	78
Moscow (R)	89
Novosibirsk (R)	97
Nizhne-Kamenka (R)	49
Vladivostok (R)	83
Klaipeda (L)	98

 

ch = Paediatric Clinic  ad = Clinic for adults

E = Estonia, F = Finland, I = Iceland, L = Lithuania, N = Norway, S = Sweden, R = Russia

 

Table 2 Results of SPT and CLA with cockroaches, RML and shrimp, performed on 550 atopic patients whose sera were analysed with CLA, because of positive SPTs with  RML, cockroach, shrimp, DP or DF

The figures indicate percentages.

 

	Cockroach	RML	Shrimp
SPT positive	39	18	27
CLA positive	9	6	28
Both SPT and  CLA positive	5	4	7
Either SPT or CLA positive	43	20	45
Correlations between SPT and CLA
CLA positive when SPT positive	12	20	24
CLA positive when SPT negative	6	3	30
SPT positive when CLA positive	55	58	23
SPT positive when CLA negative	37	15	29

 

 

 

 

 

 

Table 3

Results of CAP RAST with cockroach and RML performed on sera from 50 patients having positive SPT and negative CLA with cockroach

 

 

Allergen	Class 0	Class 0.05	Class 1	Class 2	Class 3
Cockroach	22	2	11	15	0
RML	41	3	1	3	2

 

 

Table 4. RAST results with 9 different insect allergens in 16 Scandinavian patients having strongly positive SPTs with cockroach or RML *).

 

 

Allergen	Class 0	Class 0.5	Class 1	Class 2	Class 3	Class 4	Total number > Class 0
Silk moth (Bombyx mori) (i8)	3		1	5	7		13
Cockroach (Blatella germanica) (i 6) *)	5		4	4	2	1	11
Horse botfly (Gastrophilus intestinalis) (Ri201)	6		4	3	3		10
Mosquito (Aedes communis) (i71)	6		4	3	3		10
Flour moth (Ephestia kuehniella) (Ri203)	7		3	3	3		9
RML (Chironomus Thummi Th) (i73) *)	8	2	2	2	1	1	8
Grain weevil (Sitophilus granarius) (Ri202)	9		2	2	3		7
Horsefly (Gadfly)(Tabanaus spp) (Ri204)	10		1	3	2		6
Berlin beetle (Trogoderma augustum) (i76)	13		1	2			3

 

*)   Inclusion criteria for RAST analyses were  SPT with cockroach >3+ or SPT with cockroach >2+ in combination with SPT RML >2+

 

Table 5  Cats and dogs in the homes of the patients.

 

                       

	Cats		Dogs
	At present, %	Earlier, %	At present, %	Earlier, %
Reykjavik (I) (I)	11	36	12	21
Aarhus (D)	14	30	13	51
Tromsö (N)	15	48	31	22
Gothenburg. ch (S)	2	14	12	18
Gothenburg. ad. (S)	14	24	8	30
Halmstad. ch. (S)	25	21	17	13
Malmö (S)	6	27	10	24
Örebro (S)	24	28	20	42
Uppsala (S)	9	38	8	21
Stockholm (S)	21	29	13	37
Umeå. ad. (S)	15	38	25	27
Umeå. ch. (S)	19	17	20	11
Tallinn (E)	24	28	29	26
Tartu (E)	23	23	43	8
St Petersburg (R)	23	40	25	23
Novosibirsk (R)	40	21	25	16
Nizhne-Kamenka (R)	100		92	6
Vladivostok (R)	33	19	27	21
Klaipeda (L)	17	14	38	17
Total %	21	26	23	23

 

ch = Paediatric Clinic  ad = Clinic for adults

E = Estonia, F = Finland, I = Iceland, L = Lithuania, N = Norway, S = Sweden, R = Russia

 

At  five clinics (Halmstad ad., Falun, Boden, Helsinki and Moscow) the patients were not questioned about pets at home.

Table 6. Cockroaches in the patients´ homes and patients´ contacts with aquariums and red mosquito larvae (RML) according to questionnaires

 

	Cockroaches at home			Aquarium at home		Contacts with RML
	At present %	Earlier, %	Don’t know, %	At present, %	Earlier, %	At present, %	Earlier, %	Don’t know, %
Reykjavik (I) (I)	0	2	0	8	40	1	11	12
Aarhus (D)	0	0	1	10	33	1	5	4
Tromsö (N)	0	2	6	10	25	4	4	21
Gothenburg, ch (S)	0	2	2	26	37	2	20	8
Gothenburg, ad. (S)	0	4	17	13	25	4	11	11
Halmstad, ad. (S)	0	1	4	9	34	6	15	6
Halmstad, ch. (S)	0	0	2	19	15	10	12
Malmö (S)	0	1	2	20	27	4	10	18
Örebro (S)	1	0	2	7	44	1	20	8
Falun (S)	0	14	0	11	26	4	14	11
Uppsala (S)	2	0	17	6	28	3	6	9
Stockholm (S)	1	1	2	13	33	4	11	5
Umeå, ad. (S)	1	3	14	16	18	3	8	14
Umeå, ch. (S)	0	0	1	24	27	4	7	7
Boden (S)	0	0	5	10	24	0	9	9
Helsinki (F)	0	0	2	8	10	2	2	4
Tallinn (E)	17	28	2	10	18	7	18	1
Tartu (E)	18	0	2	1	11	1	11
St Petersburg (R)	34	43	1	7	30	7	20	1
Moscow (R)	67	18	0	12	36	6	41	4
Novosibirsk (R)	40	53	0	5	35	0	10	21
Nizhne-Kamenka (R)	2	12	0	2	6	2	8
Vladivostok (R)	53	29	1	16	19	15	21	1
Klaipeda (L)	16	25	5	5	19	11	18	17
Total %	11	10	4	11	27	4	13	8

ch = Paediatric Clinic  ad = Clinic for adults

E = Estonia, F = Finland, I = Iceland, L = Lithuania, N = Norway, S = Sweden, R = Russia

 

 

 

Table 7

Correlations (Spearman´s correlation coefficients) between SPT results with 13 different allergens.

 

 

 

DP

DF

Birch

Mugwort

Timothy

Cladosporium

Alternaria

RML

Cockroach

Shrimp

Chi t I

Cat

Dog

DF

0.77**

Birch

-0.09**

-0.14**

Mugwort

0.00

-0.02

0.20**

Timothy

-0.05**

-0.07**

0.26**

0.25**

Cladosporium

0.13**

0.12**

0.08**

0.17**

0.13**

Alternaria

0.09**

0.12**

0.04

0.15**

0.10**

0.52**

RML

0.15**

0.15*

0.00

0.14**

0.06*

0.26**

0.20**

Cockroach

0.24*

0.27**

-0.04*

0.08**

0.01

0.18**

0.16**

0.55**

Shrimp

0.10**

0.10**

0.09**

0.18**

0.34**

0.21**

0.18**

0.32**

0.37**

Chi t I

0.21**

0.10

-0.13*

0.14*

-0.07

0.09

0.06

0.78**

0.55**

0.22**

Cat

0.01

0.01

0.17**

0.08**

0.22**

0.14**

0.11**

0.07*

0.06*

0.12**

-0.02

Dog

0.11**

0.12**

0.18**

0.13**

0.26**

0.21**

0.16**

0.13**

0.10**

0.18**

0.00

0.55**

Horse

0.06*

0.05*

0.16**

0.07**

0.20**

0.24**

0.21**

0.07*

0.07**

0.15**

-0.07

0.46**

0.51**

 

* p < 0.01. ** p < 0.001

 

Table 8

Correlations (Spearman´s correlation coefficients) between results of  CLA, performed on sera from 550 atopic patients.

 

 

RML

Cockroach

Crab

Shrimp

DF

DF

Horse

Dog

Cat

Tim

Mugwort

Birch

Cladosporium

Feathers

Clam

Cockroach

0.38**

Crab

0.25**

0.37**

Shrimp

0.19**

0.33**

0.52**

DF

0.11*

0.23**

0.45**

0.67**

DP

0.09

0.21**

0.43**

0.67**

0.92**

Horse

0.02

0.09*

0.07

0.11**

0.06

0.07

Dog

0.01

0.05

0.00

-0.01

-0.05

-0.04

0.59**

Cat

0.03

0.05

0.04

0.02

0.03

0.03

0.51**

0.76**

Timothy

0.01

0.01

0.05

-0.01

-0.05

-0.05

0.39**

0.30**

0.44**

Mugwort

0.10*

0.08

0.06

0.07

0.04

0.04

0.33**

0.19**

0.26**

0.47**

Birch

-0.02

-0.06

-0.05

-0.03

-0.02

-0.04

0.32**

0.30**

0.30**

0.40**

0.39**

Cladosporium

0.06

0.12*

0.17**

0.16**

0.14*

0.14*

0.18**

0.22**

0.21**

0.15**

0.20**

0.18**

Feathers

0.36**

0.36**

0.20**

0.18**

0.14*

0.09*

0.05

0.05

0.09*

0.04

0.05

0.03

0.17**

Clam

0.31**

0.55**

0.55**

0.38**

0.28**

0.24**

0.13**

0.09*

0.09*

0.06

0.13**

0.01

0.12*

0.35**

Cod

0.24**

0.39**

0.51**

0.42**

0.35**

0.35**

0.15**

0.16**

0.15**

0.09*

0.10*

-0.01

0.24**

0.30**

0.53**

 

* p < 0.01. ** p < 0.001

 

Inclusion criteria for CLA determinations were positive SPTs with  RML , cockroach, shrimp, DP or DF

 

 

Table 9

Correlations (Spearman´s correlation coefficients) between RAST results performed on sera from 16 atopic patients.

 

 

 

Allergen	RML	Grain weevil	Horsefly	Mosquito	Cockroach	Horse botfly	Berlin beetle	Silk moth	Flour moth
Grain weevil	0.19
Horsefly	0.15	0.83**
Mosquito	0.29	0.69*	0.53
Cockroach	0.38	0.84**	0.66*	0.81**
Horse botfly	0.09	0.90**	0.82**	0.78**	0.83**
Berlin beetle	0.18	0.66*	0.64*	0.50	0.60	0.61
Silk moth	0.19	0.71*	0.50	0.75*	0.78**	0.71*	0.50
Flour moth	0.29	0.90**	0.66*	0.87**	0.89**	0.85**	0.61	0.87**

 

* p < 0.01. ** p < 0.001

*)   Inclusion criteria for RAST analyses were  SPT with cockroach >3+ or SPT with cockroach >2+ in combination with SPT RML >2+

 

For description of scientific names and CAP RAST code numbers of the insect allergens. see Table 4