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Objective: To present an update of birth cohort study designs and their contributions to allergic risk., Data Sources: The PubMed database was used to search for relevant articles., Study Selections: Peer-reviewed prospective and retrospective studies involving the assessment of allergy using human birth cohorts between 2014 and 2021 were evaluated., Results: Parental history of allergic diseases, especially in cases involving both parents, is associated with increased risk of allergy. Exposure to prenatal and postnatal smoking and limited diet diversity were associated with increased allergic burden. The impact of early-life infections and antibiotics on disease development may be associated with the onset of asthma, though this remains debated. Cohort studies also revealed that the mode of delivery and breastfeeding duration affect the odds ratio of asthma and eczema development. Household exposures, including pets, house dust mites, and scented aeroallergens may confer protective effects, whereas high air pollution exposure and low socioeconomic status may be risk enhancing. Exposure to antibiotics during early life may be associated with increased asthma risk, whereas viral infections may lead to disease protection, though the impact of the coronavirus disease 2019 pandemic on allergic risk is yet to be understood., Conclusion: Although evaluating the risk of allergic disease development is complex, clinicians can apply these insights on the multifactorial nature of atopy to better understand and potentially mitigate disease development., (Copyright © 2021. Published by Elsevier Inc.)

Objective: Allergic rhinitis (AR) is an immunoglobulin (Ig) E-mediated inflammatory condition that causes sneezing, nasal congestion, rhinorrhea, and nasal itch. Although subcutaneous immunotherapy for the treatment of AR has been in use and well established as a treatment modality, sublingual immunotherapy (SLIT) is increasingly considered to be the safer and more convenient alternative. Thus, the objective of this review is to describe recent findings pertaining to the use of SLIT tablets (SLIT-T) for AR., Data Sources: A database search (PubMed.gov) for articles published between January 1, 2017, and February 9, 2021, was conducted using the following key words: "allergic rhinitis," AND-ed "sublingual immunotherapy." Included were randomized placebo-controlled trials. Other experimental design studies were excluded., Study Selections: A total of 11 randomized placebo-controlled trials were selected for full-text review and included in the analysis. All studies investigated the use of SLIT on patients with seasonal AR (4 tree pollen, 1 grass pollen, and 1 Japanese cedar) or perennial AR (3 house dust mite)., Results: Our review of 7 recently published randomized placebo-controlled trials with 2348 subjects receiving SLIT reported increased efficacy, safety, supportive immunologic parameters (IgE and IgG4 pre- and posttreatment levels), and improved quality of life. All studies excluded subjects with overlapping seasonal or perennial allergens, a history of moderate-to-severe uncontrolled asthma, or reduced lung function., Conclusion: Our review highlights that SLIT is a safe and effective treatment that considerably reduces symptoms and medication requirements in AR and improves quality of life., (Copyright © 2021. Published by Elsevier Inc.)

Background: To diagnose and adequately treat allergies, identification of sensitizing allergens is crucial. Skin prick or serum immunoglobulin E testing determines sensitization to potential allergens. Consensus varies regarding degree of cross-reactivity between aeroallergens., Objective: To quantify correlations between aeroallergen skin prick test results., Methods: A total of 11,832 patients' quantitative skin prick test results and basic characteristics were obtained from a tertiary academic center's electronic medical record and deidentified. Data were analyzed using Spearman's rank correlation coefficients to detect nonlinear associations between wheal sizes of skin prick test results., Results: The highest correlation among grasses was 0.903 (fescue and red top). Of note, 13 more grass pairs had correlation more than 0.8, and 19 had correlation between 0.7 and 0.8. The Northern grass comparative results are from a satellite clinic that tested more grasses than the main clinic, in which only Kentucky blue and Bermuda were tested (correlation 0.768; n = 9348). Highest correlation among weeds was 0.74 (lambs quarter and pigweed). In addition, 6 more weed pairs had correlation more than 0.7. Highest correlation among trees was 0.724 (palm and alder) and 6 more tree pairs had correlation more than 0.7. Highest correlation among molds was 0.711 (Helminthosporium and Epicoccum). Dust mite correlation between Dermatophagoides farinae and Dermatophagoides pteronyssinus was 0.848 (n = 10,022)., Conclusion: This study confirmed the expected high degrees of correlation not only between skin prick test results of related environmental allergens but also between less closely related Northern grasses and Bermuda grass. This has implications for simplification of testing and immunotherapy protocols in the future., (Copyright © 2020 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Household dust often contains aeroallergens, such as the house dust mite antigen Der p 1. It has been proposed that overnight exposure to particulate matter from bedding and other sources may be an important driver of atopic asthma. Whether variability in overnight particulate matter exposure is a significant determinant of asthma control is unknown., Objective: To test the hypothesis that overnight particulate matter exposure is associated with day-to-day symptoms, lung function, and airway inflammation in patients with asthma who are sensitized to house dust mite., Methods: We undertook a prospective, single-center panel study in 28 adults with asthma and house dust mite sensitization. Overnight exposure to particulate matter was measured using a commercially available indoor air quality monitor. Symptom scores, peak expiratory flow, and exhaled nitric oxide were measured and electronically recorded daily. Participants were followed up for 12 weeks and attended study visits every 4 weeks, at which they underwent spirometry and completed the Asthma Control Questionnaire and Asthma Quality of Life Questionnaire. Data were analyzed using cross-correlation and linear mixed-effects models., Results: No significant associations were observed between overnight particulate matter exposure and clinical outcomes measured daily or at study visits., Conclusion: Natural variability in overnight particulate matter exposure does not appear to be a major determinant of daily asthma control in patients with asthma and house dust mite sensitization., (Copyright © 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: The clinical efficacy of controlling environmental allergens as a component of allergic asthma treatment remains controversial. Multifaceted allergen reductions appeared to be the most efficient methods. However, they require home visits with indoor technicians., Objective: To examine the characteristics of indoor environments that might be related to symptoms of children and adult patients with mite allergic rhinitis and/or asthma., Methods: We included 315 patients allergic to house dust mites with rhinitis and/or asthma who had been visited at home by 2 medical indoor environment counselors (MIECs) from the Strasbourg University Hospital between January 2007 and June 2015. In a cluster analysis, we analyzed 42 characteristics of respiratory symptoms, dwelling characteristics, and indoor pollutants in this population., Results: Three clusters were defined among the patients. Cluster 1 included 55 patients, all with rhinitis, 32% with asthma, and all living in an urban area. Clusters 2 and 3 included 86 and 174 patients, respectively. The important factors in these 2 clusters were asthma incidence and exposure to different indoor pollutants, such as indoor perfumes, cleaning products, and tobacco smoke., Conclusion: Our results underlined the variability of indoor environments and the importance of MIEC home visits to investigate individual patient environments and propose an appropriate avoidance management plan. Our results showed that sensitization to mite and exposure to indoor chemical pollutants were associated with severe asthma., (Copyright © 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: The temporal sequence in which allergic sensitization to different allergens emerges is not well characterized at the level of general population., Objective: We describe the incidence patterns of atopic sensitization to different allergens from birth up to 12 years of age in an unselected Finnish population., Methods: The study population comprised all children born between 2001 and 2006 identified from the nationwide population register as residents of the province of South Karelia, Finland (n = 5564). The results of allergy tests (22,380 results from skin prick tests, immunoglobulin E [IgE] antibodies, and open food challenges [OFCs], performed in 1827 children) were collected from patient records of all the health care units in the area., Results: The incidence rates of positive results for food and animal allergens as well as positive OFCs for cow's milk showed prominent peaks at 5 months of age. Positive results for pollen allergens started to emerge after 1.5 years of age. The 12-year cumulative incidence of sensitization to food, animal, pollen, and any allergens was 12%, 8%, 10%, and 18%, respectively. The cumulative incidence of sensitization to house dust mites was 1% and to molds or latex less than 1%. Firstborn boys had the highest, and those who were not firstborn girls and children born in rural municipalities had the lowest early incidence of sensitization to inhalation allergens., Conclusion: In the unselected population, the atopic sensitization against food and animal allergens began before 6 months of age and was followed by sensitization to pollen allergens before 2 years of age. Primary prevention of sensitization to food and inhalation allergens should therefore occur in early infancy., (Copyright © 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Allergic rhinitis with or without conjunctivitis (AR/C) is common, necessitating evaluation of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet efficacy in various subgroups., Objective: To evaluate 12 SQ-HDM efficacy and safety across subgroups, and the onset, duration, and recurrence of local application site reactions., Methods: Subgroup (age, sex, race, asthma status, and allergen sensitization) efficacy was assessed using pooled data from 2 previously described trials of daily 12 SQ-HDM vs placebo for AR/C (n = 2,138). Efficacy was measured by average total combined rhinitis score (TCRS; rhinitis daily symptom plus medication score) during the last 8 weeks of treatment. Safety in subgroups and local application site reaction onset, duration, and recurrence were evaluated using pooled data from 5 previously described trials of SQ HDM SLIT-tablet (n = 2,923)., Results: Significant (based on 95% confidence intervals [CIs]) reduction in TCRS was seen with 12 SQ-HDM relative to placebo across all subgroups, with TCRS improvements ranging from 15% to 25%. The AE profile was generally similar within subgroups. Approximately 95% of local application site reactions were mild to moderate in severity. Median duration on day 1 of treatment for the most common local application site reactions (throat irritation, oral pruritus, ear pruritus, and lip swelling) ranged from 30 to 60 minutes; median first day of onset ranged from days 1 to 4 of treatment; median days that reactions recurred ranged from 3 to 12 days., Conclusion: Treatment with 12 SQ-HDM consistently improved symptoms and was well tolerated in relevant subgroups of subjects with HDM AR/C. Local application site reactions to 12 SQ-HDM were typically mild to moderate and transient., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To provide a comprehensive overview of common school exposures and the association between school exposures and pediatric asthma morbidity., Data Sources: A comprehensive literature review was performed using PubMed., Study Selections: Full-length, peer-reviewed studies published in English were considered for review. In vivo, in vitro, and animal studies were excluded. Studies of school exposure to cockroach, mouse, dust mite, dog, cat, molds, pollution, and endotoxin associated with asthma and asthma morbidity were considered., Results: The current literature establishes an association between school exposure and pediatric asthma morbidity. There is a need for ongoing research to evaluate the effects of school-based environmental interventions on asthma morbidity., Conclusion: It is evident that the indoor school environment is a significant reservoir of allergens, molds, pollutants, and endotoxin and that there is an association between school exposure and pediatric asthma morbidity. School-based interventions have the potential for substantial individual, community, and public health benefit. It is important that researchers continue to study the health effects associated with school exposures and assess cost-effectiveness of multifaceted school-based interventions., (Copyright © 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: The prolonged effect of allergen immunotherapy is unknown, especially in older patients., Objective: To analyze the 3-year effect of sublingual allergen-specific immunotherapy (SLIT) to house dust mites in elderly patients with allergic rhinitis., Methods: Forty-seven elderly patients (65.78 ± 4.89 years old) underwent SLIT to house dust mites and were monitored for 3 years and compared with a placebo group. SLIT was performed with the use of oral Staloral 300 SR Der p and Der f 50/50% extract (Stallergens Greer, London, United Kingdom) or placebo. Symptoms and medication score, represented by the average adjusted symptom score (AAdSS), serum level of immunoglobulin (Ig) G4 to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Der p 1, and Der p 2, and quality of life, were assessed immediately after SLIT and 3 years later., Results: The AAdSS was significantly decreased after SLIT, and the level remained low during the 3 years after SLIT compared with placebo. Serum-specific IgG4 against D pteronyssinus, D farinae, Der p 1, and Der p 2 increased during the SLIT trial in the study group. For the 3 years of observation after SLIT, there were no significant changes of specific IgG4 levels against the analyzed allergens compared with results just after SLIT. Quality of life based on the Rhinoconjunctivitis Quality of Life Questionnaire score was significantly decreased in patients who received SLIT, from 1.48 (95% confidence interval 1.33-1.79) to 0.98 (95% confidence interval 0.67-1.07; P < .05) compared with 0.94 (95% confidence interval 0.55-1.04) 3 years after SLIT., Conclusion: The prolonged positive effect after SLIT to house dust mites was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect., Trial Registration: ClinicalTrials.gov Identifier: NCT01605760., (Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Objective: To provide physicians, researchers, and other interested health care professionals with information about how mite source materials and allergen extracts are manufactured, including the critical process parameters that can affect the final composition of allergenic extracts available for clinical use., Data Sources: A PubMed search was performed using focused keywords combined with relevant regulatory documents and industry guidelines., Study Selections: The information obtained through literature and specialized books was evaluated and combined with the personal expertise and experience of the authors., Results: Dermatophagoides farinae and Dermatophagoides pteronyssinus are the primary species responsible for allergen sensitizations and allergy symptoms in genetically predisposed individuals. Storage mites belonging to the families Glycyphagidae, Echimyopodidae, and Acaridae can also be relevant sources of indoor mite allergens. The cultivation and purification processes used to produce mite raw materials play a critical role in the final composition of mite allergen extracts. Mite extract standardization in the United States is based on total allergenic activity with respect to a single national standard, whereas in Europe consistency is ensured by in-house standards and international references. Because of the limitation of allergen avoidance and pharmacotherapy for patients with severe allergic rhinitis and asthma, house dust mite subcutaneous immunotherapy or sublingual immunotherapy can be an invaluable treatment option for them., Conclusion: Differences in manufacturing processes and extract standardization approaches may lead to differences in extract quality and potency. Physicians should be aware of these potential sources of mite extract variability. Use of well-standardized house dust mite extracts would be critical for success in the diagnosis and treatment of house dust mite allergy., (Copyright © 2016 American College of Allergy, Asthma & Immunology. All rights reserved.)

Background: Treatment with SQ house dust mite (HDM) sublingual immunotherapy (SLIT) tablet is effective for HDM respiratory allergic disease, but data on long-term effects are lacking., Objective: Post hoc analyses were conducted to determine the long-term effect of SQ HDM SLIT-tablet on nasal, ocular, and cough symptoms 1 year after discontinuation of treatment., Methods: Study participants underwent environmental exposure chamber (EEC) challenges at baseline and week 24 in a randomized, placebo-controlled, double-blind trial (NCT01644617) during which participants received daily 12 SQ-HDM, 6 SQ-HDM, or placebo for 24 weeks. Asthma had to be stable, well controlled, and nonsevere. The mean total asthma symptom score (TASS; sum of 3 symptoms: cough, wheeze, and dyspnea) during baseline and week 24 EEC challenge was analyzed in all participants who completed the trial (n = 106). Approximately 1 year after trial completion, another EEC challenge was conducted in a subset of participants (n = 51). Total nasal symptom score (sum of 4 symptoms), total ocular symptom score (sum of 2 symptoms), and cough were assessed., Results: Compared with baseline and end-of-treatment values, sustained improvement of all symptoms assessed at the 1-year follow-up EEC challenge was evident in participants treated with 12 SQ-HDM. Results with 6 SQ-HDM were less notable. After 24 weeks of 12 SQ-HDM, TASS during EEC challenge was improved 65% vs baseline; at 1-year follow-up, cough was improved 57% vs baseline., Conclusion: Persistent improvement of nasal and ocular symptoms was observed up to 1 year after completing 24 weeks of 12 SQ-HDM treatment. Beneficial effects on cough were also observed., Trial Registration: clinicaltrials.gov Identifier NCT01644617., (Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Tropomyosin is the most studied shellfish allergen and has been involved in cross-reactivity among different invertebrates (crustacean, mollusks, mites, insects, and nematodes)., Objective: To determine the relevance of tropomyosin in mite- and shellfish-sensitized patients using tropomyosin skin testing., Methods: Patients were divided into 3 groups: group M included mite allergic patients (ie, individuals with respiratory symptoms and a positive result on skin prick testing [SPT] to house dust mites), group S included shellfish allergic patients (ie, individuals who reported symptoms with shellfish), and group MS included mite- and shellfish allergic patients (ie, individuals who simultaneously fulfilled the inclusion criteria for groups M and S). Tropomyosin was purified from shrimp, characterized, and used in SPT for diagnosis in the patient population., Results: Eight hundred fifty patients were included in the study: 790 (92.9%) in group M, 21 (2.5%) in group S, and 39 (4.6%) in group MS. Tropomyosin was purified from shrimp with a purity higher than 95%. Forty-two individuals tested positive to tropomyosin: the prevalence was 2.7% in group M, 28.6% in group S, and 38.5% in patients of group MS. Twenty-one (50%) of the tropomyosin-positive individuals had symptoms with shellfish, and 3 (14.3%) reported anaphylaxis., Conclusion: The prevalence of tropomyosin was low in mite-sensitized patients (2.7 %) and high in shellfish allergic patients (28.6%). The higher prevalence of tropomyosin was found in patients sensitized to both mite and shellfish (38.5%). The selection of tropomyosin-sensitized patients by SPT might help in the choice of appropriate treatments or management for these patients., (Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Clinical evidence suggests that acupuncture improves symptoms in persistent allergic rhinitis, but the physiologic basis of these improvements is not well understood., Objective: A randomized, sham-controlled trial of acupuncture for persistent allergic rhinitis in adults investigated possible modulation of mucosal immune responses., Methods: A total of 151 individuals were randomized into real and sham acupuncture groups (who received twice-weekly treatments for 8 weeks) and a no acupuncture group. Various cytokines, neurotrophins, proinflammatory neuropeptides, and immunoglobulins were measured in saliva or plasma from baseline to 4-week follow-up., Results: Statistically significant reduction in allergen specific IgE for house dust mite was seen only in the real acupuncture group, from 18.87 kU/L (95% CI, 10.16-27.58 kU/L) to 17.82 kU/L (95% CI, 9.81-25.83 kU/L) (P = .04). A mean (SE) statistically significant down-regulation was also seen in proinflammatory neuropeptide substance P (SP) 18 to 24 hours after the first treatment from 408.74 (299.12) pg/mL to 90.77 (22.54) pg/mL (P = .04). No significant changes were seen in the other neuropeptides, neurotrophins, or cytokines tested. Nasal obstruction, nasal itch, sneezing, runny nose, eye itch, and unrefreshed sleep improved significantly in the real acupuncture group (postnasal drip and sinus pain did not) and continued to improve up to 4-week follow-up., Conclusion: Acupuncture modulated mucosal immune response in the upper airway in adults with persistent allergic rhinitis. This modulation appears to be associated with down-regulation of allergen specific IgE for house dust mite, which this study is the first to report. Improvements in nasal itch, eye itch, and sneezing after acupuncture are suggestive of down-regulation of transient receptor potential vanilloid 1., Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN 12610001052022., (Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Local and especially systemic reactions are important problems in subcutaneous immunotherapy (SCIT). Local and systemic reactions develop in 0.7% to 4% and 0.2% of all injections, respectively., Objective: To evaluate the frequency of and risk factors for reactions developing in pediatric patients undergoing SCIT., Methods: Local and systemic reactions developing after 14,308 injections between 2003 and 2013 were retrospectively evaluated in the current study using the Subcutaneous Immunotherapy Systemic Reaction Grading System, as recommended by the World Allergy Organization. The type of allergic disease, allergens producing a sensitivity, allergen immunotherapy content, adjuvant content, and the effects of treatment phase on the frequency of adverse effects were investigated., Results: Of 319 patients, local reactions occurred in 11.9%, wide local reactions occurred in 5%, and systemic reactions occurred in 4.7%. A local reaction was observed in 0.38% of all injections, whereas a systemic reaction was observed in 0.1% of all injections. Local reactions were most frequent in the build-up phase, and systemic reactions were most frequent in the maintenance phase (P = .01). Side reactions were more common in patients undergoing SCIT with multiple allergens (P = .002) and house dust mite (P = .001). No statistically significant difference was found between adjuvant content and adverse effect frequency (P = .32)., Conclusions: The frequencies of local and wide local reactions during SCIT were lower than expected. Although systemic reactions were frequently seen, no fatal reaction was observed in the current study. House dust mite SCIT and multiple allergen use increased the risk of reaction., (Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Diagnosing house dust mite (HDM) allergic rhinitis is difficult. The nasal provocation test (NPT) has been shown to be the most pertinent, but several methods are available. According to guidelines, the NPT requires a skin end-point titration and an objective measurement of nasal patency. Hence, NPT is time consuming and its use is limited., Objective: To evaluate the sensitivity, specificity, and safety of a new, more rapid, and simple alternative NPT (NPT-R) to HDM., Methods: Eighty-eight patients with from rhinitis (49 allergic to HDM and 39 controls with and without atopy) were included. Allergic rhinitis to HDM was confirmed by a "classic" NPT based on the Lebel score and rhinomanometry. After a period of 4 weeks, NPT-R was performed and only the clinical score was measured., Results: The study population was young (mean ± SD, 27.7 ± 8.5 years old), composed mostly of women (61 vs 27 men), and 24% reported asthma. The sensitivity and specificity of NPT-R were 83.7% and 100%, respectively. The correlation between the NPTs was statistically significant (0.833, P < .0001, n = 88) and the 2 NPTs were completely safe. Performing NPT-R was more rapid (mean ± SD, 22 ± 8 minutes) than the classic NPT (97 ± 20 minutes)., Conclusion: The NPT-R is safe and easier and faster than the classic NPT. This new method appears to be a very useful tool in the diagnosis of HDM allergic rhinitis when the diagnosis is uncertain or before initiating immunotherapy., Trial Registration: ClinicalTrials.gov, identifier NCT01485523., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Urbanization is frequently associated with allergic conditions during childhood; however, the literature lacks studies on the association between allergies and degree of urbanization in the elderly population., Objective: To determine how the degree of urbanization affects the prevalence of allergic sensitization and self-reported rhinitis symptoms in elderly community populations., Methods: The study population consisted of 1,311 elderly subjects identified from 2 community population cohort datasets who were divided into 3 groups according to the degree of urbanization (urban, semirural, and rural) where they resided. Current rhinitis symptoms were assessed using a questionnaire. Sensitization to inhalant allergen was measured using skin prick tests for 9 common allergens., Results: Sensitization to inhalant allergen showed a positive correlation with degree of urbanization (urban 17.2%, semirural 9.8%, rural 6.0%; P for trend <.001), with a significant correlation observed between house dust mite allergens and degree of urbanization. Self-reported rhinitis symptoms were mostly nonallergic, but showed a positive correlation with degree of urbanization (urban 26.8%, semirural 18.2%, rural 11.5%; P for trend <.001). Self-reported rhinoconjunctivitis also correlated with urbanization. Correlations between self-reported allergic conditions and urbanization remained statistically significant in multivariate logistic regression tests., Conclusion: The present analyses found significant correlations between degree of urbanization with self-reported rhinitis symptoms and sensitization to inhalant allergen in the elderly population. These findings warrant further investigation of the roles that urban factors play in the development of elderly rhinitis and allergen sensitization., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Cytokine responses accompanying sublingual immunotherapy (SLIT) responder phenotypes have not previously been reported., Objective: To investigate clinical and cytokine responses of house dust mite (HDM) sensitive patients with allergic rhinitis receiving HDM SLIT or placebo for 2 years., Methods: Sixty adults were randomized to receive SLIT or placebo. Clinical symptoms were measured using the Total 5 Symptom Score (TSS5) and Juniper Rhinitis Quality of Life Questionnaire. HDM specific IgE, IgG, skin prick tests, and HDM-stimulated release of interleukin (IL) 5 and interferon γ (IFN-γ) in peripheral blood mononuclear cells was studied at 0, 6, 12, and 24 months and IL-13, IL-4, and IL-10 at 0 and 24 months., Results: A total of 32 of 39 SLIT and 16 of 21 placebo patients completed the study. There was significant clinical improvement in both the SLIT and placebo groups. Median T5SS decreased from 14.75 to 5.25 in the SLIT group (P < .001) and 12.7 to 6.0 in the placebo group (P = .003). The median quality-of-life score also decreased in the SLIT group (P < .001) and the placebo group (P < .001). A subgroup analysis of patients found a 60% or greater improvement (on the T5SS and the Juniper Rhinitis Quality of Life Questionnaire) in the good responders group and a 30% to 59% improvement or no improvement in the intermediate responders group. This subgroup analysis also found more good responders in the SLIT group (47%) compared with the placebo group (25%; P = .07). Significant decreases in the IL-5/IFN-γ (P < .001), IL-13/IFN-γ (P < .001), and IL-4/IFN-γ (P = .03) ratios were found in the combined good clinical improvement group at 24 months., Conclusion: A good clinical response (≥60% improvement in both TSS5 and quality of life) is associated with significant decreases in IL-5, IL-13, and IL-4 relative to IFN-γ during 2 years of SLIT therapy for HDMs., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Clothing is largely presumed as being the mechanism by which house dust mites are distributed among locations in homes, yet little research to date has investigated the capacity with which various clothing fabric types serve as vectors for their accumulation and dispersal. Although previous research has indicated that car seats provide a habitat for mite populations, dynamics involved in the transfer of mites to clothing via car seat material is still unknown., Objective: To investigate the dynamics involved in the transfer of house dust mites from car seat material to modern clothing fabrics., Methods: A total of 480 samples of car seat material were seeded with mites and subjected to contact with plain woven cotton, denim, and fleece. Contact forces equivalent to the mass of a typical adult and child were administered for different durations of contact., Results: Mean transfer efficiencies of mites from car seat material to receiving clothing fabrics ranged from 7.2% to 19.1%. Fabric type, mite condition (live or dead), and the force applied all revealed a significant effect (P < .001 for each variable) on the transfer efficiency of house dust mites from seeded material to receiving fabrics, whereas duration of contact revealed no effect (P = .20). In particular, mean numbers of mites transferred to fleece (compared with denim and plain woven cotton) were greater for each treatment., Conclusion: These findings indicate that clothing type can have important implications for the colonization of other biotopes by house dust mites, with potential for affecting an individuals' personal exposure to dust mite allergens., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Co-sensitization to house dust mites (HDMs) and storage mites (SMs) is very frequent, although the clinical relevance is not well established., Objective: To describe the pattern of sensitization and immunologic characterization of patients with positive skin prick test reactions to HDMs and SMs in 4 areas of Spain, selected according to high exposure to HDMs and variable exposure to SMs., Methods: One hundred sixty-nine individuals with positive skin prick test reactions to HDMs and SMs were included. Specific IgE levels to different mite species and to Der p 1, Der p 2, and Der p 10 were determined. Immunoblots to Dermatophagoides pteronyssinus, Lepidoglyphus destructor, and Tyrophagus putrescentiae extracts were carried out, and allergograms were obtained. Results of different areas were compared., Results: A high rate of polysensitization to SMs was observed, although 12% of participants did not have specific IgE to any SM species. Sensitization to Dermatophagoides species, Der p 2, and L destructor were predominant, although significant differences were observed among areas depending on the grade of exposure to SMs. In areas with high exposure, the SM allergogram showed greater recognition of group 2 allergen., Conclusion: Sensitization patterns to SMs in patients sensitized to HDMs and SMs differ depending on the exposure to SMs. Sensitization, mainly to L destructor, seems to exist in areas with high exposure, possibly with group 2 allergens mainly involved. However, in areas with low SM populations, sensitizations observed by skin prick testing appear to be related to HDM exposure., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: There have been few investigations of farming-related activities or specific characteristics resulting in the associations between those exposures and atopic disease., Objective: To study the associations between farm-associated exposures and atopic diseases., Methods: As part of a longitudinal study of lung health in rural residents, a cross-sectional baseline study was conducted in rural Saskatchewan, Canada. This included an initial survey phase followed by a clinical testing phase. A subsample of 584 children (grades 1-8) completed skin prick testing to assess atopic status. Atopy was defined as a positive reaction to any of 6 allergens (local grasses, wheat dust, cat dander, house dust mite, Alternaria species, or Cladosporium species) of at least 3 mm compared with the negative control., Results: Of those who completed clinical testing, the prevalence of atopy was 19.4%, that of hay fever was 8.8%, and that of eczema was 27.4%. Based on skin prick testing, sensitization was highest for cat dander (8.6%) followed by local grasses (8.2%) and house dust mite (5.1%). After adjustment for potential confounders, home location (farm vs non-farm) was not associated with atopic status. However, livestock farming was protective against atopy (adjusted odds ratio 0.38, 95% confidence interval 0.17-0.88). In contrast, current residence on a farm was associated with an increase in the likelihood of hay fever in these children (adjusted odds ratio 3.68, 95% confidence interval 1.29-10.45). Also, regular farming activities in the past year were associated with an increased risk of hay fever., Conclusion: In children, livestock exposure has a protective effect on skin prick test positivity, whereas farm living and activities increase the risk of hay fever., (Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Up to 40% of the world's population has been diagnosed with an allergic disease. The most prevalent allergy is to house dust mites. Impermeable mattress covers are often the first treatment in the prevention and decrease of symptoms of allergic disease., Objective: To perform a meta-analysis evaluating the effectiveness of impermeable mattress covers in the primary prevention of allergic disease and as a single intervention in the tertiary prevention of allergic disease symptoms., Methods: MEDLINE, Embase, Web of Science, and CINAHL were systematically searched for relevant publications. Seven primary prevention trials (n = 3,461) and 17 tertiary prevention trials (n = 1,671) met the inclusion criteria and were included in the review. All article reviews and abstractions were performed in duplicate., Results: No significant pooled relative risks were found for the prevention of allergic disease. The pooled relative risks were 0.97 (95% confidence interval [CI] 0.62-1.51) for house dust mite sensitization, 0.92 (95% CI 0.81-1.05) for wheeze, 0.85 (95% CI 0.70-1.02) for asthma, 1.03 (95% CI 0.90-1.19) for allergic rhinitis, and 1.05 (95% CI 0.84-1.32) for allergic dermatitis. Likewise, no significant pooled standardized mean differences were found in the tertiary prevention of symptoms. The pooled standardized mean differences were -0.03 (95% CI -0.15 to 0.09) for peak flow, -0.06 (95% CI -0.32 to 0.20) for asthma symptom score, and -0.39 (95% CI -0.88 to 0.11) for nasal symptom score. A significant effect was seen in the decrease of house mite dust level in the mattress (-0.79, 95% CI -0.98 to -0.60)., Conclusion: No evidence was found to support the use of impermeable mattress covers in the primary prevention of allergic disease or in the tertiary prevention of allergic disease symptoms., (Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Forty million children are regularly exposed to environmental tobacco smoke (ETS) each year, increasing their risk for premature death and middle ear and acute respiratory infections. Early life exposure to ETS also is clearly associated with wheezing. However, there is no clear understanding of the influence of ETS on the development of allergic sensitization., Objective: To determine the association of combined exposure to ETS and indoor allergens on IgE sensitization to aeroallergens in children., Methods: This case-control study enrolled 116 cases and 121 controls from low-income families from Kansas City, Missouri. The adjusted odds ratio was calculated using a logistic model to assess the association between ETS and allergic sensitization using dust allergen levels as a covariate., Results: Thirty-six percent of atopic children and 39% of controls were exposed to ETS (P < .05). Unadjusted analyses showed no significant influence of ETS on IgE sensitization to indoor allergens. Logistic regression analyses also showed no significant influence of ETS on sensitization when adjusted for levels of allergens in the home dust and family history of allergic rhinitis., Conclusion: These data suggest that ETS exposure was not associated with IgE sensitization to indoor allergens, even when home allergen levels were taken into consideration. Further understanding of how components of tobacco smoke influence the immune response is necessary to interpret the disparate findings across studies., (Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: An understanding of the mechanisms responsible for the development and maintenance of allergic inflammation and their clinical implications is needed to develop specific and successful treatment for allergy., Objectives: To characterize in vitro T-cell responses to Der p 2, one of the major allergens of house dust mite (HDM), and investigate potential correlations between clinical and laboratory parameters., Methods: Forty-two patients monosensitized to HDM and 10 age-matched, healthy children were studied. Dendritic cells pulsed with Der p 2 were used to stimulate autologous CD14(-) cells. Der p 2-specific T-cell activation markers, proliferation, and cytokine production profiles were examined., Results: Der p 2-specific T-cell activation markers, proliferation, and T(H)2 cytokine production were significantly higher in HDM patients compared with healthy controls. Moreover, a significant correlation between proliferation and T(H)2 cytokine production was observed. Within the allergic group, skin reaction to HDM was significantly stronger in patients with a Der p 2-specific T-cell response. Levels of HDM-specific IgE directly correlated with interleukin 5 and interleukin 13 levels and with skin prick test results and, ultimately, with the patient's family history of allergy. Furthermore, the presence of atopic march correlated with T-cell proliferation., Conclusion: We found that, in HDM patients, Der p 2-specific T(H)2 responses, promoted by autologous dendritic cells in vitro, correlate with clinical parameters., (Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: It is suggested that polysensitized patients might not benefit from specific allergic rhinitis immunotherapy as much as monosensitized patients, although further research on this subject is needed., Objective: To compare the efficacy of sublingual immunotherapy (SLIT) with standardized house dust mite extract in monosensitized and polysensitized patients with allergic rhinitis., Methods: Patients who were sensitized to house dust mites and treated with SLIT for house dust mites for at least 1 year between November 2007 and March 2010 were studied. The monoallergen sensitized group was defined as patients who were sensitized to Dermatophagoides pteronyssinus and/or Dermatophagoides farinae (n = 70). The polyallergen sensitized group was defined as patients who were simultaneously sensitized to house dust mites and other allergens (n = 64). A standardized extract of house dust mites was used for immunotherapy. Antiallergic medication and the total nasal symptom score (TNSS), including rhinorrhea, sneezing, nasal obstruction, and itchy nose, were evaluated before and 1 year after SLIT., Results: This study enrolled 134 patients. The TNSS improved significantly after SLIT in both groups, whereas the change in the TNSS did not differ significantly between the groups. The antiallergic medication scores also decreased significantly in both groups, but there was no significant difference between the groups., Conclusions: In polysensitized allergic rhinitis patients, SLIT for D pteronyssinus and/or D farinae produced improvements in both nasal symptoms and rescue medication scores comparable to those in monosensitized patients, regardless of other positive allergens. SLIT for D pteronyssinus and/or D farinae should be considered in polysensitized allergic rhinitis patients., (Copyright © 2011 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Seafood allergy has been related to mite sensitization, mainly mediated by the muscle protein tropomyosin., Objectives: To determine the correlation between seafood hypersensitivity and mite sensitization (Dermatophagoides pteronyssinus and Chortoglyphus arcuatus, a highly prevalent storage mite in Spain) and to investigate the implication of tropomyosin in cross-reactivity., Methods: Patients from Northwest Spain were divided into 2 groups. The mite-seafood group contained 30 allergic mite individuals with a clinical history of food hypersensitivity. The mite group contained 40 individuals with positive skin prick test results to D pteronyssinus and C arcuatus but negative seafood test results. Specific IgE (sIgE) to whole mite and shrimp extracts, mite tropomyosin (rDer p 10), and shrimp tropomyosin (rPen a 1) were determined in each serum sample. Allergenic profiles were analyzed by immunoblot. Cross-reactivity studies were investigated by enzyme-linked immunosorbent assay and immunoblot inhibition studies., Results: In the mite-seafood group, 71% of patients had positive sIgE results to shrimp and 55% of them to shrimp tropomyosin. A strong correlation was found between sIgE to shrimp tropomyosin and mite tropomyosin. Positive correlation was observed between sIgE to shrimp tropomyosin and severity of symptoms. In the mite group, none of the 20% of patients with sIgE to shrimp tested positive to shrimp tropomyosin. In the immunoblot inhibition experiment, the shrimp extract was totally inhibited by mite extract. These data suggest that primary sensitization is related to mite sensitization., Conclusion: Tropomyosin does not seem to be the main allergen involved in mite-seafood sensitization in mite sensitized individuals. High levels of sIgE to tropomyosin seem to be related to severity of symptoms., (Copyright © 2011 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Children with asthma living in urban environments experience disproportionately high asthma hospitalization rates. Excessive exposure to perennial allergens, including cockroach and house dust mite (HDM), have been implicated, but data are limited., Objective: To examine the relation between cockroach and HDM exposure and measures of asthma morbidity and health care utilization., Methods: Participants included 86 atopic asthmatic children living in New Orleans, Louisiana. Sensitization status was determined by means of serum specific IgE testing, and vacuum dust samples were collected for allergen analysis. Logistic regression analysis was used to assess the odds of persistent wheezing, emergency department visits, and asthma hospitalization in those with high vs low levels of allergen exposure., Results: Approximately 44% and 40% of children were exposed to Bla g 1 levels greater than 2 U/g and HDM levels greater than 2 μg/g, respectively, and 24% reported at least 1 hospitalization in the previous 4 months. The median Bla g 1 level was significantly higher in the homes of children hospitalized compared with those with no hospital admissions (7.2 vs 0.8 U/g). In multivariable models, the odds of hospitalization were significantly higher in children exposed to Bla g 1 levels greater than 2 U/g (adjusted odds ratio, 4.2; 95% confidence interval, 1.24-14.17), independent of sensitization status. Exposure to HDMs was not associated with any measure of morbidity., Conclusions: Exposure to cockroach allergen was strongly associated with increased hospitalization in children with asthma. This effect cannot be explained entirely by IgE-mediated inflammation. Controlled interventional trials are needed to determine whether isolated cockroach abatement improves asthma control., (Copyright © 2011 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Tiredness, fatigue, and impaired quality of life are common in patients with persistent allergic rhinitis (PAR). These symptoms may also be associated with reduced sleep quality in individuals with rhinitis., Objective: To determine whether sleep disturbance can be detected using actigraphy in patients with PAR., Methods: Ten house dust mite-allergic rhinitic patients and 10 nonallergic nonrhinitic control subjects were studied for 5 consecutive days and night. Continuous activity monitoring during the study period using actigraphy was used to obtain markers of sleep quality, such as sleep onset, sleep duration, and sleep fragmentation. In addition, participants recorded in a sleep diary the time they went to bed, the time they went to sleep, the time they awoke, and the quality of their sleep., Results: Allergic rhinitic patients were found to have an increased fragmentation index value, indicative of reduced sleep quality and increased sleep disturbance, compared with the control group (P = .007)., Conclusions: Using actigraphy, we identified specific sleep disturbances in patients with PAR that may result in the increased tiredness, fatigue, and impaired quality of life typically experienced in such patients.

Background: The worldwide incidence and prevalence of atopic dermatitis (AD) are increasing. Few good studies have addressed AD in terms of the factors affecting disease prognosis., Objective: To identify significant correlates of persistent AD because this would be clinically valuable information., Methods: Potential correlates of AD, including race, onset age, age of solid food introduction, breastfeeding, sinopulmonary infections, other atopic diseases, peripheral eosinophilia, total IgE level, and eosinophilic cationic protein levels, were investigated in 177 patients aged 5 to 18 years. Correlates were compared with AD remission vs nonremission status., Results: A total of 133 patients (75.1%) were not in remission at the age of 5 years or older and were, thus, classified as having persistent AD. Patients with histories of peanut allergy (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.30-6.55), egg allergy (OR, 2.71; 95% CI, 1.17-6.30), or dust mite allergy (OR, 4.02; 95% CI, 1.84-8.82) were significantly more likely to have persistent AD than those without these factors. There was a trend toward increased odds of persistence in those with peripheral eosinophilia (P = .06) and decreased odds of persistence in those with frequent sinopulmonary infections (OR, 0.51; 95% CI, 0.25-1.03)., Conclusions: Egg, peanut, and dust mite allergies are significant correlates of AD persisting beyond school age. There may also be increased odds in those with peripheral eosinophilia and decreased odds in those with frequent sinopulmonary infections. This highlights the importance of assessing these correlates in patients with AD and modifying the correlates that can be modified. Further studies on whether modification of these correlates and/or early aggressive AD management improves outcome are needed.

Background: The prevalence of allergic airway diseases in childhood is higher in boys than in girls but switches toward a female predominance in adolescents and adults. The sex-specific prevalence of allergic sensitization to 1 of the most common allergens worldwide, house dust mite (HDM), has not been examined systematically by age group and species., Objective: To systematically review the literature to examine sex-specific differences in the prevalence of allergic sensitization to HDM., Methods: On the basis of a systematic MEDLINE search for population-based studies published between 1990 and 2007, we conducted meta-analyses of male to female ratios for sensitization to 2 different species of HDMs (Dermatophagoides pteronyssinus and Dermatophagoides farinae) separately for children and adults., Results: We included data from 7,822 children and 18,522 adults from 15 studies. The prevalence of sensitization to D pteronyssinus was significantly higher in boys vs girls (male to female ratio, 1.39; 95% confidence interval [CI], 1.13-1.71) and in men vs women (male to female ratio, 1.40; 95% CI, 1.22-1.61). For sensitization to D farinae, the significant male predominance in adults was even more pronounced (male to female ratio, 1.95; 95% CI, 1.37-2.79), but there were no sex-specific differences in children (male to female ratio, 0.90; 95% CI, 0.56-1.46)., Conclusions: In adults, the male predominance in sensitization to HDM seems to be contrary to the prevalence of allergic airway symptoms, which has a female predominance. The male predominance is even higher in allergic sensitization to D farinae than to D pteronyssinus. Further research is necessary regarding sex-specific differences in allergy and asthma.

Background: The atopy patch test (APT) may be the only positive skin test result in patients with either atopic eczema/ dermatitis syndrome (AEDS) or respiratory abnormalities with or without AEDS., Objective: To investigate the possible significance of APT to dust mite by comparing the positive result to this test with that of the skin prick test (SPT) in patients with different characteristics., Methods: A total of 297 individuals (178 boys and 119 girls) aged 5 to 221 months (mean [SD] age, 64.5 [42.1] months; median age, 58 months) were included in this study. Participants were divided into 4 groups: current AEDS, current AEDS and respiratory symptoms, past AEDS and respiratory symptoms, and respiratory symptoms with neither current nor past AEDS (control group). All the patients underwent SPT and APT using house dust mite extract., Results: In the study groups, the rate of positivity was significantly higher for APT, whereas in the control group, there were significantly more positive results to SPT (P < .001 for both). Multivariate analysis showed that there was a high probability of a positive APT result in patients with AEDS (odds ratio [OR], 17.4), with AEDS and respiratory disease (OR, 21.9), and with past AEDS and respiratory disease (OR, 22.8)., Conclusions: These patients with AEDS showed 2 different patterns of allergic response to allergens, one IgE mediated (as evaluated by positive SPT results) and the other cell mediated (as evaluated by positive APT results). The former seems to follow the so-called atopic march model, and the latter persists even after the disappearance of AEDS and is likely to be implicated in the pathogenesis of respiratory allergy.

Background: Season of birth has been associated with the development of atopy and asthma. Relationships among a particular birth season, maternal allergen exposure during the birth season, and childhood development of allergies to allergens in higher concentration during the birth season may be important., Objective: To investigate the effects of winter birth (January 1 to March 31) and prenatal cockroach and mouse allergens in settled dust on indoor allergen-specific cord blood mononuclear cell (CBMC) proliferation, TH2 production, and cord blood IgE concentration., Methods: As part of an ongoing prospective study, 350 cord blood samples were collected. The CBMCs were cultured with cockroach, dust mite, and mouse protein extracts, and proliferation was measured. Interleukin 5, interferon-delta, and total IgE levels were measured. Home dust samples were analyzed for cockroach and mouse allergens., Results: An isolated association was observed between winter birth and a greater mean (SD) cockroach interleukin 5 ratio (winter vs nonwinter birth: 26,043 [11,403] vs 11,344 [3,701]; P = .02). Other associations between winter birth and increased CBMC proliferation, T-helper cytokines, or cord blood IgE levels were not detected. Higher mouse allergen levels were associated with decreased mouse-induced proliferation (winter vs nonwinter birth: mean [SD] stimulation index, 1.72 [0.12] vs 2.02 [0.11]; P = .04)., Conclusions: Winter birth and increased cockroach or mouse allergen levels during pregnancy were not consistently associated with greater CBMC proliferation, T-helper cytokine production, or cord blood IgE levels. Greater indoor allergen exposure during pregnancy does not seem to affect the development of cockroach or mouse immune responses in utero.

Background: Recent evidence suggests that regulatory T cells (Treg cells) and immunosuppressive cytokines, such as transforming growth factor BETA1 (TGF-BETA1) and interleukin 10 (IL-10), may have a role in clinically effective allergen specific immunotherapy (SIT)., Objective: To evaluate the effect of SIT on the induction of Treg cells in house dust mite-allergic children and on the expression of specific Treg cell markers (cytotoxic T-lymphocyte-associated protein 4 [CTLA-4], IL-10, and TGF-BETA1)., Methods: In this uncontrolled open-label study, the percentage of peripheral blood CD4+ Treg cells (CD69 CD45RO+CTLA-4+ and CD3+CD4+CD25+FOXP3+) and the expression of molecules associated with their functions (CTLA-4, TGF-BETA1, and IL-10) were analyzed using flow cytometry in 16 children allergic to house dust mites before and at 3 and 12 months of subcutaneous SIT. Clinical variables, such as symptom score, medication requirements, forced expiratory volume in 1 second, peak expiratory flow rate, and serum IgE levels, were also determined. Ten healthy children were included as controls., Results: All the clinical variables improved during immunotherapy. The percentage of CD4+CD25+CD69-CD45RO+ Treg cells remained unchanged. The percentage of CTLA-4+ -expressing Treg cells transiently increased after 3 months of immunotherapy, whereas the percentage of FOXP3+ Treg cells did not change after 1 year of immunotherapy. Levels of IL-10+ cells transiently decreased after 3 months of immunotherapy. Four children who required inhaled fluticasone propionate administration for significant symptom worsening had no statistically significant increase in TGF-BETA1-secreting T cells at 12 months of SIT, in contrast to 12 children without inhaled corticosteroid treatment., Conclusions: The increase in TGF-BETA1-positive T cells only in children without significant symptom worsening requiring inhaled corticosteroid treatment limits the usefulness of TGF-BETA1 in monitoring response to allergen immunotherapy.

Background: Limited data are available on the immunochemical compatibilities of standardized and nonstandardized allergen extracts in immunotherapy vaccines. Extract combinations recommended in immunotherapy practice parameters are based primarily on theoretical considerations rather than on actual product compatibilities., Objectives: To determine the stabilities of standardized grass, short ragweed, dust mite, and cat extracts after mixing with fungal and cockroach extracts at final product concentrations similar to those recommended for maintenance immunotherapy injections., Methods: Mixtures were prepared using individual products from multiple sources at variable glycerin concentrations and were analyzed after storage for up to 1 year at 2 degrees C to 8 degrees C. Quantitative analyses included radial immunodiffusion assays for cat Fel d 1 and short ragweed Amb a 1 and human IgE enzyme-linked immunosorbent assay inhibitions for meadow fescue grass and dust mite allergens. Immunoblot analyses provided qualitative patterns of IgE binding., Results: Meadow fescue grass allergens were unstable after mixing with fungal or cockroach extracts but were highly compatible with dust mite extracts from numerous commercial sources. Fescue and dust mite allergen recoveries varied considerably when mixed with different mold extracts. The presence of cockroach extracts reduced dust mite allergen potencies but retained moderate levels of cat and short ragweed allergen activities. In all cases examined, glycerin provided concentration-dependent improvements in allergen recoveries., Conclusions: Several allergen extract combinations generally regarded as unstable by current practice parameters seem to possess considerable biochemical compatibilities. Use of these mixtures in immunotherapy vaccines is supported for practitioners seeking to optimize formulations, doses, and treatment regimens for their patients.

Background: Childhood sensitization rates for many aeroallergens are underreported., Objectives: To examine aeroallergen sensitization rates in military children undergoing skin testing for rhinitis and investigate the timing of atopic development for perennial and seasonal allergens., Methods: A skin testing database was retrospectively analyzed. Children 18 years and younger referred for rhinitis underwent skin prick testing to either a screening panel of 8 tests or a standard panel of 51 allergens., Results: A total of 209 patients underwent skin testing to the 8-test panel. Of these patients, 35.4% had at least 1 positive result. Atopy increased with age, from 6.3% in those younger than 1 year to 58.8% in those 5 years old. The most common allergens were mold mix (16.3%), cat (13.2%), dust mite mix (11.4%), tree mix (9.4%), and grass mix (9.4%). Only 4.0% were sensitized to seasonal aeroallergens before the age of 3 years. A total of 345 children underwent testing to a 51-allergen panel. A total of 80.3% had at least 1 positive test result, and the average number of positive test results was 11.4. Both the percentage of atopy and the average number of positive skin test results increased with age. The most common allergens were grasses, Alternaria, and cottonwood. Thirty-two of 51 allergens were positive in 20% or more children. Rates for many underreported allergens are presented., Conclusions: In children, aeroallergen sensitization rates are high and increase with age. Perennial allergens predominate up to the age of 3 years. Rates for many underreported allergens are presented. Although performed in a military population, these results should be applicable to many practices.

Objectives: To investigate the duration of effective inhalant subcutaneous immunotherapy (SCIT) reported in the published literature and to determine if any specific biomarkers or clinical predictors exist that may identify patients who will remain in long-term remission after discontinuing treatment., Data Sources: Articles were selected from a search of the PubMed database from 1976 to 2006 using the search terms immunotherapy and allergen immunotherapy in combination with venom, allergic rhinitis, asthma, mechanism, efficacy, and duration, as well as articles known to the authors and referenced in review articles., Study Selection: Articles were selected if evaluation of efficacy of the primary allergic disease treated after discontinuation of SCIT was stated as one of the objectives of the study., Results: The rate of relapse after discontinuing SCIT ranges from 0% to 55% of patients in the studies reviewed in this article. The length of the specific allergen immunotherapy and allergen type (ie, perennial vs seasonal) may be variables that affect the duration of clinical remission after cessation of SCIT. One study found the duration of SCIT efficacy after discontinuation depended on duration of treatment and correlated with decrease in skin test reactivity., Conclusion: Until specific tests or clinical markers are identified that will clearly distinguish between patients who will relapse from those who will remain in long-term clinical remission after discontinuing effective allergen immunotherapy, the decision to continue or stop immunotherapy must be individualized.