Thomas Wayne R, Smith Wendy-Anne, Hales Belinda J
Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Australia.
Chang Gung Med J. 2004 Aug;27(8):563-9.
The most important house dust mites are Dermatophagoides pteronyssinus and in drier areas D. farinae. In subtropical and tropical regions the glycyphagid mite Blomia tropicalis is a major source of allergen, which co-exists with D. pteronyssinus. The group 1 and 2 allergens of Dermatophagoides mites are clearly major specificities and it is likely that these allergens could be the basis of new strategies of immunotherapy for many mite-allergic subjects. About 20% of patients, however, do not have IgE antibody to the group 1 and 2 allergens, and even though this is a minority, it constitutes a large population. There are also many other house dust mite allergens which have high IgE binding activity but these are present in low and variable concentrations in mite extracts, usually at less than 1% of the group 1 and 2 allergens. It must be appreciated that mite extracts are arbitrary preparations that do not accurately represent the relative concentrations of allergens in inhaled air. There is now the opportunity to produce more representative and more balanced formulations of allergens, possibly by mixtures of recombinant allergens. It is likely that the group 3, 5, 7 and 9 allergens will be important along with the high molecular weight group 11, 14, 15 and 18. The tropomyosin group 10 may be an important cross-reacting allergen. B. tropicalis is, because of its distribution in highly populated regions with increasing affluence, a very important allergen. It has low-grade cross-reactivity with Dermatophagoides but most allergens only have 30-40% sequence identity between the different families so they require different allergens for immunotherapy and new diagnostic measures are required to distinguish the sensitivity between the mite families. Studies on B. tropicalis allergens are required to identify the major allergens that do not appear to be the group land 2 specificities. Component resolved diagnosis is a newly developing procedure that uses allergen arrays to provide a diagnostic format to differentiate between cross-reacting allergens and to identify the optimal formulation of allergens for different patients.
最重要的屋尘螨是粉尘螨，在较为干燥的地区则是粗脚粉螨。在亚热带和热带地区，嗜糖螨类的热带无爪螨是主要的过敏原来源，它与粉尘螨共存。粉尘螨的第1和第2类过敏原显然是主要的特异性过敏原，很可能这些过敏原可成为许多螨过敏患者免疫治疗新策略的基础。然而，约20%的患者对第1和第2类过敏原没有IgE抗体，尽管这只是少数，但人数众多。还有许多其他屋尘螨过敏原具有较高的IgE结合活性，但它们在螨提取物中的浓度较低且变化不定，通常低于第1和第2类过敏原的1%。必须认识到，螨提取物是随意制备的，不能准确代表吸入空气中过敏原的相对浓度。现在有机会通过重组过敏原混合物等方式生产更具代表性和更平衡的过敏原制剂。第3、5、7和9类过敏原以及高分子量的第11、14、15和18类过敏原可能很重要。原肌球蛋白第10类可能是一种重要的交叉反应性过敏原。由于热带无爪螨分布在人口密集且日益富裕的地区，它是一种非常重要的过敏原。它与粉尘螨有低度交叉反应，但不同家族的大多数过敏原之间只有30 - 40%的序列同一性，因此免疫治疗需要不同的过敏原，并且需要新的诊断措施来区分不同螨家族之间的敏感性。需要对热带无爪螨过敏原进行研究，以确定那些似乎不是第1和第2类特异性的主要过敏原。组分分辨诊断是一种新出现的程序，它使用过敏原阵列提供一种诊断形式，以区分交叉反应性过敏原，并为不同患者确定最佳的过敏原制剂。
