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Clinical Consequences of Mite Hypersensitivity, a Global Problem

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Clinical Consequences of Mite Hypersensitivity, a Global Problem International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Sánchez-Borges, M., E. Fernandez-Caldas, W. R. Thomas, M. D. Chapman, B. W. Lee, L. Caraballo, N. Acevedo, et al. 2017. “International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem.” The World Allergy Organization Journal 10 (1): 14. doi:10.1186/s40413-017-0145-4. http://dx.doi.org/10.1186/s40413-017-0145-4. Published Version doi:10.1186/s40413-017-0145-4 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:32630454 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Sánchez-Borges et al. World Allergy Organization Journal (2017) 10:14 DOI 10.1186/s40413-017-0145-4 CONSENSUSDOCUMENT Open Access International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem Mario Sánchez-Borges1,2*, Enrique Fernandez-Caldas3, Wayne R. Thomas4, Martin D. Chapman5, Bee Wah Lee6, Luis Caraballo7, Nathalie Acevedo8, Fook Tim Chew9, Ignacio J. Ansotegui10, Leili Behrooz11, Wanda Phipatanakul11, Roy Gerth van Wijk12, Demoly Pascal13,14, Nelson Rosario15, Motohiro Ebisawa16, Mario Geller17, Santiago Quirce18, Susanne Vrtala19, Rudolf Valenta19, Markus Ollert20, Giorgio Walter Canonica21, Moises A. Calderón22, Charles S. Barnes23, Adnan Custovic24, Suwat Benjaponpitak25 and Arnaldo Capriles-Hulett1 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. Introduction major issues concerning human diseases caused by mites Mite allergens are able to sensitize and induce allergic will be presented, as a contribution to the understanding of symptoms in sensitized and genetically predisposed indi- theimportanceofmitehypersensitivityasanimportant viduals resulting in allergic rhinoconjunctivitis, asthma, inducer of diseases that constitute a major public health and atopic dermatitis. The main sources of allergens in concern all around the world. house dust worldwide are the fecal pellets of the mite spe- cies Dermatophagoides pteronyssinus, Dermatophagoides Methodology farinae, Euroglyphus maynei, and the storage mites Blomia A working committee that included members of the par- tropicalis, Lepidoglyphus destructor and Tyrophagus putres- ticipating organizations who are actively working in the centiae. Recent advances in the study of mite biology, mite field of mite hypersensitivity was formed, taking into allergen properties and cross-reactivities, have provided account regional representation and previous individual better approaches for the prevention and management of publications. Members were assigned sections which, diseases produced by exposure to mite allergens, including when completed, were compiled by the project leader improved diagnostic and immunotherapeutic methods [1]. and circulated to all members. After corrections were In this ICON document a comprehensive review of the included the final draft was submitted for approval by the governing boards of the participating organizations. * Correspondence: [email protected] 1Allergy and Clinical Immunology Department, Centro Médico Docente La Overview of biology Trinidad, Caracas, Venezuela Mites and ticks are included in the subclass Acari, which 2Clínica El Avila, 6ª transversal Urb. Altamira, Piso 8, Consultoria 803, Caracas 1060, Venezuela forms one of the most abundant and diverse biological Full list of author information is available at the end of the article groups within the arachnids (Arthropods) (Fig. 1). Its © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Sánchez-Borges et al. World Allergy Organization Journal (2017) 10:14 Page 2 of 26 Fig. 1 Taxonomy of Mites with Allergenic Relevance name derives from the Latin word acarus, which in turn habitats. They can be found in the soil of forests and derives from the Greek name Akari, whose first known grasslands, or on any organic waste. Many species spend mention is attributed to Aristotle (, Historia Animalium, part of their life cycle in trees and shrubs, while others Book 5, Chapter 32). He most likely used this name to live in caves or have adapted to live in hot springs. mention the mite species Carpoglyphis lactis. Mites are Depending on the species, they feed on plants, fungi, characterized by having four pairs of legs, such as algae, organic matter, animal waste, other arthropod, spiders and scorpions (insects have three pairs of legs; nematode, or infest the exterior and interior of all kinds crustaceans five pairs of legs) which are relatively smaller of animals (insects, reptiles, birds and mammals) [2]. than their bodies. Most of the mite species have a size of Most domestic mites belong to the order Astigmata. less than 1 mm (most house dust mite species are below They do not have external respiratory openings or stig- half a millimeter). Mites can be considered as one of the mata (Astigmata means “no stigma”). Their small size oldest terrestrial animals. One of the first known mite makes the ratio between the body surface and its interior fossils (identified as Protoacarus crani, Raford) originates sufficient to allow efficient gas exchange through the from the Devonian period, nearly 400 Ma ago. Approxi- skin. In other orders, breathing could also take place mately 30,000 species of mites, placed in more than through body openings (1–4 stigmas), which are located 1,700 genera, have been described. However, it is consid- in the front half of the body, or through a trachea [3]. ered that the number of undescribed species could be Mites have developed a digestive tract, including a more than 100,000. Mites are distributed worldwide and mouth and mouth parts, salivary glands, and an intes- have competed with insects for aquatic and terrestrial tine, consisting of esophagus, small intestine, along with Sánchez-Borges et al. World Allergy Organization Journal (2017) 10:14 Page 3 of 26 a large intestine and an anal opening. Their digestive was pointed out by different investigators on several system produces spherical fecal particles (diameter of occasions. The presence in house dust of mites of the about 20 μm) wrapped in a peritrophic membrane, genus Dermatophagoides farinae was indicated for the which are the main vector of mite allergens. Mites most first time in 1964 by Oshima [11]. However, Voorhorst commonly found inside the houses worldwide include and Spieksma in 1964, showed that house dust contains D. pteronyssinus, D. farinae, E. maynei and B. tropicalis mite species with a high allergenic power, which could be [4, 5]. They feed mainly on human scales and other responsible for the allergenicity of house dust [12]. Fain micronutrients. The amount of human flakes released identified in 1966 the mite D. pteronyssinus as the daily by an adult is of 0.5 to 1 g, and therefore, it is a main allergen source responsible for numerous re- very abundant food source. In addition to human skin spiratory allergies induced by the inhalation of house scales the diet may also include: fungi and other constit- dust [13]. uents of the skin microbiota, body fragments of insects Mites found worldwide in human premises can gener- (beetles, cockroaches, moths), etc. ally be grouped into house dust mites and storage mites. The life cycle of dust mites and some of the storage They are found in carpets, fabrics, upholstery, pillows mites consists of five stages (egg, larva, protonymph, trito- and mattresses. Blomia tropicalis, was formerly known nymph and adults). In each stage, there is an active period as a storage dust mite, but is now also accepted as a followed by another, shorter, quiescent stage, before a new house dust mite as it is found extensively in dust from stadium emerges from the old exoskeleton. The quiescent homes in tropical and subtropical
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