For the allergy sufferer, house dust mite feces are the main villains. Allergic reactions to dust mite waste particles are the most common cause of nasal allergy, allergic asthma, and allergic eczema (atopic dermatitis).
For the allergy sufferer, house dust mite feces are the main villains. Allergic reactions to dust mite waste particles are the most common cause of nasal allergy, allergic asthma, and allergic eczema (atopic dermatitis).
Allergic disorders are on rise with increase in urbanization, improved personal hygiene & more people migrating in search of jobs, better opportunities. Diagnosis of allergy can aid the clinician is appropriate counselling of the patient for avoidance of specific allergens & if required prescribe appropriate immunotherapy.
FMD is serious , acute and highly contagious animal disease.
Affecting all cloven hoofed animals(hoof split in to two toes)
High morbidity and low mortality.
FMD is disease of animals not humans and affecting livestock in every part of the world.
Animals include cattle , buffaloes, goats , sheep, swine and many wild animals including deer.
Allergic disorders are on rise with increase in urbanization, improved personal hygiene & more people migrating in search of jobs, better opportunities. Diagnosis of allergy can aid the clinician is appropriate counselling of the patient for avoidance of specific allergens & if required prescribe appropriate immunotherapy.
FMD is serious , acute and highly contagious animal disease.
Affecting all cloven hoofed animals(hoof split in to two toes)
High morbidity and low mortality.
FMD is disease of animals not humans and affecting livestock in every part of the world.
Animals include cattle , buffaloes, goats , sheep, swine and many wild animals including deer.
Biology of vertebrate and there managementMANISH JADHAV
The vertebrates of greatest pest importance to humans are the bats, bird, commercial mice and rats and squirrel which either roost or nest on or within human structures or nearby. These animals are not only a nuisance, but they may damage or destroy the property, eat and contaminate stored food. For example, bats may transmit rabies; bat and bird droppings are a common source of the respiratory fungal diseases histoplasmosis; rat and mice are vectors of the food poisoning, rat-bite fever, murine typhus.
Abstract
Study was conducted to record prevalence of gastrointestinal parasites of cat. A total of 100 fecal samples from cat (50 from
male and 50 from female) were collected and examined for the presence of GIT parasites. Samples were collected and
transported for the laboratory diagnosis. Animal data such as age, sex, and breed were recorded. Results of the present study
revealed that 24% cats found positive for the gastrointestinal parasites. The percentage of infection was found higher in female
cats (28%) than males (20%). The prevalence in adults and kitten was recorded as 21.42% and 30% respectively. Dipylidium
caninum was found more prevalent with the infection rate of 9% followed by Toxocara cati, Aeluroslonglun obstrusus, Taenia
taeniaeformis and Paragonimus kellikotti with the infection rate of 5, 5, 3 and 2% respectively.
Key words: Cat, Felus catus, GIT parasites, Prevalence
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Scope
• Introduction
• HDM allergens and Cross-reactivity
• HDM & Respiratory allergic diseases
• Mechanisms of HDM allergen induced sensitization
• Diagnosis of HDM Allergy
• Preventive and Therapeutic Approaches for HDM Allergy
3. Introduction
• Major perennial indoor allergen cause Asthma, AR, AD
• 50 – 85% of asthmatics are typically HDM allergic
• Prevalence data for HDM allergen sensitization vary from 65 to130 million
persons (1-2%) in the general population worldwide
• Geographic variation
• In1967, Spieksma and Voorhorst established that the dust mite,
Dermatophagoides pteronyssinus, was an important source of house dust
allergens in the Netherland
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
Gregory and Lloyd.Trends Immunol. 2011; 32(9): 402–411.
4. Phylum Arthropoda
Domestic mite:
Any species of mite found in house
Dust mite:
Family Pyroglyphidae
- Dermatophagoides
- Euroglyphus
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
Storage mite(flour,grain, barn, hay):
Family Acaridae & Glycyphagidae
(Tropical mite : Blomia tropicalis)
5. J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Domestic
mite
6. Family Pyroglyphidae
• Dermatophagoides (Subfamily Dermatophagoidinae)
- Dermatophagoides pteronyssinus (Dp)/ European HDM
- Dermatophagoides farinae (Df)/ American HDM
• Euroglyphus (Subfamily Pyroglyphinae)
- Euroglyphus maynei (Em)
>> England, Europe, the southern United state
>> Em frequently co-inhabits with Dp and Df in some geographical areas
>> Many patients sensitive Dp, Df are also sensitive to Em
>> Extracts of Em for diagnosis and immunotherapy are not
commercially available
House dust mite
The two most common HDM species worldwide : Dp, Df
Fernández-Caldas et al. Chem Immunol Allergy, 2014, vol 100, 234–242.
Morgan S. et al.Int Arch Allergy Immunol 2015;166:267–272.
7. • D. pteronyssinus (Dp) tends to be most abundant.
• Only a few countries have either predominantly D. pteronyssinus or D. farinae.
- Australia, New Zealand, England and Mauritius have D. pteronyssinus
with few other HDM
- Singapore has a bias to D. pteronyssinus but with B. tropicalis
- Most of South Korea has a bias to D. farinae especially in the northwest
- Italy also has D. farinae -biased
• In Asia; Singapore, Malaysia, Hong Kong and the Phillipines have
D.pteronyssinus as the dominant pyroglyphid HDM.
Thailand and Taiwan and have more D. pteronyssinus than D. farinae
Distribution of Dermatophagoides species
Wayne R Thomas. Asian Pac J Allergy Immunol 2010;28:211-24.
9. • Eight-legged, Sightless
• 0.3 mm. in length
• Absorbing water through Hygroscopic substance
extrude from leg joints
• Habitat with 3 key macromolecules derived from
organic debris
- keratin (human skin scales) --> food source
- cellulose (textile fibers)
- chitin (fungal hyphae and mite cuticles)
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
Caldereon, et al. J Allergy Clin Immunol. July 2015;136:38-48.
• Excrete fecal particles
- contain allergenic digestive enzyme
- chitinous peritrophic membrane (not waterproof)
- size 10-35 micron (similar to pollen grain)
- carry allergen 0.2 ng
- airborne and easily inhaled
10. Life cycle- Egg to adult : 1 month
- Adult living an additional 1-3 months.
- Adult females lay up to 40-80 eggs
11. • Temperature : 65-80°F (20-25°C)
• Relative humidity (RH) : 70-75%
>> carpets, sofas, mattresses, or clothing
Optimum growth condition
Thomas A.E. Plattes-Mills.Middleton's Allergy 8th Edition. 453-469.
Yu SJ, et al.Asia Pac Allergy 2014;4:241-252.
12. • Environmental factors of temperature and RH is reflected in seasonal fluctuations
in dust mite numbers and allergen levels in different parts of the world.
• Summer is warm and dump so mite population can expand.
• The most important facilitative factor for mite growth is RH.
- Once humidity decreases below 50%, mite proliferation and survival
is decreased.
- Mites can survive for weeks before they die.
- As humidity falls, it may take months for mites to die and longer for
allergen levels to decrease in carpets, sofas, or mattresses.
- An elevated RH for as briefly as little as 1.5 hours per day (cooking, bathing),
the mite can survive. 2 to 3 hours per day, mites can reproduce.
13. HDM allergens
Gregory and Lloyd.Trends Immunol. 2011; 32(9): 402–411.
• Mite allergens are present in mite bodies, secretion and excretion
• Fecal particles contain the greatest proportion of mite allergen
14. • Airborne mite allergen is detected only during or shortly after
disturbance of dust. Fell rapidly after disturbance.
• Little or no airborne allergen (e.g., less than 1 ng/m3) is
present in undisturbed conditions.
• Indicate that mite allergen is predominantly airborne on
particles greater than 10 µm in diameter.
• Fecal particles become airborne and easily inhaled.
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
15. Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
• Exposure to mite allergens is in the form of fecal particles contain
- Mite-derived proteins
- Endotoxin derived from bacteria >> potent TLR-4 agonist
- Mite DNA and bacterial DNA (unmethylated) >> activate TLR-9.
- Chitin peritrophic membrane >> Chitin and its breakdown products can act on
TLR-2 and dectin-1
Potential adjuvants
16. Mite Allergen Group
M. RAULF et al. Allergo J Int 2015; 24: 68–80. Fernández-Caldas et al.
Chem Immunol Allergy, 2014, vol 100, 234–242.
33 groups
Major allergens (frequency of patients sensitized and amount of specific IgE)
- Group 1 (Der p 1 and Der f 1)
- Group 2 (Der p 2 and Der f 2)
17. • Allergens from mites include commonly encountered functions
of allergens from a wide variety of sources
- Proteases (Group1, 3, 6, 9, 20)
- Lipid-binding proteins (Group 2, 7, 13, 14)
- Contractile proteins (Group 10, 11, 16, 17, 24)
- Glycosidases and carbohydrate-binding proteins (Group 4, 12, 15, 18, 23)
- Glutathione S-transferase (Group 8)
- Unidentified function
• Most mite allergens are enzymes
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Rubaba Hamid Shafique, M.Phil et al. Allergy Rhinol 3: 74–90, 2012.
Mite Allergen functions
18. Group 1
Caldereon, et al. J Allergy Clin Immunol. July 2015; 38-48
Schulz O. et al. J. Exp. Med. 1998, 271-275
Cysteine proteases
- Destroy the epithelial tight junctions
- Innate immune response :recognized by
PAR-2 and TLRs --> PAMPs
- Adaptive immune : Promote Th2
- Activating mast cells independently of IgE
• Glycoprotein 25 kDa, Heat-labile
• Peptidase enzyme/ Proteolytic enzyme
(Identity with plant enzyme papain)
• Location: Gut
• Der p1, Der f1
• Der p 1: significant role in IgE antibody responses
1.) Cleavage of CD23 (FCeRII on B cells) ----> IgE
2.) Cleavage of CD25 (IL-2R on T cells) ----> Th2 response
19. • Group 3 : Trypsin-like enzyme
- also found in insect venoms
- Der p 3 quite similar to the cockroach Bla g 10
• Group 6 : Chymotrypsin
• Group 9 : Collagenolytic serine protease
Group 3,6,9
Serine proteases
• Trypsin
- Destroy the epithelial tight junctions
- Trigger PAR-2 ---> results in the initiation of multiple G-protein
coupled signaling cascades
- Promote Th2
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
20. • Innate immune: TLR4 (on DCs, airway
epithelium, and airway smooth muscle cells)
bind endotoxin
• Adaptive immune: Promotion of TH2
polarization and inflammatory cell recruitment
Group 2
• Glycoprotein 15 kDa, Heat-stable
• Molecular mimicry of MD-2 protein
(lymphocyte antigen 96)
• Lipid-transfer or lipid-carrying proteins
• Location: Intracellular
• Der p2, Der f2
MD-2 like
lipid-binding protein
Caldereon, et al. J Allergy Clin Immunol. July 2015; 38-48.
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Associated with Oral mite syndrome
21. • Occurs because of shared similar or identical IgE-binding epitopes
• Der p highly cross-reactivity with Der f
- Group 2 allergens are very similar to each other in structure,
with greater than 90% sequence homology, indeed,
no mAb assays currently available can distinguish Der p 2 from Der f 2
• B. tropicalis cross-react partially with other dust mites
>> designated Blo t 5 because it has sequence homology with Der p 5
G. Reese et al.Int Arch Allergy Immunol 1999;119:247–258.
Thomas A.E. Plattes-Mills.Middleton's Allergy 8th Edition. 453-469.
Cross-reactivity
22. Group10
Tropomyosin
• Muscle protein
• coiled- coil structure, two
parallel alpha-helical
• Location: Muscle
• Der p10, Der f10
• Invertebrates
- Crustaceans (shrimp, lobster,
crab, craw-fish)
- Arachnids (house dust mites)
- Insects (cockroaches)
- Mollusks (e.g. squid)
• 5% to 15% of patients who are
highly sensitized to dust mite also
are sensitized to crustaceans
G. Reese et al.Int Arch Allergy Immunol 1999;119:247–258.
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
• Found
- Invertebrate >> Allergic
- Vertebrate >> Non-allergic
23. • Shrimp (Pen i 1, Pen a 1, Met e 1) identity 81-90%
• Cockroachs (Per a 7, Bla g 7) identity 80%
• Other Crustacean
- Crab: Cha f 1
- Lobster: Pan s 1, Hom a 1 identity 81-90%
• Mollusk (Cra g 1, Tur c 1, Tod p 1)
• Helminth (Ascaris, Filaria and Anisakis simplex)
G. Reese et al.Int Arch Allergy Immunol 1999;119:247–258
Tropomyosin
• Der p10, Der f10
24. Threshold level
• Most studies accept
- Sensitization threshold level 2 μg/g. of dust (100 mites/g.)
- Threshold levels for for developing symptoms
in already sensitized individuals 10 μg/g. of dust (500 mites/g.)
- For nonallergic children higher threshold level 20 μg/g. of dust
World Health Organization (WHO).Bull World Health Organ 1988;66:769-80.
HDM & Respiratory allergic diseases
25. 1. Two-side monoclonal antibody (mAb) based enzyme
immunoassay (ELISA) -- --> Gold standard
- most common available : Der p1, Der f1/ Der p2, Der f2/ Blo t5
2. Guanine (the major nitrogenous excretory product of arachnids)
3. Mite count
Methods of estimating dust-mite allergens
A. Custovic.Allergy 1998; 53 (Suppl 48): 71-76
26. • Environmental assessment and exposure control of dust mites:
a practice parameter 2013
• Advise patients to minimize exposure of susceptible children to dust mite allergens
to decrease their risk of developing mite-specific IgE. Because intermittent
exposure to mite allergens can lead to sensitization. (Strength of recommendation:
strong, A evidence)
• Advise patients to minimize exposure of dust mite sensitized children to dust mite
allergens to decrease their risk of developing asthma and possibly rhinitis.
(Strength of recommendation: strong, A evidence)
Sensitization & Development respiratory disease
27. Sporik R et al. N Engl J Med (1990);323: 502-7.
Active asthma was very strongly associated with
both atopy & sensitivity to HDM
Significant relation between high levels of expose
and early onset of wheezing (P=0.001)
28. Casas et al.European journal of allergy and Clinical Immunology.Allergy 70 (2015); 820-827.
Early life exposure plays a role in the development
of sensitization
29. Lodge,et al.J Allergy Clin Immunol 2011;128:782-8.
• Birth cohort of 620 children
oversampled for familial allergy
• SPTs to 6 allergens at ages 6, 12, and 24 months
• Wheeze and eczema were recorded during
the first 2 years
• Current wheeze was recorded at age 12 years
• New-onset sensitization by 2 years or sensitization at both 1 and 2 years were both strong predictors
of wheeze at age 12 years
30. Lodge,et al.J Allergy Clin Immunol 2011;128:782-8.
HDM sensitization was associated with current wheeze at age 12 years
31. Danansuriya et al. World Allergy Organization Journal (2015) 8:19
• Students with current asthma
were having13 times
higher risk of atopy to HDM
compared to their healthy siblings
32. • House dust mite and the cockroach are
the most important aeroallergen
sensitizers in Thai allergic rhinitis
patients, since more than half the
patients were skin test positive to the
house dust mite and the cockroach.
• 85% of mite-sensitive patients were
skin test positive to both species of
Dermatophagoides, indicating
substantial cross reactivity.
Pumhirun et al.Asian Pac J Allergy Immunol (1997) 15: 183-185
33. • 2 Main route
1.) Innate immune system --> Epithelial cells, Dendritic cells
2.) CD4+ TH2 cells induce and IgE-dependent allergic response
Mechanism of HDM allergen induced sensitization
Gregory and Lloyd.Trends Immunol. 2011; 32(9): 402–411.
Innate epithelial cytokines
Dendritic cells
Th2
34. Gregory and Lloyd.Trends Immunol. 2011; 32(9): 402–411.
Innate immune system : Epithelial cell
Group 1(cystein protease): PAR-2
Group 2 (MD-2 like LBP): TLR-4
Endotoxin : TLR-4
B-glycan : Dectin-1
Chitin : TLR-2, Dectin-1
Mite&Bac. DNA : TLR-9
35. Potential enhancement of the allergic response by
HDM
Caldereon, et al. J Allergy Clin Immunol. July 2015;136:38-48.
Der p 1: significant role in IgE antibody responses
1.) Cleavage of CD23 (FCeRII on B cells) ----> IgE
2.) Cleavage of CD25 (IL-2R on T cells) ----> Th2 response
Group 1(cystein protease): PAR-2
Group 2 (MD-2 like LBP): TLR-4
Endotoxin : TLR-4
B-glycan : Dectin-1
Chitin : TLR-2, Dectin-1
Mite&Bac. DNA : TLR-9
36. • Skin testing and/or specific IgE
• Nasal provocation testing (NPT) : perennial AR due to HDM when the
patient history provides inconclusive information
Diagnosis of HDM allergy
M. RAULF et al. Allergo J Int 2015; 24: 68–80
37. • D. farinae ,D. pteronyssinus, Mite mix extracts are standardized.
• Commercially available in many country ex. the United States, Europe, Maxico.
• Content of extracts varies depending on whether purified mite bodies or total spent
culture is used as the source material
- Mite bodies greater than 99% purity and are almost exclusively used in the
United States >> 40 µg/mL of Der p 1 and 30 µg/mL of Der p 2
- Spent cultures containing adult mites, eggs, larvae, fecal particles, and culture
medium are often used in Europe >> at least 10 times more group 1 than group 2
Dust mite extracts
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-481.
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
38. 1. ) Environment control
- Recommend avoidance for SPT positive to HDM
2. ) Immunotherapy - Subcutaneous (SCIT), Sublingual (SLIT)
Preventive and Therapeutic Approaches
Fernández-Caldas et al.History of Allergy. Chem Immunol Allergy, 2014, vol 100, 234–242.
Thomas A.E. Plattes-Mills.Middleton's Allergy 8th Edition. 453-469.
39. Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
Environmental control
Avoidance
1.) Physical
2.) Chemical
40. • A special mite-impermeable
membrane was used in PE and CE
group
• Regular bedsheets were applied to
all groups
• PE group : mattresses were
encased on tops and sides only
CE group : complete mattress
encasement was undertaken
• Mattress encasing with a special membrane was highly efficacious in the reduction of mite
allergen (90%).
• Complete mattress encasing in a tropical environment does not offer any advantage over
partial encasing in the reduction of mite allergen
Vichyanond et al. Allergy 1999, 54, 736-741.
Cover mattresses and pillows with impermeable cover
41. • The ideal mite cover should have at least 2
important characteristics
1.) block the leakage of mite
allergens from the inside of the
bedding
2.) prevent mites from penetrating
through the covers in either
direction
Mahakittikun et al. J Allergy Clin Immunol 2006;118:1164-8.
Cover mattresses and pillows with impermeable cover
42. • Environmental assessment and exposure control of dust mites: a
practice parameter 2013
- Woven microfiber fabrics with a mean pore size smaller than 10 micron
can effectively block passage of Der p 1 (Strong, B evidence)
- Dust mite allergens (Der f 1 and Der p 1) were decreased to below
detectable limits by fabrics with a pore size smaller than 10 micron
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Cover mattresses and pillows with impermeable cover
43. Remove carpets, stuffed animals, and clutter from bedroom
• Removing carpets is more effective in the long term than any currently available carpet
cleaning measure.
• Designing the house with polished floors and wooden or vinyl or leather furniture, to limit the
sites where mites can grow and to reduce dust collectors so as to make cleaning easier.
• Environmental assessment and exposure control of dust mites: a
practice parameter 2013
• The most effective way to manage reservoirs of mite allergens is to remove them completely
from the environment. That means removing carpets, drapes, and upholstered furniture and
sealing mattresses, box springs, and pillows in mite-impermeable covers
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
44. Wash bedding regularly 130° F
• 130°F (55°C) can kill mites and allergen removed by washing generally reappears within 1
month
• Washing bedding at 130°F (55°C) once weekly is effective
• Environmental assessment and exposure control of dust mites: a practice parameter
2013
- Most mites that are killed in the washing process die by drowning. Although higher temperature
kills slightly more mites.
- There is evidence that temperatures lower than 130°F are adequate, high temperature is
not necessary.
- Home hot water should be kept below 120°F prevent danger to children.
- Wash bedding weekly in warm water, without aiming for a specific and potentially dangerous
temperature. This will remove most, not all, mites and mite allergens. Clothing also should be
washed after use. (strong, B evidence)
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
45. • Vacuum weekly (wearing a mask) using vacuum cleaner with a double-
thickness bag or a high-efficiency particulate air (HEPA) filter.
• Regular (at least weekly) vacuuming is essential for preventing buildup
of mite allergens in homes with carpets.
• Vacuuming does not remove all live mites, mite allergens in the form of
fecal particles can be removed.
Vacuuming
Vacuuming
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
46. Reduce humidity
• Reduce humidity below 45% relative humidity (or 6 g H2O/ kg air)
• Environmental assessment and exposure control of dust mites:
a practice parameter 2013
- Advise patients that relative humidity in the home should be kept
between 35% and 50% to decrease the growth of dust mites (Strong, B evidence)
- Encourage dust mite-allergic patients to obtain and use a hygrometer to
measure humidity in their home. (Strong, D evidence)
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507
47. Reduce humidity
• Remove excessive : Using a dehumidifier and/or air conditioning
- Dehumidifier needs to be emptied regularly or set to drain continuously,
and it should be located in areas where dampness is likely to occur.
- Air conditioners need to run long enough to remove sufficient moisture from
the air to decrease RH.
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507
48. • killing mites
• Benzyl benzoate Moist powder and foam.
- The active powder kills 90% of mites in culture within 12 hours
and 100% in 24 hours
- Reapplied at 2-3 month intervals
• Environmental assessment and exposure control of dust mites: a
practice parameter 2013
- Acaricides are not recommended for use on mattresses, particularly
given the likelihood of exposure to the chemical
- Limited efficacy at decreasing allergen levels
(moderate, B evidence)
Acaricides
Ex. Benzyl benzoate,pyrethroids, natamycin (an antifungal), pirimiphosmethyl
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507.
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
Treat carpets with benzyl benzoate or tannic acid
49. • Protein-denaturing agent
• Reduce allergen levels in house dust : 1% and 3% solutions
• Does not kill mites, so the effect can only be temporary. Reapplied at 1-2 week intervals
• TA was very effective at reducing mite allergen levels in dust, though it required up to 4
hours to exert its full effect.
Tannic acid
Woodfolk et al. Allergy Clin lmmunol. Volume 94, Number 1, 1994, 19-26.
Thomas A.E. Plattes-Mills. Middleton's Allergy 8th Edition. 453-469.
Treat carpets with benzyl benzoate or tannic acid
• Environmental assessment and exposure control of dust mites: a practice
parameter 2013
- Do not recommend tannic acid for decreasing mite allergens in carpet
dust because it is only marginally effective : concentrations of tannic
acid as low as 0.1% were found to inhibit the ELISA assays
(Moderate, C evidence)
51. • Recommend 3 to 5 years
• Effective dose
- SCIT : 7 mg of Der p 1 per dose for European extracts
500-2,000 AU per dose for US extracts
(US >> Der p1:Der p2 = 1:1, Europe >> Der p1:Der p2 = 10:1)
- SLIT : 4,200 AU containing approximately 70 mg of Der f 1 given daily
• Frequency of administration once maintenance is reached
- SCIT : Ranged from weekly to monthly
- SLIT : Daily to 3 times per week
• No evidence to support giving lower doses more frequently or higher doses less
frequently to obtain similar efficacy
• Dust mite extracts are compatible with pollen and animal dander extracts and can be
mixed with fungal and cockroach extracts provided they are kept in glycerin at a
concentration of at least 10%
Immunotherapy
J. Portnoy et al. / Ann Allergy Asthma Immunol 111 (2013) 465-507
Practice parameter 2013
52. • Retrospective study
• 39 patients (23 boys,16 girls)
• Children with asthma and rhinitis who
were allergic to house dust mite
• 3 years of SLIT with 50 % Der p and
50 % Der f in a standardized extract
Conclusion
• SLIT is effective in children who have
allergic airway disease which cannot be
controlled effectively with allergen
avoidance measures only
Y Nuhoglu, et al. J Investig Allergol Clin Immunol 2007; Vol. 17(6): 375-378.
53. Cingi C. et al. Eur Arch Otorhinolaryngol. 2014.
• 186 patients with AR who had positive SPT for HDMs
• Administered SLIT using for 1 year
• Evaluation of the patients regarding
- symptom scores
- clinical findings
- Rhinitis Quality of Life Questionnaire (RQLQ)
• At baseline, 6 and 12 months of therapy.
54. HUI Y. et al. Expiramental and therapeutic medicine 7: 630-634, 2014.
• 90 asthmatic children (with or without
allergic rhinitis) with a mild to moderate
HDM allergy (aged, 5-14 years) were
recruited
• SCIT combined with standardized
management (ICS) for 36 months.
• Suggest that long-term SCIT may
alleviate asthma symptoms and reduce
the required dose of ICS.
55. In thailand
• A double blind, self-controlled study between the
SMAV and standardized commercial mite allergen
vaccine
• 17 normal Thai adult males and non-pregnant or non-
lactating females aged 18-60 years
Result
- No significant difference in wheal and flare
diameter
- Significant correlation between wheal diameter
- Suggested that SMAV could be used for SPT
instead of using the more expensive imported
commercial vaccine
Visitsunthorn, et al.ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY (2010) 28: 41-45.