STUDIES ON THE HOUSE

DUST MITES OF KOLKATA

IN RELATION TO
NASOBRONCHIAL
ALLERGIC DISORDERS
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 INTRODUCTION

INTRODUCTION:

MITES ARE VERY DIVERSE AND WIDE SPREAD GROUPS OF ANIMALS WHICH

CAN BE FOUND ALMOST IN ALL THE HABITATS KNOWN ON THE EARTH. IN THE

WORDS OF SCHAUFF (2000), THEY ARE "UBIQUITOUS, INCONSPICUOUS, HARMFUL

AND HELPFUL". MORE THAN 48,200 SPECIES (SCHAUFF, 2000) HAVE SO FAR BEEN

IDENTIFIED FROM THE WORLD, OF THOSE SOME ARE PLANT FEEDERS, SOME ARE

FUNGIVOROUS, SOME ARE COPROPHAGOUS, SOME ARE SAPROPHAGOUS AND

SOME ARE CARNIVOROUS, SOME ARE BLOOD AND LYMPH SUCKERS WHILE

THERE ARE MANY WHOSE FEEDING HABITS ARE STILL UNKNOWN. REGARDING
HABITATS, THE MAJORITY OF MITES ARE FREE LIVING BUT THOUSAND OF

SPECIES ARE THERE WHICH PARASITISE PLANTS AND ANIMALS, WHILE OTHER

SERVES AS BOTH RESERVOIRS AND VECTORS OF SERIOUS PATHOGENS CAUSING

RICKETTSIAL POX, PROTOZOANS, BACTERIAL, SPIROCHAETE AND VIRAL

DISEASES TO LIVESTOCK AND HUMAN BEINGS ON ONE HAND AND ON THE

OTHER HAND ACT AS VECTORS OF VIRULENT OF PLANT VIRAL DISEASES.

NEEDLESS TO MENTION, ALL THESE CAUSE COLOSAL ECONOMIC LOSS. AMONG

DIFFERENT GROUPS OF MITES, HOUSE DUST MITES HAVE EARNED A WORLD

WIDE INTEREST AMONG ACAROLOGISTS AND ENTOMOLOGISTS IN GENERAL AND

MEDICAL ENTOMOLOGISTS IN PARTICULAR BECAUSE OF THEIR INTRICATE

ASSOCIATION WITH HUMAN BEINGS AND THIS ASSOCIATION IS OF GREAT

CONCERN AS CERTAIN SPECIES OF MITES PLAY A SIGNIFICANT ROLE IN PUBLIC

HEALTH SUCH AS SARCOPTES SCABIAE CAUSES SCABIES, DEMODEX SP. CAUSES

DEMODICTIC MANGE TO MAN AND OTHER ANIMALS AND OFTEN CAUSES

DERMATITIS. SEVERAL OTHER SPECIES OF MITES HAVE BEEN IMPLICATED AS

CAUSAL FACTOR OF CONTACT DERMATITIS IN PERSONS HANDLING INFESTED

GRAINS. FOR EXAMPLE COPRA-ITCH (TYROPHAGUS PUTRESCENTIAE), BAKER'S

ITCH (ACARUS SIRO), GROCER'S ITCH (GLYCYPHAGUS DOMESTICUS) ETC.

HOWEVER, SINCE THE 1900S IT HAS BEEN ESTABLISHED THAT THE HOUSE DUST ,
COMPLEX MIXTURE OF HUMAN DANDER, DEBRIS FROM WOOL, FEATHERS,

HAIRS, INSECTS, COTTON, MILK, JUTE AND SYNTHETIC FIBRES, CARPETS,

BEDDINGS, FURNITURES AND UPHOLSTERY, FUNGAL SPORES, POLLENS,

BACTERIA, MICROORGANISMS AND SHEDDING FROM OTHER HOUSE HOLD

ARTICLES, PLAY A SIGNIFICANT ROLE TO CAUSE SNEEZING AND WHEEZING IN

SENSITIVE INDIVIDUALS. KERN (1921) AND COOKE (1922) FIRST OF ALL POINTED

OUT THE ROLE OF HOUSE DUST IN CAUSING RESPIRATORY ALLERGY

 INTRODUCTIO
N

AND SUSPECTED THE PRESENCE OF DISTINCT ALLERGEN IN IT. HOWEVER,

DURING SIXTIES, IT HAS BEEN ESTABLISHED THAT HOUSE DUST MITES

ESPECIALLY BELONGING TO THE FAMILY PYROGLYPHIDAE ARE A SOURCE OF

ALLERGENS THAT LAY A SIGNIFICANT ROLE IN DIFFERENT ALLERGIC DISORDERS

LIKE ALLERGIC RHINITIS, HAY FEVER, ECZEMA AND IN EXTREME CASES

BRONCHIAL ASTHMA.(VOORHORST,1964; SPIEKSMA-BOEZMAN, 1967; WHARTON,

1976; CHARLET ET AL, 1977; FELDMAN- MUHSAN ET AL, 1985; HURTUDO & PARINI,

1987; PLETTS-MILLS ET AL,1992; FEMANDEZ-CALDAS ET AL. 1993; CARSWELL ,1995;

SAHA, 1993, WARNER ET AL, 1999; EGGLESTON AND BUSH, 2001 AND PODDER ET

AL, 2006). THESE MITES ARE FREE LIVING AND FOUND IN EVERY CORNER OF THE

HOUSE AND ARE MORE ABUNDANT IN BEDS THAN ELSEWHERE, AS BEDS

CONTAIN MUCH MORE HUMAN SKIN SCALES ON WHICH THEY FEED (SPIEKSMA,

1967; LARSON ET AL, 1969; BRONSWIJK, 1972) AND ALSO PROVIDE IDEAL

MICROCLIMATE SUCH AS TEMPERATURE AND HUMIDITY WHICH ARE FAVORABLE

FOR MITE POPULATION GROWTH AND MULTIPLICATION OF MITE POPULATION

(CHEW ET AL, 1999). THERE HAS BEEN A SUBSTANTIAL INCREASE IN THE

INCIDENCE AND PREVALENCE OF NASOBRONCHIAL ALLERGIC DISORDERS,

AFFECTING 12-20% OF THE POPULATION WORLD WIDE (SMITH, 1983). THE

SITUATION IS WORST IN MOST OF THE LESS PROSPEROUS AND DEVELOPING

COUNTRIES WITH WEAK ECONOMIC CONDITION. IN INDIA, 10 MILLION PEOPLE

SUFFER FROM ASTHMA AND ANOTHER 15 MILLION FROM OTHER RECURRENT

ALLERGIC DISEASES (PODDER ET AL, 2006). THERE ARE MANY FACTORS SUCH AS

LIVING HABITS, OCCUPATION, HUMIDITY, CLIMATE, HOME STANDARDS AND

VENTILATION WHICH HAVE BEEN ATTRIBUTED TO SUCH INCREASE OF VARIOUS

NASOBRONCHIAL ALLERGIC DISORDERS (KOOSGAARD, 1998).

WHAT IS AN ALLERGY?
 THE TERM "ALLERGY" WAS FIRST COINED BY VAN PIQUET IN 1906 FROM

THE GREEK WORDS " ALIOS" MEANS OTHER AND "ERGON" MEANS ACTION;

HENCE THE "OTHER ACTION" OR "ALTERED REACTION". ACCORDING TO HIM, IT

IS A CHANGE RESPONSIVENESS OF INDIVIDUALS, WHO HAVE PREVIOUSLY BEEN

EXPOSED TO AN ANTIGEN (ALLERGENS). THE SECOND TIME EXPOSURE TO THAT

ANTIGEN RESULTED IN ALTERED RESPONSIVENESS. THE MAJORITY, HOWEVER,

PREFER TO DESCRIBE
 INTRODUCTI
ON

ALLERGY AS AN IMMUNOLOGICALLY MEDIATED STATE OF HYPERSENSITIVITY

THAT IS DAMAGING THE BODY.

IN THE YEAR 1922, COCA COINED A TERM "ATOPY" TO DESCRIBE A FORM

OF CLINICAL ALLERGY WHICH IS OF INHERITED NATURE. PATIENTS WITH ATOPY

HAVE A HEREDITARY TENDENCY TO PRODUCE REAGINIC ANTIBODIES (IGE) IN

HIGHER AMOUNT AFTER NORMAL EXPOSURE TO SUBSTRATE (ATOPENS), WHICH

ARE OTHERWISE HARMLESS TO NORMAL PERSONS. ATOPIC PERSONS HAVE AN

INCREASED RISK OF DEVELOPING ASTHMA, URTICARIA, ATOPIC ECZEMA AND

RHINOCONJUNCTIVITIS.

MECHANISM OF ALLERGIC REACTION:

WHEN AN INDIVIDUAL IS IMMUNOLOGICALLY PRIMED, FURTHER CONTACT WITH

ANTIGEN LEADS TO SECONDARY BOOSTING OF THE IMMUNE RESPONSE.
HOWEVER, THE REACTION MAY BE EXCESSIVE LEADING TO GROSS TISSUE
DAMAGE (HYPERSENSITIVITY), IF THE ANTIGEN IS PRESENT IN RELATIVELY
LARGE AMOUNTS OR IF THE HUMORAL AND CELLULAR IMMUNE STATE ARE AT
HIGHER LEVEL.

ON THE BASIS OF DIFFERENT IMMUNOLOGICAL MECHANISMS, GELL ET

AL. (1977) CLASSIFIED THE ALLERGIC REACTION INTO 4 DISTINCT CLASSES:-

1. TYPE -I REACTION (IMMEDIATE HYPERSENSITIVITY)

2. TYPE -II REACTION (CYTOTOXIC)

3. TYPE - III REACTION (IMMUNE COMPLEX MEDIATED REACTION)

4. TYPE -IV REACTION (DELAYED HYPERSENSITIVITY)

IN CASE OF NASOBRONCHIAL ALLERGIC DISORDERS, TYPE- I

HYPERSENSITIVITY REACTION THAT IS IMMEDIATE REACTION OCCURS IN OUR
SELVES. THE REACTION OCCURS IN THE FOLLOWING STEPS.
1. SENSITIZATION PHASE:
SENSITIZATION TO A PARTICULAR ANTIGEN IS DEPENDENT ON

STIMULATION OF IGE ANTIBODY PRODUCTION. THIS REQUIRES CD4+ TH2

CELLS TO INDUCE CLASS SWITCHING OF ANTIGEN SPECIFIC CELLS AND TO

SECRETE IL-4 FOR B- CELL GROWTH AND DIFFERENTIATION.

 INTRODUCTI
ON

2. EFFECTOR PHASE:
IGE ANTIBODY PRODUCED FOLLOWING INITIAL CONTACT WITH THE

SPECIFIC ANTIGEN (LIKE POLLENS, DUST, DUST MITES ETC.), WITH THE

SPECIFIC ANTIGEN, BIND TO IGE RECEPTORS ON MAST CELLS AND

BASOPHILS. CROSSLINKING BY ANTIGEN OF THE IGE AND THE RECEPTORS

WITH WHICH IT IS ASSOCIATED, RESULTS IN RAPID DEGRANULATION AND

RELEASE OF PHARMACOLOGICAL MEDIATORS (EG. HISTAMINE) CAUSING

LOCAL INFLAMMATION. THESE POWERFUL MEDIATORS ACT ON DIFFERENT

ORGANS OF THE BODY RESULTING IN VARIOUS MANIFESTATIONS OF

ALLERGIC DISEASES. AMONG THEM, THE LUNG IS RECOGNIZED AS THE MOST

IMPORTANT AND VULNERABLE TARGET IN IMMUNOLOGIC DISEASES. WHEN

THIS REACTION OCCURS IN THE LUNG, THE RESULTANT EFFECT IS ASTHMA.

THE BRONCHI OF TIRE SUBJECT WITH ASTHMA ARE SENSITIVE TO MANY

EXTERNAL STIMULI. ACCORDING TO COCKEROFT ET AL. (1977) THE DEGREE

OF HYPERRESPOSIVENESS MAY INCREASE IN SUBJECTS WITH ASTHMA AFTER

DELIBERATE EXPOSURE TO INHALED ALLERGENS.

 CONCLUSIO
N

CHAPTER - IV: BIOLOGY OF DERMATOPHAGOIDES

PTERONYSSINUS:

IT IS NOW WELL DOCUMENTED THAT THE MITE ALLERGEN IS ONE

OF THE COMMON SOURCE OF RESPIRATORY ALLERGY. STUDIES ON MITE
FAUNA SUGGEST THAT DERMATOPHAGOIDES PTERONYSSINUS IS THE
MOST COMMON DOMESTIC MITE SPECIES IN KOLKATA, INDIA. THE
CLINICAL RELEVANCE OF D. PTERONYSSINUS WAS ALREADY
INVESTIGATED AMONGST AN ASTHMATIC POPULATION FROM KOLKATA.
IT WAS FOUND TO BE A SOURCE OF SENSITIZING ALLERGENS IN HOUSE
DUST (PODDER ET AL, 2006). NATURALLY, THE INFORMATION REGARDING
THE BIOLOGY OF THIS MITE IS IMPORTANT FOR UNDERSTANDING THE
POPULATION DYNAMIC OF LABORATORY CULTURES AND IN MITE
CONTROL. HENCE, THE LIFE CYCLE OF THIS MITE WITH SPECIAL
REFERENCE TO DURATION OF DIFFERENT STAGES WAS STUDIED AND
RESULTS THEREOF ARE PRESENTED HERE.

MATERIALS AND METHODS:

ADULT MITES (BOTH MALES AND FEMALES) WERE ISOLATED FROM

HOUSE OCCUPIED BY ASTHMATIC PATIENTS IN AND AROUND KOLKATA.
FIFTY MILLIGRAM OF DUST FROM EACH SAMPLE WAS SUSPENDED IN 50%
LACTIC ACID. ALL MITES PRESENT IN EACH SAMPLE WERE COLLECTED
WITH A FINE NEEDLE, PLACED IN TWO DROPS OF HEINZE'S MEDIUM ON A
MICROSLIDE, THEN IDENTIFIED. MASS CULTURE OF D. PTERONYSSINUS
WAS SET UP AT 25°C AND 80% RH IN PETRIDISHES (3.5 CM. IN DIAMETER)
AND APPROXIMATELY 2 MG OF FOOD (WHEAT FLOUR) WAS PLACED IN
EACH DISH. ALL THE DISHES WERE KEPT IN BOD INCUBATOR AT THE
AFORESAID TEMPERATURE AND HUMIDITY.
 TO DETERMINE THE DURATION OF LIFE STAGES, 30 FRESHLY LAID
EGGS WERE PLACED IN 30 SEPARATE DISHES AND OBSERVATIONS WERE
RECORDED AT 24 HRS INTERVAL. THE TIME OF DEVELOPMENT OF
DIFFERENT STAGES FROM EGG TO ADULT WAS RECORDED. THE DATA
PERTAINING TO DIFFERENT LIFE STAGES WERE TAKEN FROM THOSE CASES
WHERE THE COMPLETE LIFE CYCLE COULD BE REACHED AND THIS ALSO
GAVE THE PERCENTAGE OF MORTALITY AT DIFFERENT STAGES. FOR
COMPUTATION AND STATISTICAL ANALYSIS OF THE DATA, ONLY THOSE
CASES WHERE LIFE CYCLE WAS COMPLETED WAS TAKEN FOR STATISTICAL
ANALYSIS. IN ORDER TO DETERMINE PRE-OVIPOSITION, OVIPOSITION AND
POST-
 CONCLUSION

OVIPOSITION PERIOD, A SEPARATE EXPERIMENT WAS DESIGNED. FOR THIS, 25

PAIRS OF PETRIDISHES WERE TAKEN AND IN EACH OF THOSE A PAIR NEWLY

EMERGED ADULT MALE AND FEMALE WERE RELEASED. WHILE TAKING

OBSERVATIONS, THE NUMBER OF NEWLY LAID EGGS WAS COUNTED IN EACH OF

THESE PETRIDISHES AND THEREAFTER THE EGGS WERE DESTROYED BY

PRICKING THOSE WITH A NEEDLE. THIS WAS CONTINUED TILL CESSATION OF

EGG LAYING. THE TIME BETWEEN THE DEPOSITION OF THE FIRST AND LAST EGG

WAS DEFINED AS THE REPRODUCTIVE PERIOD.

RESULTS:

EGGS REQUIRED AN AVERAGE OF 11.26 DAYS TO DEVELOP INTO ADULTS.

FIFTEEN OF THE 30 EGGS OBSERVED (50%) BECAME ADULT. MORTALITY AT THE

LARVAL AND PROTONYMPH STAGES WAS 23% AND 12% RESPECTIVELY. THERE

WAS NO MORTALITY AT THE TRITONYMPH STAGE. DURATION OF EGG STAGE WAS

APPROXIMATELY 2.45 DAYS, FOLLOWED BY LARVAL 1.57, PROTONYMPHAL AND

TRITONYMPHAL STAGES EACH ACCOUNTING FOR 2.64 AND 2.6 DAYS

RESPECTIVELY (TABLE 26).RESTING PROTONYMPHAL AND RESTING

TRITONYMPHAL STAGES WERE ALSO OBSERVED, EACH ONE WITH DURATION OF

APPROXIMATELY 1 DAY.

THE PRE-OVIPOSITION PERIOD WAS FOUND TO BE 2.57 DAYS, OVIPOSITION

PERIOD 23.78 DAYS AND POST OVIPOSITION PERIOD. FECUNDITY RANGED FROM
51 - 122 EGGS). THE TOTAL OVIPOSITION PERIOD RANGED FROM 8-22 DAYS AND
1.3 TO 6.4 EGGS / DAY/ FEMALE.
MATED MALES AND FEMALES LIVED 18 - 64 DAYS AND 20 - 54 DAYS,
RESPECTIVELY.
 CONCLUSION

TABLE 21. THE DURATION OF DIFFERENT DEVELOPMENTAL STAGES (IN DAYS) AND

REPRODUCTIVE STATISTICS FOR FEMALES OF DERMATOPHAGOIDES

PTERONYSSINUS MITE AT 25°C AND 80% RH.

STAGE DURATION (DAYS)

MEAN ± RANG
S.E E
EGG 2.45±0.1 2-3
LARVA 1.57 ±0.11 1-2
PROTONYMPH 2.64 ±0.19 2-4
TRITONYMPH 2.46 ±0.13 2-3
EGG - ADULT 11.26±0.47 9-14
PRE-OVIPOSITION PERIOD 2.57 ±0.19 1-4
OVIPOSITION PERIOD 23.78±1.51 10-34
POST-OVIPOSITION PERIOD 25.73±2.75 5-42
FECUNDITY 85.06±6.94 51-122
EGG-LAYING DAYS 16.2 ±0.98 8-22
RATE OF REPRODUCTION 4.2 ±0.41 1.3-6.4
LONGEVITY OF MALES 46.46±3.25 18-64
LONGEVITY OF FEMALES 38.2 ± 3.45 20-54

DISCUSSION:

IN THE PRESENT STUDY, THE DEVELOPMENT OF D. PTERONYSSINUS FROM EGG TO

ADULT WAS FASTER (9 - 14 DAYS) THAN OTHER REPORTS LIKE MULVEY (1972), HO &

NADCHATRAM (1984), MARIANA ET AL. (1996), WHO STATED THAT THE LIFE CYCLE OF D.

PTERONYSSINUS WAS COMPLETED WITHIN 16-24 DAYS. BRONSWIJK & SINHA (1971),

REPORTED THAT THE PYROGLYPHIDS HAVE 5 DISTINCT LIFE STAGES VIZ. EGG, LARVA,

PROTONYMPH, TRITONYMPH AND ADULT AND WHEREAS HO & NADCHATRAM (1984)

AND MATSUMOTO ET AL (1986) CLAIMED THAT THE PYROGLYPHIDS HAVE 7 DISTINCT

LIFE STAGES VIZ. EGG, LARVA, PHARATE PROTONYMPH, PROTONYMPH, TRITONYMPH

AND PHARATE ADULT. OUR FINDINGS ARE IN CONFORMITY WITH THOSE OF HO &

NADCHATRAM (1984) AND MATSUMOTO ET AL.(1986). OUR FINDINGS REVEALED THAT

THE SPAN OF LIFE-CYCLE OF ADULT MALE MITES IS ABOUT 6-7 WEEKS, FEMALE MITES

WERE, HOWEVER, OBSERVED TO LIVE SHORTER THAN THEIR MALE

 CONCLUSION

COUNTERPARTS. IN THE OPINION OF SPIEKSMA & SPIEKSMA - BOEZEMAN (1967)

AND MULVEY (1972), THE ADULT MALE AND FEMALE OF D. PTERONYSSINUS
LIVED FOR 60-80 DAYS AND 100-150 DAYS RESPECTIVELY AT 25 °C AND 80% RH.
STUDIES ON THE FECUNDITY OF D. PTERONYSSINUS REVEALED THAT THE

NUMBER OF EGGS LAID/FEMALE/DAY RANGED BETWEEN 1.3 TO 6.4 UNDER

LABORATORY CONDITIONS (26°C AND 80% RH). THE PRESENT FINDINGS

DISAGREE WITH THE OBSERVATION OF SPIEKSMA (1967), WHO OBSERVED A LOW

FECUNDITY RATE FOR D. PTERONYSSINUS I.E. 1.2-2.5 / DAY AT 25 °C AND ALSO

WITH MATSUMOTO ET AL. (1986) ,WHO ALSO OBSERVED THAT THE FECUNDITY OF

D. PTERONYSSINUS WAS 1-2 EGGS/ DAY AND AT 86% RH.

OBSERVATION ON THE LIFE-CYCLE OF D. PTERONYSSINUS FURTHER

POINTED OUT THAT THE RATE OF MORTALITY WAS HIGHEST DURING LARVAL

STAGES (23%) BUT AS THE DEVELOPMENT PROGRESSED A GRADUAL DECREASE

IN MORTALITY RATE WAS NOTICED. THIS FINDING AGREES WITH THE

OBSERVATION MADE BY HO & NADCHATRAM (1984). COLLOFF (1987A) REPORTED

MARKED DIFFERENCES IN THE DEVELOPMENT AND MORTALITY' OF EGGS

BETWEEN LABORATORY AND WILD POPULATIONS OF D. PTERONYSSINUS REARED

UNDER FLUCTUATING CONDITIONS OF TEMPERATURE AND HUMIDITY.

TEMPERATURE, RH AND FOOD AVAILABILITY ARE THE MOST IMPORTANT

ENVIRONMENTAL FACTORS THAT INFLUENCES THE BIOLOGY AND GROWTH OF

DUST MITES (MERCADO ET AL, 2001). ACCORDING TO HIM THESE FACTORS

DETERMINE WHERE THEY LIVE, HOW LARGE THE POPULATIONS BECOME AND

HOW THEY FLUCTUATE SEASONALLY. HE ALSO POINTED OUT THAT THE D.

PTERONYSSINUS MITES HAS A BROAD DISTRIBUTION RANGE THAT APPEARS TO

BE LESS CONSTRAINED BY MICROCLIMATES. THIS CAN BE EXPLAINED BY THE

BETTER MAINTENANCE OF THE BODY WATER BALANCE WITHIN THE

PYROGLYPHIDAE, WHICH MAKES PYROGLYPHID MITES MORE ADAPTED TO THE

PERIODIC MICROCLIMATIC FLUCTUATIONS IN HOMES (MERCADO ET AL, 2001)

 CONCLUSION

CONCLUSION: ROLE OF MITES IN NASOBRONCHIAL ALLERGIC

DISORDERS

MATERIALS AND METHODS:

ALL THE ALLERGENIC MITES WHICH ARE REPORTED TO BE ALLERGENIC
ELSEWHERE IN THE WORLD (KRONQRIST ET AL, 2000; ARLIAN,. 2002; SOLARZ ET
AL, 2004; SZILMAN ET AL, 2006 AND YADAV ET AL, 2006) ARE ALSO ISOLATED FROM
THE DUST COLLECTED FROM THE SURROUNDINGS OF THE PATIENTS RESIDING
IN KOLKATA. THE PHYSICAL PRESENCE OF ALL THESE ALLERGEN PRODUCING
MITES IN THE PATIENTS ENVIRONMENT IN LARGE QUANTITY TEMPTED US TO
SEARCH FOR AN ALLERGIC ETIOLOGY TOWARDS THESE SPECIES OF MITES. THE
ISOLATED ALLERGENIC MITES ARE

5. DERMATOPHAGOIDES PTERONYSSINUS
6. D. FARINAE

7. AUSTROGLUCYPHAGUS GENICULATUS

8. BLOMIA TROPICALIS
9. ACARUS SIRO

10. GLYCYPHAGUS DOMESTICUS

11. EUROGLYPHUS MAY END.

12. TYROPHAGUS PUTRESCENTIAE

SELECTION OF PATIENTS' AND CONTIVL SUBJECTS:

PATIENTS BETWEEN THE AGE GROUP OF 5-50 YEARS AND REPORTED TO BE

SUFFERING FROM DIFFERENT NASOBRONCHIAL ALLERGIC MANIFESTATIONS

LIKE BRONCHIAL ASTHMA, ALLERGIC RHINITIS, URTICARIAL RASH EITHER

ALONE OR IN DIFFERENT COMBINATION WERE SELECTED FOR THIS PURPOSE.

THE PERSONAL AND/OR FAMILY HISTORY OF INDIVIDUAL PATIENTS WERE

RECORDED IN A WELL PREPARED QUESTIONNAIRE INCLUDING AGE OF ONSET OF

SYMPTOMS, FREQUENCY OF ATTACKS, MONTHS OF WORST SUFFERING, TYPE OF

FOOD INTAKE, EXPOSURE TO PET ANIMALS, INFLUENCE OF DUSTS, FOOD AND

NON SPECIFIC STIMULI SUCH AS COLD, EXERCISE AND OTHER IRRITANT

FACTORS. BOTH MALE AND FEMALE PATIENTS WERE CATEGORIZED INTO THREE

AGE GROUPS RANGING - UP TO 15 YEARS, 15-40 YEARS AND

ABOVE 40 YEARS. CASES WITH OTHER ORGANIC AND SYSTEMATIC
DISEASES SUCH AS HYPERTENSION, DIABETES AND ALSO PREGNANT AND
BREAST FEEDING WOMAN WERE EXCLUDED. SELECTION OF PATIENTS
WAS DONE ON THE BASIS OF THE FOLLOWING CRITERIA MENTIONED
EARLIER BY SAHA (1993). PATIENTS HAVING AT LEAST 6 POSITIVE AMONG 8
FOLLOWING CRITERIA ARE CONSIDERED AS SUFFERING FROM
BRONCHIAL ASTHMA - THE SEVERE FORM OF ALLERGIC MANIFESTATION.

3. PRESENCE OF WHEEZY DYSPONEA

4. PRESENCE OF FREQUENT COUGH
5. PRESENCE OF RONCHI
6. SHOWING INTERVALS OF RELATIVE/ COMPLETE FREEDOM FROM
SYMPTOMS.
7. REPORTS OF ONSET OF ASTHMATIC BOUTS AT AN EARLY AGE
8. WITH PERSONAL HISTORY OF ATOPIC DISEASES SUCH AS INFANTILE
ECZEMA, HAY FEVER AND OR URTICARIA
9. HAVING FAMILY HISTORY OF ATOPY (BRONCHIAL ASTHMA / ECZEMA /
RHINITIS / URTICARIA)
10.REPORT OF DEFINITE HISTORY OF ALLERGY TO INHALANT ALLERGEN,
PARTICULARLY TO HOUSE DUST.

THE FOLLOWING LABORATORY INVESTIGATIONS WERE CARRIED OUT TO

PRECLUDE THE POSSIBILITY OF PRESENCE OF ANY ASSOCIATED SYSTEMIC
/ ORGANIC DISORDERS OTHER THAN BRONCHIAL ASTHMA.

• THE SPIROMETER WAS USED TO MEASURE THE PEAK EXPIRATORY

FLOW RATE (PEFR) TO CONFIRM THE NATURE AND EXTENT OF
REVERSIBILITY OF BRONCHIAL SPASM. (20% IMPROVEMENT IN PEFR
AFTER 20 MINS, OF AEROSOL INHALATION IS INDICATIVE OF
REVERSIBLE OBSTRUCTIVE AIRWAY DISEASE (ROAD) - BRONCHIAL
ASTHMA.
• A COMPLETE RECORD OF THE PATIENTS' PHYSICAL AND CLINICAL
CONDITION WAS ALSO MAINTAINED.
• STOOL EXAMINATION FOR THREE CONSECUTIVE DAYS WAS DONE
FOR INDIVIDUAL PATIENTS TO EXCLUDE TIRE PRESENCE OF ANY
PARASITIC INFESTATIONS BY FLOTATION TECHNIQUE TO EXCLUDE
THEIR POSSIBLE INTERFERENCE IN THE IGE LEVEL OF PATIENTS'
SERA.
SELECTION OF CONTROL SUBJECT:

FIFTY HEALTHY PERSONS (25 MALE AND 25 FEMALE) BELONGING TO THE

SAME AGE GROUP AS PATIENTS WITH NO PERSONAL AND / OR FAMILY HISTORY

OF ATOPY AND WITHOUT ANY HISTORY OF SENSITIVITY TOWARDS DUST

INHALATION WERE SELECTED TO SERVE AS CONTROL SUBJECTS. STOOL

EXAMINATION OF ALL THE CONTROL SUBJECTS WERE ALSO DONE.

ALLERGY SKIN TEST TO ASSESS IMMEDIATE HYPERSENSITIVITY RESPONSE:

ALLERGY SKIN PRICK TEST (SPT) WAS CARRIED OUT BY CONVENTIONAL

METHOD OF GISLASON ET AL, (1999). STANDARD ALLERGEN EXTRACTS WERE

PROVIDED BY CREDISOL INDIA LIMITED. PRICK TEST SOLUTION ARE

GLYCERINATED AQUEOUS ALLERGEN EXTRACTS PREPARED AFTER THE METHOD

OF COCA (1922). THESE SOLUTIONS ARE STANDARDIZED IN TERMS OF PROTEIN

NITROGEN UNIT (PNU) PER ML. THE EXTRACTS CONTAIN 50% GLYCEROL AND

ARE PRESERVED IN 0.4% PHENOL. HISTAMINE ACID PHOSPHATE WAS USED AS

POSITIVE CONTROL AND GLYCEROSALINE AS NEGATIVE CONTROL

RESPECTIVELY. SINCE THE AIM OF THE PRESENT STUDY IS TO IDENTIFY THE

ALLERGENS RESPONSIBLE FOR CAUSATION OF VARIOUS ALLERGIC

MANIFESTATIONS IN PATIENTS' SENSITIVE TO DUST AND OTHER COMMON

INHALANTS AND INGESTANTS, THE FOLLOWING ALLERGENS WERE SELECTED

FOR PRIMARY SCREENING.

TABLE 22. ALLERGENS USED FOR PRIMARY SCREENING IN THE PRESENT STUDY.

POLLENS MOLDS OTHER ALLERGENS

COCOS NUCIFERA ASPERGILLUS NIGER COTTON
BRASSICA NIGRA ASPERGILLUS FUMIGATUS KAPOK
DELONIX SP. CANDIDA ALBICANS DOG DANDER
AZADIRACHTA
INDICA CLADOSPORIUN SP. CAT DANDER
CAESALPINIA SP. ALTERNARIA ALTERNATE HOUSE DUST
DERMATOPHAGOIDES
 PTERONYSSINUS

DERMATOPHAGOIDESFARINAE

BLOMIA TROPICALIS
 CONCLUSION

ALLERGY SKIN TEST PROCEDURE:

SKIN PRICK TEST WERE APPLIED ON THE FLEXOR SIDE OF

FOREARMS. BEFORE THE TEST PERFORMING, BOTH ARMS OF THE SUBJECT
WERE THOROUGHLY CLEANED WITH WATER AND DRIED IN AIR. ONE
SMALL DROP OF THE TEST SOLUTION WAS APPLIED ON THE FLEXOR SIDE
OF THE ARM. THE TEST SIDE WAS APPROXIMATELY 4CM. APART FROM
EACH OTHER. A PRE-STERILE LANCET WAS INSERTED THROUGH THE SKIN
INSIDE THE DROP OF EXTRACT AT A 90° ANGLE AND LIFTED SLIGHTLY. THE
SAME PROCESS WAS REPEATED FOR EACH TEST SOLUTION. THE LANCET
WAS WIPED CAREFULLY BY MEANS OF COTTON WOOL PRIOR TO ITS USE
FOR NEXT SOLUTION. ANY EXCESS SOLUTION REMAINING ON THE SKIN
AFTER PRICKING WAS REMOVED WITH THE HELP OF A TISSUE PAPER. THE
WHEAL SIZE WAS RECORDED 20 MINUTES AFTER APPLICATION OF THE
ANTIGENS BY CIRCLING THE REACTION WITH A RED COLORED PEN AND
TRANSFERRED IT TO A TEST FORM WITH THE ADHESIVE TAPE. THE WHEAL
DIAMETER WAS CALCULATED ALONG THE MEAN OF THE WIDEST
DIAMETER AND THE PERPENDICULAR DIAMETER WAS MEASURED AT ITS
MIDPOINT AND GRADED AS 1+, 2+- 3+, 4+AS COMPARED TO POSITIVE
CONTROL.

INTERPRETATION OF TEST RESULTS:

THE SKIN PRICK TEST METHOD MAY VARY FROM WORKERS TO

WORKERS AND FROM LABORATORY TO LABORATORY AND HENCE IT HAS
NOT ALWAYS BEEN POSSIBLE TO COMPARE THE RESULTS OBTAINED. IN
THE PRESENT STUDY, THE INTERPRETATION OF RESULTS WAS DONE ON
THE BASIS OF COMPARISON OF REACTION AGAINST A NEGATIVE (-) OR A
POSITIVE (+) REFERENCE AS SUGGESTED BY AAS AND BELIN (1972) AND
GRADED FOLLOWING THE METHOD SUGGESTED BY AMERICAN COLLEGE
OF ALLERGISTS (GRATER ET AL.,1982), WHICH IS DETAILED BELOW.
- NO WHEAL OR A WHEAL NOT LARGER IN SIZE THAN THAT PRODUCED AT THE
NEGATIVE CONTROL SITE.
1» WHEAL SLIGHTLY LARGER THAN NEGATIVE CONTROL, AREA OF ERYTHEMA
SIGNIFICANTLY LARGER THAN THAT OF NEGATIVE CONTROL.
2+ WHEAL 5-7 MM., ERYTHEMA LARGER THAN 1+ REACTIONS BUT LESS THAN POSITIVE
CONTROL SITE.
3+ WHEAL 7-10 MM., REACTION EQUAL OR NEARLY EQUAL TO THAT PRODUCED BY
HISTAMINE AT THE POSITIVE CONTROL SITE.
4+ ANY REACTION WITH WHEAL AND ERYTHEMA LARGER THAN POSITIVE
CONTROL, PSEUDOPODIA AND ITCHING LIKELY TO OCCUR.
 FIG. 23. SKIN PRICK TEST AGAINST HD, DP. DF AND BT ALLERGENS

PRECAUTIONS:

• THE PATIENTS WERE INSTRUCTED TO REFRAIN FROM TAKING ANY

ANTIHISTAMINES FOR AT LEAST SEVENTY TWO HOURS BEFORE THE
TEST TO AVOID POSSIBLE INTERFERENCE OF THE STUDY.
• AN EMERGENCY KITS MUST BE KEPT READY AT ALL TIMES.
A TOTAL OF 682 PATIENTS' REPORTED TO SUFFER FROM DIFFERENT
NASOBRONCHIAL ALLERGIC MANIFESTATION BETWEEN THE AGE GROUP
MENTIONED EARLIER WERE SELECTED FROM ALLERGY AND ASTHMA
RESEARCH CENTER AND OTHER PRIVATE CLINICS OF KOLKATA
METROPOLIS FOLLOWING THE CRITERION DESCRIBED EARLIER. OUT OF
THE 682 PATIENTS, THE STUDY GROUP COMPRISED OF 394 MALES AND 288
FEMALES WITH THE HISTORY OF DIFFERENT ALLERGIC SYMPTOMS. ALL
THE PATIENTS AND CONTROL SUBJECTS WERE SUBJECTED TO
CONVENTIONAL SKIN PRICK TEST AGAINST 14 INHALANTS AS MENTIONED
EARLIER. THE POLLENS WERE SELECTED FOR THE PRESENT STUDY
FOLLOWING THE POLLEN CALENDARS OF KOLKATA PREPARED BY CHANDA
(1994). ALL STATISTICAL ANALYSIS WERE CARRIED OUT FOLLOWING ZAR
(1999) AND SPSS VER. 10 SOFTWARE (KINNEAR AND GRAY, 2000).

PROCEDURE FOR MEASUREMENT OF TOTAL SERUM IGE BY ENZYME IMMUNO ASSAY:

SERUM SAMPLES WERE COLLECTED FROM 337 BRONCHIAL ASTHMA

PATIENTS FOR MEASUREMENT OF TOTAL SERUM IGE AND DETECTION OF
ALLERGEN SPECIFIC IGE ANTIBODIES AGAINST HD, DP, DF AND BT
ALLERGEN. A HIGH TOTAL IGE WAS DEFINED AS A TOTAL IGE VALUE IN THE
HIGHEST QUARTILE OF THE POPULATION UNDER STUDY. TOTAL SERUM IGE
IN HUMAN WAS MEASURED BY USING EIA
TECHNIQUE USING CHEMICALS - PATHOZYME IMMUNOGLOBULIN (REF: OD 417)

SUPPLIED BY GLAXO SMITHKLINE PHARMACEUTICALS LTD., MUMBAI.

SPECIFIC MONOCLONAL ANTI IGE ANTIBODIES ARE COATED ON TO

MICROTITRATION WELLS. TEST SERA WERE SUPPLIED AND INCUBATED WITH

ZERO BUFFER. IF HUMAN IGE IS PRESENT IN THE SAMPLE, IT WILL COMBINE

WITH THE ANTIBODY ON THE WELL. THE WELL WAS THEN WASHED TO REMOVE

ANY RESIDUAL TEST SPECIMEN AND THEN IGE ANTIBODY, LABELED WITH

HORSERADISH PEROXIDASE ENZYME (CONJUGATE) IS ADDED. THIS RESULTS IN

THE IGE MOLECULES BEING 'SANDWICHED' BETWEEN THE SOLID PHASE AND

THE ENZYME LINKED ANTIBODIES ON ADDITION OF THE SUBSTRATE

TETRAMETHYL BENZIDINE (TMB). A COLOR WAS DEVELOPED ONLY IN THOSE

WELLS IN WHICH ENZYME CONJUGATE WAS PRESENT, INDICATING THE

PRESENCE OF IGE. THE ENZYME REACTION WAS STOPPED BY THE ADDITION OF

DILUTE HYDROCHLORIC ACID (HCL) AND ABSORBANCE WAS THEN MEASURED

AT 450NM WITH THE HELP OF ELISA READER. THE CONCENTRATION OF IGE IS

DIRECTLY PROPORTIONAL TO THE COLOR INTENSITY OF THE TEST. THE ASSAY

WAS CALIBRATED AGAINST THE WHO STANDARD FOR IGE. TOTAL IGE

CONCENTRATION DIFFERS IN DIFFERENT AGE GROUPS, 0-4 DAYS <1.5 IU/ML, 5-12

MONTHS < 15 IU/ ML, 1-5 YEARS < 60 IU/ML, 6- 9 YEARS < 90,10-16 YEARS < 200 IU/

ML AND 16+ YEARS < 100 IU/ ML.

PROCEDURE FOR DETECTION OF ALLERGEN SPECIFIC IGE ANTIBODIES BY PHARMACIA

IMMUNO CAP 100 SYSTEM:

SPECIFIC IGE WERE MEASURED USING PHARMACIA IMMUNO CAP 100

SYSTEM. THE CAP WAS PERFORMED IN COLLABORATION WITH PHARMACIA

AUTHORIZED METROPOLIS LABORATORY, MUMBAI, INDIA. THE SPECIFIC

ALLERGEN OF INTEREST, COVALENTLY COUPLED TO IMMUNO CAP WITH THE

SPECIFIC IGE IN THE PATIENT'S SAMPLE. AFTER WASHING AWAY NON-SPECIFIC

IGE, ENZYME LABELED ANTIBODIES AGAINST IGE WERE ADDED TO FORM A

COMPLEX. AFTER INCUBATION, UNBOUND ENZYME ANTI- IGE WAS WASHED

AWAY AND THE BOUND COMPLEX WAS THEN INCUBATED WITH A DEVELOPING

AGENT. AFTER STOPPING THE REACTION, THE FLUORESCENCE OF ELUTE WAS

MEASURED BY UNICAP FULLY INTEGRATED AND AUTOMATED ANALYSER. THE

FLUORESCENCE IS DIRECTLY PROPORTIONAL TO THE CONCENTRATION OF

SPECIFIC IGE PRESENT IN THE SAMPLE. TO EVALUATE THE TEST

RESULTS, THE RESPONSE UNITS FOR PATIENT SAMPLES WERE COMPARED

DIRECTLY TO THE RESPONSE FOR THE CALIBRATORS. THE ASSAY WAS

CALIBRATED AGAINST THE WHO STANDARD FOR IGE WITH A RANGE OF 0.35-

100KU/L FOR SPECIFIC IGE. SPECIFIC IGE WAS MEASURED AGAINST THE HOUSE

DUST AND THREE HOUSE DUST MITES (DERMATOPHAGOID.ES PTERONYSSINUS, D.

FARINAE AND BLOMIA TROPICALIS). A SPECIFIC IGE LEVEL OF 0.35- 0.70 KU/L WAS

DEFINED AS CLASS I, 0.70- 3.5 KU/L AS CLASS II, 3.5-17.5 KU/L AS CLASS III, 17.5- 50

KU/L AS CLASS IV AND > 100 KU/L AS CLASS V.

RESULTS:
COMPARISON IN MITE DENSITY BETWEEN PATIENTS AND CONTROL HOUSES:

FOR THIS STUDY THE DUST SAMPLES WERE COLLECTED FROM BED AND

CORRESPONDING BED ROOM FLOOR DUSTS OF 123 PATIENTS' AND 40 CONTROL

HOUSES. THE DUST SAMPLES WERE PROCESSED IN THE SAME FASHION AS

MENTIONED EARLIER. THE DATA OBTAINED FROM BED AND BED-ROOM FLOOR

DUSTS WERE POLLED TOGETHER. TO INVESTIGATE THE DIFFERENCES IN MITE

DENSITY BETWEEN PATIENTS AND CONTROL HOUSES, PAIRED SAMPLE T-TEST

WITH UNEQUAL VARIANCE WAS PERFORMED. RESULTS REVEALED THAT ALMOST

ALL THE DUST SAMPLES WERE POSITIVE FOR THE PRESENCE OF ACARINE

FAUNA. THE ALLERGENIC MITES NAMELY DERMATOPHAGOIDES PTERONYSSINUS,

D. FARINAE AND BLOMIA TROPICALIS WERE ISOLATED FROM THE DUSTS. THE

AVERAGE NUMBER OF ALL MITES PER GRAM OF DUSTS IN PATIENTS AND

CONTROL HOUSES WERE 385 ± 43.33 AND 54 ± 10.45 RESPECTIVELY. THE DENSITY

OF THREE MITE SPECIES OF INTEREST NAMELY DP, DF AND BT IN BOTH PATIENTS

AND CONTROL SUBJECTS WERE 164.84 ± 40.49 AND 17.75 ± 7.30; 76.01 ± 17.81 AND

9.45 ± 4.47; 77.95 ± 17.33 AND 12.47 ± 6.41 RESPECTIVELY (TABLE 23). THE

STATISTICAL ANALYSIS REVEALED THAT THE DIFFERENCE IN MITE DENSITIES

BETWEEN PATIENTS' AND CONTROL SUBJECTS WERE HIGHLY SIGNIFICANT. (P<

0.0005, TABLE 24). THIS PHYSICAL APPEARANCE OF MITES IN LARGE QUANTITY IN

PATIENTS' ENVIRONMENT TEMPTED US TO SEARCH FOR AN ALLERGIC ETIOLOGY

TOWARDS THESE MITE SPECIES.

 CONCLUSION

TABLE 23. DISTRIBUTION AND DENSITY OF TMC, DP, DF AND BT MITES IN PATIENTS AND
CONTROL HOUSES (NO. OF

MITES/GM OF DUST:

SOURCE TMC DP DF BT

PATIENTS 385 ±43.33 164.84140.49 76.01 ±17.81 77.95117.33

(N= 123)

CONTROL 54110.45 17.7517.3 9.4514.47 12.4716.41

(N= 40)

TMC =TOTAL MITE COUNT; DP = D. PTERONYSSINUS; DF = D.FARINAE AND BT =

BLOMIA TROPICALIS

TABLE 24. STATISTICAL ANALYSIS OF MITE DENSITIES IN PATIENTS AND CONTROL HOUSES

COMPARING GROUP DF T - VALUE REMARK

TMC-PT. VS. TMC-CN. 161 78.16 P< 0.0005

DP-PT. VS. DP-CN. 161 38.41 P< 0.0005

DF-PT. VS. DF-CN. 161 37.92 P< 0.0005

BT-PT. VS. BT-CN. 161 35.13 P< 0.0005

RESPONSE TO POLLENS, MOULDS AND OTHER ALLERGENS:

RESULTS:
RESULTS OF SKIN TEST AMONG 682 PATIENTS' AGAINST 14 DIFFERENT
INHALANTS TESTED REVEALED THAT ALMOST ALL THE PATIENTS SHOWED
SENSITIVITY TO AT LEAST ONE OF THE 14 ALLERGENS TESTED. THE
HIGHER DEGREE OF SENSITIVITY WERE OBSERVED TOWARDS COTTON
(86.07%) FOLLOWED BY KAPOK (78.88%) AND COCOS NUCIFERA (72.58%).
MODERATE RESPONSE WERE OBSERVED AGAINST POLLENS OF BRASSICA
NIGER (55.42%), DELONIX SP. (48.38%), AZADIRACHTA INDICA (43.25%) AND
CAESALPINIA SP. (40.02%) WHILE RESPONSE TO REMAINING ALLERGENS
WERE NOT ENCOURAGING AS SHOWN IN TABLE 25.
 CONCLUSION

TABLE 25. ALLERGIC RESPONSE TO COMMON INHALANTS (POLLENS, MOULDS & OTHERS

AMONG NASOBRONCHIAL ALLERGIC PATIENTS OF KOLKATA, N = 682).

NO. OF PATIENTS % OF PATIENTS

ALLERGENS POSITIVE POSITIVE
POLLENS
COCOS NUCIFERA 495 72.58
BRASSICA NIGRA 378 55.42
DELONIX SP. 330 48.38
AZADIRACHTA INDICA 295 4325
CAESALPINIA SP 237 40.02
MOULDS
ASPERGILLUS FUMIGATUS 152 2228
A- NIGER 125 18.32
CANDIDA ALBICANS 105 1539
CLADOSPORIUM SP. 79 11.58
ALTEMARIA ALTERNATE 28 4.1
OTHERS
DOG DANDER 63 923
CAT DANDER 39 5.71
KAPOK 538 78.88
COTTON 587 86.07

INCIDENCE OF ALLERGIC RESPONSE TO HOUSE DUST AND HOUSE DUST MITES

(DERMATOPHAGOIDES PTERONYSSINUS, D.FARINAE AND BLOMIA TROPICALIS):

A TOTAL OF 1079 (INCLUDING 682 PATIENTS) PATIENTS' FIFTY CONTROL

SUBJECTS WERE SELECTED ON THE BASIS OF CRITERIA MENTIONED EARLIER.

THIS STUDY GROUP COMPRISED OF 585 MALE AND 494 FEMALES WITH THE

HISTORY OF DIFFERENT ALLERGIC SYMPTOMS.

 CONCLUSION

RESULTS OF SKIN TESTS AGAINST TOTAL HOUSE DUST AND SELECTED

HOUSE DUST MITES (DP, DF AND BT) TO 1079 SELECTED PATIENTS REVEALED

THAT 1035 (96.22%) PATIENTS' SHOWED SENSITIVITY TOWARDS HOUSE DUST.

SINCE HOUSE DUST IS A COMPLEX HETEROGENEOUS MIXTURE OF SUBSTANCES

OF BOTH PLANT AND ANIMAL ORIGIN, HIGH DEGREE OF SENSITIVITY TOWARDS

HOUSE DUST IS NOT UNCOMMON. IN CASE OF PYROGLYPHID MITES THE

SENSITIVITY WAS HIGHEST TOWARDS D. PTERONYSSINUS (75.06%) THAN

D.FARINAE (63.72%). INTERESTINGLY, THE OTHER MITE BLOMIA TROPICALIS IS

RESPONSIBLE FOR CAUSING 72% ALLERGY TO KOLKATA POPULATION.

HOWEVER, THERE IS NO PUBLISHED WORK REGARDING THE ALLERGENIC

POTENTIALITY OF B. TROPICALIS FROM INDIA (TABLE 26).

TABLE 26. SKIN TEST SENSITIVITY TOWARDS HOUSE DUST AND SELECTED HOUSE DUST MITE
ALLERGENS (DP, DF AND BT)
AMONG KOLKATA
PATIENTS'.
NO. OF POSITIVE % OF POSITIVE
ALLERGEN NAME PATIENTS PATIENTS

HOUSE DUST 1035 96.22

DERMATOPHAGOIDES
PTERONYSSINUS 809 75.06

D.FARINAE 688 63.72

BLOMIA TROPICALIS 778 72.00

INTENSITY OF SKIN REACTIONS TOWARDS HOUSE DUST AND HOUSE DUST MITES:

THE INTENSITY OF SKIN REACTION AGAINST FOUR ALLERGENS (HOUSE

DUST AND THREE SPECIES OF MITES) TESTED VARIED BETWEEN 1+ TO 4+.

RESULTS REVEALED THAT IN CASE OF 1035 HOUSE DUST SENSITIVE PATIENTS, 356

(34.39%) GAVE 1+, 315 (30.43%) 2% 251 (24.25%) 3+ AND 113 (10.91%) 4+ REACTION. IN

CASE OF DP MITE, OUT OF THE 809 PATIENTS WITH POSITIVE REACTION TO THIS

ALLERGEN, 240(29.70%), 265 (32.71%), 197 (24.32%) AND 107 (13.01%) GAVE 1+, 2+, 3+,

4+ REACTION RESPECTIVELY (TABLE 27). RESULTS OF INTENSITY OF SKIN

REACTION TOWARDS DF SHOWED THAT AMONG 688 PATIENTS GIVING POSITIVE

REACTION TO THIS ALLERGEN EXTRACT, 177 (25.76%) SHOWED 1+, 223 (32.45%) 2 +,

175 (25.47%) 3 + AND 113 (16.56%) 4 + REACTIONS. OUT OF THE 778. PATIENTS WITH

POSITIVE REACTION TO BT EXTRACT, 179 (23.03%), 226 (29.08%), 229 (29.76%) AND

144 (18.53%) RESPECTIVELY GAVE 1+, 2+, 3+ AND 4+ REACTION (FIG. 24).
TABLE 27. INTENSITY OF SKIN REACTION TOWARDS HOUSE DUST AND MITES AMONG ASTHMATIC
PATIENTS OF KOLKATA

ALLERGEN NO. AND PERCENTAGE (%) OF PATIENTS WITH DIFFERENT SKIN

NAME TEST INTENSITY
1* 2* 3* 4*

HD 356 (34.39%) 315 (30.43%) 251 (24.25%) 113(10.91%)

DP 240 (29.70%) 265 (32.71%) 197 (24.32%) 107 (13.01%)

DF 177 (25.76%) 223 (32.45%) 175 (25.47%) 113 (16.56%)

BT 179 (23.03%) 226 (29.08%) 229 (29.16%) 144 (18.53%)

FIG. 24. HISTOGRAM SHOWING PERCENTAGE AND INTENSITY OF SKIN REACTION TOWARDS HD,

DP, DF AND BT ALLERGENS AMONG KOLKATA POPULATION.

 CONCLUSION

CROSS REACTIVITY BETWEEN HD, DP, DF AND BT ALLERGENS

TO ENUMERATE THE DEGREE OF CROSS-REACTIVITY AMONG HOUSE DUST

AND THREE SPECIES OF IMPORTANT ALLERGENIC MITES APPROPRIATE DATA

WERE PROPERLY ARRANGED AND SUBJECTED TO RELEVANT STATISTICAL

ANALYSIS.

ON ANALYZING SKIN TEST RESULTS AGAINST HD, DP, DF AND BT EXTRACTS IN

1079 FINALLY SELECTED INDIVIDUALS OF OUR STUDY GROUP, 1035 (96.22%)

SHOWED POSITIVE REACTION TO AT LEAST ONE OF THE FOUR ALLERGENS

TESTED OF WHICH 431(41.67%) RESPONDED TO ALL OF THE FOUR ALLERGENS,

223(21.57%) TO AT LEAST THREE THOUGH IN DIFFERENT COMBINATIONS

229(22.1%) TO AT LEAST TWO (IN DIFFERENT COMBINATIONS) AND 152 (14.73%) TO

ONE ALLERGEN ONLY ((TABLE 28).

AMONG 229 PATIENTS WHO REACTED TO AT LEAST TWO OF THE FOUR

ALLERGENS TESTED, 98 (42.85%) WERE POSITIVE TO HD+DP, 33 (14.28%) POSITIVE

TO HD+DF, 49 (21.42%) TO HD+BT, 22 (9.52%) TO DP+DF, 3(4.7%) TO BT+DP AND 6

(7.14%) TO BT+DF ALLERGEN TOGETHER (TABLE 28),.

OUT OF 223 PATIENTS WITH THREE ALLERGEN SENSITIVITY, 60 (26.82%)

RESPONDED TO HD+DP+DF, 147(65.85%) TO HD+DP+BT, 11(4.76%) TO HD+DF+BT
AND ONLY 5 (2.43%) TO DP+DF+BT ALLERGEN TOGETHER (TABLE 28).
AMONG 152 PATIENTS WHO REACTED WITH SINGLE ALLERGEN
SENSITIVITY, 114 (75%) RESPONDED TO HD, 11 (7.14%) TO DP, 5 (3.57%) TO DF AND
22 (14.28%) TO BT EXTRACT ONLY.
THE NUMBER AND PERCENTAGE OF PATIENTS RESPONDING POSITIVELY TO

THE ABOVE FOUR ALLERGENS EITHER SINGLY OR IN DIFFERENT COMBINATIONS

WAS 431 (41.67%).

 CONCLUSION

TABLE 28. CROSS REACTIVITY BETWEEN HD, DP, DF & BT ALLERGENS (N = 1079) AMONG
PATIENTS OF
KOLKATA
ALL FOUR
ONE ALLERGEN TWO ALLERGEN THREE ALLERGEN ALLERGEN

HD-114 (75%) HD+DP-98 (42.85%) HD+DP+DF= 60 (26.82%)

DP-11 (7.14%) HD+DF-33 (14.28%) HD+DP+BT= 147 (65.85%)

DF- 5 (3.57%) HD+BT-49 (21.42%) HD+DF+BT= 11 (4.76%)

BT-22 (14.28%) DP+DF- 22 (9.52%) DP+DF+BT= 5 (2.43%)

BT+DP-11 (4.76%)

BT+DF-16 (7.14%)
152 (14.73%) 229 (22.10%) 223 (21.57%) 431 (41.67%)

POSITIVE TO AT LEAST ONE ALLERGEN = 1035 (96.22%).

COMPARISON OF SKIN TEST RESPONSE BETWEEN HOUSE DUST AND MITE ALLERGENS:

THE COMPARATIVE RESULT OF SKIN PRICK TEST WITH HOUSE DUST AND HOUSE

DUST MITE ALLERGENS (DP, DF AND BT BEING CONSIDERED AS ONE) IN 1079

NASOBRONCHIAL ALLERGIC PATIENTS' ARE SHOWN IN (TABLE 29). OUT OF 1079

PATIENTS, 817 (75.75%) SHOWED POSITIVE SKIN REACTIONS TO BOTH THE

ANTIGENS, 140 (13.05%) RESPONDED POSITIVELY TO HOUSE DUST AND ONLY 10

(0.93%) TO MITES (EITHER DP, DF OR BT), 80(7.42%) PATIENTS', HOWEVER, DID NOT

RESPOND EITHER TO HOUSE DUST OR ANY OF THE MITE ANTIGEN. THE RESULT

INDICATES THAT THE MAIN ALLERGEN IN HOUSE DUST IS PROBABLY HOUSE

DUST MITES.

TABLE 29. COMPARISON OF SKIN TEST RESPONSE BETWEEN HOUSE DUST AND HOUSE DUST
MITES
PERCENT
HOUSE DUST MITES TOTAL AGE
+ + 817 75.75
+ - 140 13.05
— + 10 0.93
80 7.42
 CONCLUSION

SKIN TEST REACTIVITY TO HD, DP, DF AND BT ALLERGEN IN MALE (N= 585) AND FEMALE
(N=494) PATIENTS':

THE RESULT OF SKIN PRICK TEST ON BEING ANALYZED IN RELATION TO

TWO SEXES REVEALED THAT THE FREQUENCY OF POSITIVE SKIN REACTIONS

FOR EACH OF THE FOUR ALLERGENS TESTED DID NOT DIFFER

SIGNIFICANTLY( P>0.05) BETWEEN MALE AND FEMALE PATIENTS AS SHOWN IN

(TABLE 30).

TABLE 30. RESULTS OF SKIN TEST BETWEEN MALE (N= 585) AND FEMALE (N = 494) PATIENTS
AGAINST HOUSE DUST AND HOUSE DUST MITES

ALLERGENS MALE (N = 585) FEMALE IN = 494) REMARKS

HD 561 (96%) 484 (98%) P>0.05 (NS)

DP 421 (72%) 361 (73%) P>0.05 (NS)

DF 374 (64%) 376 (64%) P>0.05 (NS)
BT 421 (72%) 346 (70%) P>0.05 (NS)

NS = NOT SIGNIFICANT

SKIN PRICK TEST OF DIFFERENT AGE GROUP AGAINST FOUR ALLERGENS (HOUSE DUST AND
HOUSE DUST MITES):

FOR THIS PURPOSE ALL THE PATIENTS' (N=1079) WERE CATEGORIZED INTO

THREE DIFFERENT AGE GROUPS VIZ. GR. A. (UP TO 15 YRS.), GR. B. (16-40 YRS)

AND GR. C. (ABOVE 40 YRS.) THE SENSITIVITY OF PATIENTS BELONGING TO

DIFFERENT AGE GROUPS AGAINST FOUR DIFFERENT ALLERGENS TESTED ARE

TABULATED IN (TABLE 31). PAIRED T-TEST WAS DONE TO INVESTIGATE THE

DIFFERENCE OF SENSITIVITY TOWARDS DIFFERENT ALLERGENS AMONG

DIFFERENT AGE GROUPS WERE SIGNIFICANT OR NOT. DETAILED STATISTICAL

ANALYSIS REVEALED THAT THE FREQUENCY OF POSITIVE SKIN RESPONSE TO

DIFFERENT ALLERGENS TESTED WERE NOT AGE DEPENDENT (TABLE 31).

 CONCLUSION

TABLE 31. FREQUENCY OF POSITIVE SKIN RESPONSE AGAINST HD, DP, DF AND BT AMONG

PATIENTS OF DIFFERENT AGE GROUPS.

REMAR
AGE GROUP DP DF BT HD COMPARING KS
GROUPS

GR. A 83 77 78 109 GR. A VS.GR. B P > 0.05

(N=LLL) (75%) (70%) (70%) (98.46%)

GR.B. 680 498 603 741 GR.A VS. GR.C P > 0.05

(N=769) (88.48%) (64.74%) (78.41%) (96.35%)

GR.C. 105 88 99 151 GR.B VS. GR.C P > 0.05

(N=155) (67.85%) (57.14%) (64.28%) (97.67%)

GR. A= BELOW 15 YRS; GR.B = 16 -40 YRS.; GR.C = ABOVE 40 YRS.

TOTAL SERUM IGE LEVEL AMONG PATIENTS' AND CONTROL SUBJECTS:

FOR THIS PURPOSE, AMONG 1079 PATIENTS, 337 PATIENTS' WERE SELECTED

WHO ARE SUFFERING FROM DIFFERENT NASOBRONCHIAL ALLERGIC DISORDERS

AND ALSO SHOWED POSITIVE REACTION TO SKIN PRICK TEST AGAINST FOUR

ALLERGENS NAMELY HOUSE DUST, DERMATOPHAGOIDES PTERONYSSINUS,

D.FARINAE AND BLOMIA TROPICALIS MITE SPECIES. PAIRED SAMPLE T- TEST WAS

DONE TO INVESTIGATE THE DIFFERENCES, IF ANY, IN MEAN IGE VALUE BETWEEN

THE PATIENTS AND CONTROL SERA. THE TOTAL SERUM IGE LEVELS IN 337

ASTHMATIC PATIENTS AND 50 CONTROL SUBJECTS OF THIS STUDY GROUP

VARIED FROM 7.3- 4040 IU/ ML (MEAN 368.67 ± 26.51) AND 15-120 IU/ ML (MEAN 56 ±

34) RESPECTIVELY (TABLE 32) AND THE RESULT SHOWED THAT THE DIFFERENCE

BETWEEN THE TWO MEAN VALUES WAS STATISTICALLY SIGNIFICANT (P < 0.05).

ONLY 6.5% PATIENTS OF OUR STUDY GROUP HAD NORMAL SERUM IGE LEVEL

WITHIN NORMAL LIMIT, WHILE REMAINING 93.5% PATIENTS SHOWED ELEVATED

SERUM IGE LEVEL (300 IU/ML).

TABLE 32. TOTAL SERUM IGE LEVEL IN PATIENTS AND CONTROL SUBJECTS
RESIDING IN KOLKATA.
REMA
STUDY GROUP RANGE OF IGE IU/ML MEAN IGE IU/ML T- VALUE RK
PATIENTS (N=
337) 7.3-4040 368.67 ± 26.51
1.499 P < 0.05

CONTROL (N=50) 15-120 56±34

COMPARISON OF TOTAL SERUM IGE LEVEL AMONG DIFFERENT AGE GROUPS:

FOR THIS STUDY THE PATIENTS AND CONTROL SUBJECTS WERE

CATEGORIZED INTO THREE AGE GROUP AS MENTIONED EARLIER. THE RESULTS

REVEALED THAT THE LOWER AND UPPER LIMIT OF TOTAL SERUM IGE LEVEL IN

55 (16.32%) PATIENTS BELOW 15 YEARS OF AGE WERE 7.3 IU/ ML AND 1799 IU/ ML.

RESPECTIVELY AND THE MEAN VALUE WAS 415.47 ± 64.39 IU/ ML. IN THE MIDDLE

AGE GROUP I.E. 15- 40 YEARS (N = 92, 27.20%), THE TOTAL SERUM IGE LEVEL

VARIED BETWEEN 36 IU/ ML AND 4040 IU/ ML RESPECTIVELY (MEAN 424.47± 65.88

IU/ ML.). SERUM IGE LEVELS OF 190 (56.37%) PATIENTS BELONGING TO AGE

GROUP OF ABOVE 40 YEARS, RANGED BETWEEN 26- 2538 IU/ML (MEAN 315.64±

35.44 IU/ ML) AS SHOWN IN (TABLE 33).

STATISTICAL ANALYSIS (T-TEST WITH UNEQUAL VARIANCE) REVEALED THAT

THE MEAN IGE VALUE OF PATIENTS IN THE DIFFERENT AGE GROUP WERE NOT

STATISTICALLY SIGNIFICANT (TABLE 34). THOUGH THE MEAN IGE VALUE IN THE

MIDDLE AGE GROUP I.E. 16-40 YEARS WAS APPARENTLY HIGHER IN COMPARISON

TO OTHER TWO GROUPS OF PATIENTS. THE TABLE VALUE OF STATISTICAL

ANALYSIS IS GIVEN IN (TABLE 34).

TABLE 33. TOTAL SERUM IGE LEVEL IN DIFFERENT AGE GROUP OF

PATIENTS

AGE OF PATIENTS NO. OF PATIENTS RANGE OF IGE MEAN IGE

IU/ML IU/ML

BELOW 15 YEARS 55 (16.32%) 7.3-1799 415.47+64.39

16- 40 YEARS 92 (27.29%) 36-4040 424.47±65.88

ABOVE 40 YEARS 190(56.37%) 26-2538 315.64± 35.44

 CONCLUSION

TABLE 34. STATISTICAL ANALYSIS ON TOTAL SERUM IGE LEVEL IN DIFFERENT AGE GROUP OF
PATIENTS'.

AGE GROUP T-VALUES DF REMARK

GR. A. VS.GR. 13. 0.278 138 P>0.05

GR. A. VS. GR. C. 1.0087 73 P > 0.05

GR. B. VS. GR. C. 1.334 127 P > 0.05

COMPARISON OF TOTAL SERUM IGE LEVEL AMONG TWO SEXES:

TO EVALUATE THE DIFFERENCE OF MEAN IGE VALUE BETWEEN THE TWO

DIFFERENT SEXES, T-TEST WITH UNEQUAL VARIANCE WAS DONE. RESULTS

REVEALED THAT THE TOTAL SERUM IGE LEVELS IN 175 (51.92%) MALE PATIENTS

RANGED FROM 7.3 - 4040 IU/ ML (MEAN 383.74 ± 38.15 IU/ ML). IN CASE OF FEMALE

PATIENTS, THE CORRESPONDING VALUE WAS 23-2953 IU/ ML (MEAN 356 ± 36.73).

STATISTICAL ANALYSIS (T-TEST WITH UNEQUAL VARIANCE) WAS DONE (TABLE

35) TO FIND OUT THE VARIATION EXIST, IF ANY, IN MEAN TOTAL SERUM IGE

LEVEL IN BETWEEN TWO SEXES WHICH REVEALED THAT THE DIFFERENCE

BETWEEN THE TWO MEAN VALUES OF TOTAL SERUM IGE LEVEL WAS NOT

STATISTICALLY SIGNIFICANT (P > 0.05) AS DEPICTED IN (TABLE 35).

TABLE 35. VARIATION IN TOTAL SERUM IGE LEVEL IN RELATION TO SEX OF

PATIENTS'
REMARK
SEX RANGE OF IGE MEAN IGE T- VALUE S

IU/ ML IU/ ML

MALE 73-4040 383.74 ±38.15 0.3854 P>0.05

N=175 ( 51.92%) DF = 335

FEMALE 23-2953 356.07+36.73

N=162( 48.07%)
 CONCLUSION

DETECTION OF ALLERGEN SPECIFIC IGE ANTIBODIES:

FOR DETECTION OF SPECIFIC IGE ANTIBODIES AGAINST FOUR ALLERGENS

NAMELY HOUSE DUST, DERMATOPHAGOIDES PTERONYSSINUS, D. FARINAE AND

BLOMIA TROPICALIS MITES, 105 PATIENTS WERE SELECTED FINALLY WHO

SHOWED A HIGHER TOTAL IGE VALUES AND MAXIMUM REACTIVITY TOWARDS

THE ALLERGENS OF INTEREST BY SKIN PRICK TEST. THE ALLERGEN SPECIFIC IGE

WAS MEASURED FOLLOWING THE PROTOCOL AND CHEMICALS SUPPLIED BY

PHARMACIA IMMUNO CAP 100 SYSTEM. THE RESULTS WERE INTERPRETED IN

THE FOLLOWING WAY.

ANALYSIS OF PHARMACIA IMMUNO CAP RESULTS AGAINST FOUR

ALLERGENS OF INTEREST REVEALED THAT OUT OF 105 SERUM SAMPLES

TESTED, 89 (84.76%) SHOWED THE PRESENCE OF ALLERGEN SPECIFIC IGE

ANTIBODIES AGAINST AT LEAST ONE OF THE FOUR ALLERGENS TESTED, WHILE

16(15.23%) SAMPLES DID NOT SHOW ANY POSITIVE RESPONSE AGAINST ANY OF

THE FOUR ALLERGEN SPECIFIC IGE ANTIBODIES. AMONG POSITIVE SAMPLES, 71

(79.77%) HAD SPECIFIC IGE ANTIBODIES AGAINST HD ALLERGEN, 64 (71.91%)

AGAINST DP, 79 (88.76%) AGAINST DF AND 94 (90%) AGAINST BT ALLERGEN

(TABLE 36).

TABLE 36. ALLERGEN SPECIFIC IGE REACTIVITY AGAINST HD, DP, DF AND BT ALLERGENS
BY IMMUNO CAP 100
SYSTEM:

NO. & %
ALLERGENS NAME SENSITIVITY
HD 71 (79.77%)
DP 64 (71.91%)
DF 79 (88.76%)
BT 94 (90%)

PHARMACIA IMMUNO CAP SENSITIVITY IN RELATION TO PATIENTS' AGE:

 ANALYSIS OF IMMUNO CAP RESULTS AGAINST HD, DP, DF AND BT

ALLERGENS IN RELATION TO AGE OF PATIENTS, REVEALED THAT OUT OF 64

TESTS PERFORMED ON 16 PATIENTS IN THE AGE GROUP 15 YRS AND BELOW, 36

(56.25%) SHOWED POSITIVE IMMUNO CAP RESPONSE; OF THE 264 TESTS

PERFORMED ON 66 PATIENTS7 IN THE AGE GROUP 16 TO 40 YEARS, 187 (70.71%)

WERE IMMUNO CAP

 CONCLUSION

POSITIVE; WHILE IN THE REMAINING 23 PATIENTS IN THE AGE GROUP OF 40 AND

ABOVE, 92 TESTS WERE DONE OF WHICH 64 (69.56%) SHOWED POSITIVE

RESPONSE (TABLE 37).

STATISTICAL ANALYSIS (2X2 CONTINGENT X2 TEST) INDICATED THAT THE

FREQUENCY OF POSITIVE IMMUNO CAP RESPONSE TO DIFFERENT ALLERGENS

TESTED WERE NOT AGE DEPENDENT (P> 0.05), THOUGH THE FREQUENCY OF

IMMUNO CAP SENSITIVITY IN SUBJECTS AGED 21 YEARS AND ABOVE WAS

APPARENTLY HIGHER.

TABLE 37. FREQUENCY OF POSITIVE PHARMACIA IMMUNO CAP RESULTS AGAINST HD, DP,

DF AND BT IN PATIENTS OF DIFFERENT AGE GROUP:

TOTAL REMAR
AGE NO. OF PATIENTS TESTS NO. OF POSITIVE X2 VALUE K
TESTS

GR.A 16 64 36 (56.25%)

GR.B 66 264 187 ( 70.71%) 3.7967 P> 0.05

(D.F = 2)

GR.C 23 92 64 (69.60%)

GR.A = BELOW 15; GR.B = 16-40 YRS. AND GR.C = 40 ABOVE YRS.

IMMUNO CAP RESPONSE IN RELATION TO SEX OF PATIENTS:

ANALYSIS OF IMMUNO CAP 100 RESULTS IN RELATION TO TWO SEXES ('Z'

TEST) REVEALED THAT THE FREQUENCY OF TOTAL POSITIVE RESPONSE TO AT

LEAST ONE OF THE FOUR ALLERGENS TESTED AND AGAINST EACH OF THE

INDIVIDUAL ALLERGENS DID NOT DIFFER SIGNIFICANTLY BETWEEN THE TWO

SEXES (TABLE 38).

 CONCLUSION

TABLE 38. PREVALENCE OF IXNMUNO CAP SENSITIVITY AGAINST HD, DP, DF AND BT
ALLERGEN IN TWO SEXES.

ALLERGE NO. AND % POSITIVE REMAR

NS PATIENTS "Z" VALUE KS
MAL
E FEMALE
HD 47 (81.03%) 23 (74.19%) 1.285 P > 0.05

DP 41 (70.68%) 24 ( 77.41%) 0.060.2 P > 0.05

DF 53 (91.37%) 28 ( 90.32%) 1.003 P > 0.05

BT 59 (89.39%) 35 ( 89.74%) 1.007 P > 0.05

AT LEAST 58 (87.87%) 31 (79.48%) 1.156 P > 0.05

ONE

DISCUSSION:

A GRADUAL INCREASE IN THE INCIDENCE OF NASOBRONCHIAL ALLERGIC

DISORDERS AMONG THE POPULATION OF KOLKATA DURING THE LAST FEW

YEARS TEMPTED US TO IDENTIFY THE ETIOLOGIC AGENTS RESPONSIBLE FOR

ALLERGIC COMPLAINTS. THE SKIN PRICK TEST WAS DONE AGAINST 18

AEROALLERGENS. THE MOST COMMON AEROALLERGENS IDENTIFIED SO FAR

ARE HOUSE DUST FOLLOWED BY COTTON, KAPOK, DERMATOPHAGOIDES

PTERONYSSINUS, BLOMIA TROPICALIS, COCOS NUCIFER, BRASSICA NIGRA. THESE

EIGHT AEROALLERGENS ACCOUNT FOR ABOUT 74% OF NASOBRONCHIAL

ALLERGY AMONG THE KOLKATA POPULATION. SKIN TEST RESULTS ON 1079

PATIENTS AGAINST HD, DP, DF AND BT SHOWED THAT 96.22% PATIENTS SENSITIVE

TO HD, 75.06% TO DP, 63.72% TO DF AND 72% TO BT ALLERGENS. THE PRESENT

STUDY AGREES QUITE WELL WITH OTHER INVESTIGATORS (PEPYS ET AL., 1968;
SMITH ET AL, 1969) WHO ALSO ESTABLISHED THE CORRELATION BETWEEN

ALLERGY AND POSITIVE SKIN REACTION. IN THE PRESENT STUDY CERTAIN NEW

ALLERGENS SHOWN TO CAUSE ALLERGIC REACTION AMONG THE

 CONCLUSION

KOLKATA POPULATION WITH INCREASING FREQUENCY ARE DELONIX SP.,

AZADIRACHTA INDICA, CAESALPINIA SP., ASPERGILLUS FURNIGATUS, A. NIGER,

CANDIDDA SP., CLADOSPIRRIUM SP. AND ALTERNARIA SP. IT APPEARS THAT THE

FREQUENCY OF ALLERGIC RESPONSES TO DIFFERENT INHALANTS ARE SAME IN

DIFFERENT AGE GROUPS AND FOR BOTH GENDERS. THESE FINDINGS DISAGREED

WITH HANNWAY ET AZ.(1970) WHO CAME TO THE CONCLUSION THAT THE RATE

OF SKIN REACTIONS WAS HIGHLY AGE DEPENDENT AND PEAK REACTIVITY

OCCURRED DURING ADULTHOOD WITH A SHARP DECLINE IN THE OLDER AGE

GROUP. MURRAY ET AL.(1983) INTERPRETED IT AS THE NATURAL DECLINE IN

REACTIVITY WHICH OCCURS IN OLDER SUBJECTS THAT MAY BE ATTRIBUTED TO

EITHER ACTUAL DECREASE IN IMMUNOLOGICAL REACTIVITY OR A DECREASE IN

THE CAPACITY OF THE SKIN TO RESPOND IMMUNOLOGIC CHALLENGE.

IGE WAS CONSIDERED AS THE PRIME CARRIER OF REAGINIC

HYPERSENSITIVITY IN HUMAN (ISHIZAKA ET AL, 1966). ACCORDING TO
JOHANSSON, (1969) AND GLEICH ET AL. (1971), THE TOTAL SERUM IGE LEVEL IS
HIGH IN BRONCHIAL ASTHMATIC PATIENTS'. A WIDE RANGE OF SERUM IGE
LEVELS (7.3-4040IU/ML) HAD BEEN OBSERVED IN THIS STUDY GROUP. THE
STATISTICALLY SIGNIFICANT DIFFERENCE OF MEAN SERUM IGE LEVEL
BETWEEN PATIENTS AND CONTROL SUBJECTS WAS OBSERVED IN THE PRESENT
STUDY. ACCORDING TO GANJU ET AL. (1979), THE BASIS OF VARIATIONS IN IGE
LEVEL WAS POLYGENIC WITH A POSSIBLE EFFECT OF ENVIRONMENTAL AND
SOCIO-ECONOMIC FACTORS.

IN THE PRESENT STUDY GROUP IT IS TO BE NOTED THAT PATIENTS' BETWEEN

THE AGE OF 15 TO 40 YEARS SHOWED HIGHER MEAN IGE LEVELS IN
COMPARISON TO OTHER TWO GROUP THOUGH THE DIFFERENCE WAS NOT
STATISTICALLY SIGNIFICANT. THESE FINDINGS ARE IN CONFORMITY WITH THE
FINDINGS OF JOHANSSON ET AL. (1968) AND ZITTERSTROM & JOHANSSON, (1981),
WHO ALSO REPORTED THAT THE SERUM IGE LEVEL DID NOT DEPEND ON AGE.
HOWEVER, KHATUA ET AL. (1986) SUGGESTED THAT THE AGE OF PATIENTS HAVE
SIGNIFICANT EFFECT IN THE INCREASE OF TOTAL SERUM IGE LEVEL.

IN THE PRESENT STUDY, THE DIFFERENCE IN MEAN SERUM IGE LEVELS IN

MALE AND FEMALE PATIENTS IS NOT SIGNIFICANT. THIS FINDING AGREES WITH

ZITTERSTROM AND JOHANSSON, (1981) AND BATABYAL ET AL.(1986). HOWEVER,

THE PRESENT FINDINGS DISAGREES WITH THOSE OF WOOD AND OLIVER (1972);

BARBEE ET AL. (1981), WHO OPINED THAT TOTAL SERUM IGE LEVELS WERE

INFLUENCED
 CONCLUSION

BY SEX AS WELL AS AGE. IN CONCLUSION, IT CAN BE MENTIONED THAT THE

INCREASE OF TOTAL SERUM IGE LEVEL NEITHER AGE NOR SEX DEPENDENT.

WHILE SKIN TESTING IS AN EXCELLENT SCREENING TEST TO EVALUATE

IMMEDIATE HYPERSENSITIVITY REACTION, BUT ALLERGEN SPECIFIC IGE

ANTIBODIES TEST IS A DEFINITE PROOF OF IGE MEDIATED DISEASES

(DOCKHORN, 1982). HENCE, THE DETERMINATION OF SPECIFIC IGE PROVIDES

IMPORTANT INFORMATION REGARDING THE THERAPY TO BE ADOPTED.

ANALYSIS OF ALLERGEN SPECIFIC IGE ANTIBODIES AGAINST HOUSE DUST,

DERMATOPHAGOIDES PTERONYSSINUS, DERMATOPHAGOIDES FARINAE AND

BLOMIA TROPICALIS RESULTS IN RELATION TO PATIENTS AGE AND SEX

REVEALED THAT THE FREQUENCY OF SENSITIVITY TOWARDS FOUR SELECTED

ALLERGENS NEITHER AGE NOR SEX DEPENDENT ( P>0.05). THIS FINDING IS

CORRELATED WELL WITH CHEW ET AH (1999); KHERKHOF ET AL. (2003) AND

SIMPSON ET AL. (2003). THE PRESENT FINDINGS REVEALED THAT NEARLY ABOUT

76% PATIENTS IN KOLKATA ARE SENSITIVE TO HOUSE DUST AND THREE MITE

ALLERGEN TESTED. AMONG THESE POSITIVE PATIENTS 93.5% PATIENTS HAVE

ELEVATED SERUM IGE LEVEL. THIS PROVES THE ATOPIC STATUS OF THOSE

PATIENTS. IN THE PRESENT STUDY ALLERGEN SPECIFIC IGE ANTIBODIES

AGAINST HOUSE DUST AND THREE MITES NAMELY DP, DF AND BT WAS DONE

AND IT IS OBSERVED THAT79.77% PATIENTS HAD SPECIFIC IGE ANTIBODIES

AGAINST HD, 71.91% TO DP, 88.76% TO DF AND 90% TO BT ALLERGENS. IN CASE OF

SKIN RESPONSE 96.22% PATIENTS WERE SENSITIVE TO HD, 75.06% TO DP, 63.72%

TO DF AND 72% TO BT ALLERGENS. THIS DIFFERENCE OF SENSITIVITY AGAINST

FOUR ALLERGENS BY TWO DIAGNOSTIC METHODS MAY BE DUE TO THE

APPEARANCE OF FALSELY POSITIVE OR NEGATIVE RESULTS WHILE

DEMONSTRATION OF SPECIFIC IGE ANTIBODIES TO A DEFINED ALLERGEN IS A

DEFINITE PROOF OF IGE MEDIATED DISEASE (DOCKHORN, 1982).

 THUS THE PRESENT STUDY ESTABLISHED THE ROLE OF THREE

ALLERGENIC MITES NAMELY DP, DF AND BT IN HOUSE DUST ALLERGY AS

EVIDENCED BY THE SKIN PRICK TEST, TOTAL SERUM IGE AND DETECTION OF

ALLERGEN SPECIFIC IGE ANTIBODIES AMONG PATIENTS OF KOLKATA. IN

CONCLUSION IT COULD BE STATE THAT THESE MITES IN HOUSE DUST MAY BE

CONSIDERED AS ONE OF THE PROBABLE FACTOR FOR THESE ALLERGIC

DISORDERS.
 CONCLUSION

IN ALLERGY PRACTICE TWO THINGS ARE OF PRIME IMPORTANCE:-

1. IDENTIFICATION OF OFFENDING ALLERGENS AND,

2. THEIR SUBSEQUENT REDUCTION FROM THE PATIENTS ENVIRONMENT.

IN THIS CONTEXT, IT IS REASONABLY TO THINK THAT THE CONTROL OF THESE

MITES MAY BE HELPFUL IN THE PROPHYLACTIC MANAGEMENT OF THESE

DREADFUL DISEASES.
 TO ORDER
FULL/COMPLETE PHD THESIS
1 THESIS (QUALITATIVE/QUANTITATIVE STUDY WITH SPSS) & PPT WITH TURNITIN PLAGIARISM
REPORT (<10% PLAGIARISM)
IN JUST RS. 45000 INR*
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