R.C. Aalberse

Indoor allergens and asthma:Report of the Third International Workshop

In parallel with changes in lifestyle over the last 50 years (sedentary living in warm houses with extensive furnishing and low ventilation rates), there has been a progressive increase in the prevalence and morbidity of asthma in many parts of the world. The increase has been in perennial rather than seasonal asthma, and a large proportion of the patients are sensitized to one or more of the allergens found predominantly inside houses, that is, indoor allergens. The Third International Workshop on Indoor Allergens and Asthma was designed to discuss recent progress in basic and clinical research in this area, to formulate recommendations for allergen-specific management of asthma, and to consider future research directions. As with the two previous workshops, discussion topics included biology; allergen immunochemistry; molecular biology and immune response; epidemiology of asthma; and the role of allergen avoidance, a, 2 Because of dramatic progress in recent years, the Third International Workshop was expanded to cover not only house dust mite allergens but also allergens from cat, dog, and cockroach, for which immunochemical and epidemiologic data are available. Over the past 5 years there have been significant advances in several areas of research on indoor allergens, including: (1) cloning and expression of recombinant allergens, 3-7 (2) analysis of T-cell responses to indoor allergens, derivation of T-cell clones, and analysis of T-cell epitope specificity and cytokine profiles, s, 9 (3) investigation of the dose-response relationship between exposure to mite, cat, and cockroach allergens and sensitization, 1°-13 and (4) epidemiologic studies on indoor allergens as risk factors for the symptoms of asthma and bronchial hyperreactivity (BHR)? 4-17 Better definition of the allergens has made it possible to analyze their structure and biologic function and to define epitopes recognized by antibodies or T cells. Information obtained from those studies has provided exciting possibilities for developing new vaccines for safe and effective immunotherapy. 9, 18. 19 Studies of T-cell responses to dust mites have confirmed the dominance of T-helper cell (Tin) responses in allergic individuals.

Immunoglobulin E antibodies that crossreact with vegetable foods, pollen, and Hymenoptera venom

IgE in some human sera reacted with an antigen present in a large number of unrelated foods: potato, spinach, wheat, buckwheat, peanut, honey and others. The antigen, which was periodate-sensitive and heat-stable, was also found in pollen. Even more surprisingly, these antibodies often reacted in vitro with bee and vespid venom and were sometimes apparently induced by Hymenoptera stings.

Antigenic and structural analysis of group II allergens (Der f II and Der p II) from house dust mites (Dermatophagoides spp)

Monoclonal antibody affinity chromatography was used to purify two homologous mite allergens, Der f II from Dermatophagoides farinae and Der p II from D. pteronyssinus. They have the same molecular weight (MW) (15 kd) on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, they have similar amino acid compositions, and their N-terminal amino acid sequences differ in only four of the first 35 residues. An excellent correlation was observed between IgE antibody to Der f II and Der p II measured in sera from 65 mite-allergic patients (r = 0.94; p less than 0.001) and between quantitative intradermal skin tests to both allergens. A third allergen (Der f III, MW 29 kd) was purified from D. farinae by repeated gel filtration. In sera from 51 mite-allergic patients, IgE antibody to Der f II, Der f III, and previously purified Der f I (MW 24 kd) was detected in 92%, 16%, and 78% of the sera by radioimmunoassay, respectively. Most patients, 41/51 (80%), demonstrated IgE antibody to more than one allergen. With monoclonal antibodies fully cross-reactive with Der f II and Der p II, a two-site immunoassay was developed for measuring absolute quantities (nanograms or micrograms) of these allergens. In extracts rich in mite-fecal material (n = 5), Der f I and Der p I (group I allergens) and Der f II and Der p II (group II allergens) were measured in ratios of 11:1 to 35:1. Lower ratios (1.1:1 to 7:1) were observed in mite body extracts (n = 6). These experiments clearly define a second group of major dust mite allergens that demonstrate extensive structural and antigenic homology.

Skin tests and histamine release with P1-depleted Dermatophagoides pteronyssinus body extracts and purified P1

Monoclonal antibodies were raised against P1 and Dp X, two major allergens in Dermatophagoides pteronyssinus extracts. The concentrations of IgE antibodies to P1 and Dp X in sera of mite-sensitive patients were determined in RAST with immunosorbent-bound monoclonal antibodies used for insolubilization of the allergens. The major allergen-specific IgE titers were compared with the total IgE response against D. pteronyssinus. The results of these serologic assays confirmed studies in the literature that P1 and Dp X are major allergens. The contribution of IgE anti-P1 to the total antimite response frequently exceeded 50% and, in general, appeared to be higher than the contribution of IgE anti-Dp X. Twenty percent of the mite-sensitive patients had no detectable IgE to either P1 or Dp X. The contribution of P1 to the biologic activity of D. pteronyssinus body extracts was derived from the effect of P1 depletion on the reactivity in the histamine-release test and skin test. This technique was preferred to the study of purified allergen because biologic activity of the nonabsorbed components is not affected. Immunization of rabbits with affinity-purified P1 yielded monospecific polyclonal antisera. Mite extracts depleted with either monoclonal or polyclonal anti-P1 were applied in the histamine-release test. The skin test was performed with extracts depleted with polyclonal anti-P1. In addition, the activity of affinity-purified P1 was investigated in these tests. The results indicated that P1 depletion of D. pteronyssinus body extracts had no detectable effect on the activity in most patients, namely, at least 70% of the activity was retained in the depleted extract. There was a considerable variation between patients in the sensitivity for purified P1, as compared to the sensitivity for whole D. pteronyssinus extracts. In the histamine-release test, the activity of purified P1 was up to 35% of the activity of the D. pteronyssinus body extract but did not exceed 10% in most patients. This was in agreement with the relative activity of purified P1, as found in the skin test. Therefore, the contribution of P1 to the biologic activity of D. pteronyssinus body extracts, as measured by end point titration, appeared to be less than expected on the basis of the serologic studies and articles in literature. The depletion experiments stress that there is still much uncertainty as to the biologic activity of house dust-mite extracts.

Discrepancies between the skin test and IgE antibody assays: Study of histamine release, complement activation in vitro, and occurrence of allergen-specific IgG

Intracutaneous skin tests (STs) and RAST with the common allergens, grass pollen, house dust mite, and cat dander, were performed on 660 adult patients. In 117 patients (18%), we found 140 discordances (7%) in a total number of 1980 ST and RAST combinations. In agreement with studies in the literature, greater than 80% of the discordances consisted of positive skin reactions without detectable allergen-specific IgE antibodies in serum. The percentages of discordant results were similar for the three allergens. Reproducibility of both the RAST and the ST was evaluated in the discordant group. Repetition of the routine RAST procedure elicited results similar to those in the first test in 81% (105/130). A second ST elicited identical results in 89% (47/53). In addition to the routine IgE antibody assay, sera of patients with a positive ST but without detectable IgE antibodies were tested in two other RAST systems: (1) a RAST with allergen extracts from the same production batch as the ST reagents, and (2) the Pharmacia RAST. In spite of having a clearly positive ST, sera from 68 (80%) of 85 patients remained completely negative in all three RAST systems. Histamine release (HR) in vitro from washed leukocytes was studied in 35 patients with a reproducible positive ST and negative RAST results with serum. Interpretation of this test was possible in 28 patients. In 82% (23/28) of these patients, clearly detectable HR was found with the relevant allergen extract. A role of IgE in the skin reactions and HR tests was confirmed by positive RAST results with IgE that was affinity purified from serum of seven of these patients. Allergen-specific IgG4 antibodies are unlikely to be implicated, since no antibodies against grass pollen and house dust mite were detectable in sera of these patients. Only 18% of the patients with an unexplained skin reaction with cat dander have detectable IgG4 antibodies, but these antibodies were found in a similar frequency in a nonallergic, ST negative control group. Low total IgG responses precluded false negative RAST results caused by competition of IgG antibodies with IgE antibodies. There were no significant differences in the degree of complement activation in vitro by house-dust extracts between healthy control subjects, nonallergic patients, and patients with unexplained skin reactivity. It is concluded that a high proportion of the positive skin reactions with common inhalant allergens, which are not accompanied by a positive RAST, are probably caused by IgE antibodies that are not detectable in serum with any of the RAST procedures.(ABSTRACT TRUNCATED AT 400 WORDS)

Fine specificity of B-cell epitopes on Felis domesticus allergen I (Fel d I): Effect of reduction and alkylation or deglycosylation on Fel d I structure and antibody binding

The repertoire of B-cell epitopes on the major cat allergen, Fel d I, was analyzed with monoclonal antibodies (MoAbs) in topographic mapping studies and in immunoassays with antigen derived from other cat (Felidae) species. Four essentially nonoverlapping epitopes on Fel d I, designated Fd1A to D, were defined by use of 15 anti Fel d I MoAbs in cross-inhibition radioimmunoassay. Only MoAbs directed against epitope Fd1B bound to putative Fel d I homologues in hair and dander extracts from seven other feline species (Panthera species, [n = 5], Leptailurus serval, and Leopardus pardalus). Quantitative monosaccharide analysis showed that Fel d I was a glycoprotein, containing high levels of fucose, as well as glucosamine, galactose, and mannose. Binding of MoAbs and human IgG or IgE antibody to native, reduced and alkylated or deglycosylated Fel d I was compared by means of immunoprecipitation and immunoassay, and the effects of these treatments on the structure of Fel d I were analyzed by sodium dodecylsulfate-polyacrylamide gel electrophoresis. On reduction and alkylation, Fel d I dissociated into 14 kd and 3.2 kd peptides, and deglycosylation with trifluoromethane sulfonic acid produced a 12 to 14 kd peptide. These procedures resulted in a 100- to 1000-fold loss in murine or human antibody binding activity and caused significant loss of secondary structure, as judged by circular dichroism spectroscopy. Treatment with potassium hydroxide also caused a marked loss in antigenic reactivity. In contrast, enzymatic deglycosylation generated a 9 kd peptide, which showed strong reactivity with murine and human antibodies, comparable to native Fel d I. The results show that MoAbs define a broad repertoire of B-cell epitopes on Fel d I, one of which is expressed by other cat species. These epitopes are conformational and do not appear to involve oligosaccharide residues.

Activation of the classical pathway of human complement in vitro by house-dust extracts is caused by IgM antibodies to polysaccharide antigen(S) and is not related to atopy

The mechanism of activation of the classical pathway of human complement by house-dust extracts and its relevance to atopic disease was studied. Our results confirm that for most sera of adults, house-dust extract is, on a weight basis, a more potent C-activator than aggregated human IgG or lipopolysaccharide (endotoxin). Naturally occurring IgM antibodies directed against ubiquitous polysaccharides appeared to be the dominant factor in the C1 activation by house-dust extracts in human sera. Large variations were found between sera with respect to the concns of these IgM antibodies as measured by C1 activation or fixation of haemolytic complement. The IgM antibody titre was, however, not associated with atopic disease. Consequently, we do not support the hypothesis put forward by Berrens et al. (1978) (Allergol. Immunopath. 6, 45-54) that there might be a relation between atopy and enhanced reactivity of serum complement with allergenic extracts. More than 90% of the C-activating potential of allergen extracts like house dust was found in the fractions with high mol. wt material (mol. wt greater than 100 K). Therefore, these antigens are easily separated from the known IgE-binding major allergens of house-dust mite and cat dander.