International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem

Abstract

Since mite allergens are the most relevant inducers of allergic diseases worldwide, resulting in significant morbidity and increased burden on health services, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), the European Academy of Allergy and Clinical Immunology (EAACI), and the World Allergy Organization (WAO), has proposed to issue an International Consensus (ICON) on the clinical consequences of mite hypersensitivity. The objectives of this document are to highlight aspects of mite biology that are clinically relevant, to update the current knowledge on mite allergens, routes of sensitization, the genetics of IgE responses to mites, the epidemiologic aspects of mite hypersensitivity, the clinical pictures induced by mites, the diagnosis, specific immunotherapeutic approaches, and prevention.

A reintroduction of environmental mite allergen control strategies for asthma treatment and the debate on their effectiveness

“…However, the effectiveness of mite allergen control has become debatable, and existing guidelines show a lack of consensus on mite allergen control . Therefore, gaining knowledge of the clinical effectiveness of avoiding allergen exposure should still be considered a research priority compared to controlling other types of exposure …”

Similar localization of conformational IgE epitopes on the house dust mite allergens Der p 5 and Der p 21 despite limited IgE cross‐reactivity

“…House dust mites (HDMs) belong to the most potent and frequent allergen sources worldwide with a prevalence of sensitization of more than 40% within atopic populations . House dust mite ‐sensitized patients suffer from a variety of allergic symptoms, in particular from respiratory and skin allergy, and often exhibit severe respiratory symptoms such as asthma . Although HDM is a complex allergen source with more than 20 different reported allergen groups, only certain allergens are of high clinical relevance, among them the major allergens, Der p 1, Der p 2 and Der p 23 and a group of mid‐tier allergens including Der p 5 and Der p 21 which in some population are recognized by more than 50% of HDM‐allergic patients .…”

Ascariasis as a model to study the helminth/allergy relationships

“…Several studies have shown that HDM sensitization is the main risk factor for asthma in the tropics (reviewed in Refs ); but its historic epidemiological impact is difficult to evaluate because scientific reports on asthma prevalence in tropical countries are relatively new, which makes it impossible to determine whether the current rates reflect a recent increase or a more permanent phenomenon; although mite levels of exposure might be modified by urbanization, climate change and Westernized lifestyles.…”

“…60 Theoretically, these findings can occur in humans, supporting a role of permanent HDM exposure on the inception of asthma; therefore, this should be further investigated, especially because negative results have been obtained when exploring human cord blood cell proliferation in similar conditions. 61 Several studies have shown that HDM sensitization is the main risk factor for asthma in the tropics (reviewed in Refs [1,62]); but its historic epidemiological impact is difficult to evaluate because scientific reports on asthma prevalence in tropical countries are relatively new, which makes it impossible to determine whether the current rates reflect a recent increase or a more permanent phenomenon;…”