Studies on House Dust Mites of Kolkata and Nasobronchial Allergic Disorders

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

CONCLUSION
TABLE 25. ALLERGIC RESPONSE TO COMMON INHALANTS (POLLENS, MOULDS & OTHERS
AMONG NASOBRONCHIAL ALLERGIC PATIENTS OF KOLKATA, N = 682).
ALLERGENS
NO. OF PATIENTS
POSITIVE
% OF PATIENTS
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'.
ALLERGEN NAME
NO. OF POSITIVE
PATIENTS
% OF POSITIVE
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
NAME
NO. AND PERCENTAGE (%) OF PATIENTS WITH DIFFERENT
SKIN 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
ONE ALLERGEN TWO ALLERGEN THREE ALLERGEN
ALL FOUR
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
HOUSE DUST MITES TOTAL
PERCENT
AGE
+ + 817 75.75
+ - 140 13.05

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.
AGE GROUP DP DF BT HD COMPARING
REMAR
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.
STUDY GROUP RANGE OF IGE IU/ML MEAN IGE IU/ML T- VALUE
REMA
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'
SEX RANGE OF IGE MEAN IGE T- VALUE
REMARK
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:
ALLERGENS NAME
NO. & %
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:
AGE NO. OF PATIENTS
TOTAL
TESTS NO. OF POSITIVE X2 VALUE
REMAR
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
NS
NO. AND % POSITIVE
PATIENTS "Z" VALUE
REMAR
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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