Permeability of synthetic and feather pillows to live house dust mites and house dust

BACKGROUND: Previous studies have demonstrated significantly higher house dust mite (HDM) allergen levels from synthetic pillows, compared to feather pillows. Reasons for these differences could be lower permeability of feather pillow coverings to allergen in dust, greater HDM penetration of synthetic pillow covering, or both. OBJECTIVES: To determine the permeability of synthetic and feather pillow coverings to live HDMs and house dust. METHODS: Twenty live adult HDMs were seeded on top of two types of synthetic pillow covering (one standard polyester and one newer polyester/cotton type) and one type of feather pillow coverings with adequate food supply below in sealed culture dishes, kept at 23 degrees C and 70% relative humidity. After 24 and 48 h live HDM numbers remaining on top of the coverings were enumerated microscopically. Three aliquots of fine house dust (each in triplicate) were placed on top of the synthetic and feather pillow coverings, shaken gently for 30 min and penetrated dust was collected and weighed. RESULTS: After 24 h, all 20 HDMs had penetrated the standard synthetic pillow coverings, and no HDMs had penetrated either the feather pillow or the new synthetic pillow coverings after 24 or 48 h. Dust permeability (% of applied dust) for the standard synthetic, new type synthetic and feather pillow coverings were 0.88%, 0.07%, and 0.07%, respectively. This compared to 0.02% for a commercial occlusive pillow cover. CONCLUSIONS: These findings of total permeability of standard synthetic pillow coverings to live HDMs, and their greater permeability to house dust could explain their reported higher HDM allergen levels, compared to feather pillow coverings. Newer types of synthetic pillow coverings are similar to feather pillow coverings in their permeability to live HDMs and house dust.     

Seasonal differences in airway hyperresponsiveness in asthmatic patients: relationship with allergen exposure and sensitization to house dust mites

Background The degree of airway hyperresponsiveness in allergic asthmatic patients may be influenced by changes in environmental exposure to inhalant allergens. Objective This study investigates the relationship between seasonal changes in exposure to house dust mite (HDM) allergens and non-specific airway hyperresponsiveness in asthmatic patients with multiple sensitizations to inhaled allergens. Methods In 43 asthmatic patients sensitized to several inhalant allergens, lung function (FEV₁), airway hyperresponsiveness (PC₂₀ histamine), serum total IgE, house dust mite (HDM) specific IgE and number of peripheral blood eosinophils were measured during autumn 1990 (September-November) and spring 1991 (March—May). During each season. floor dust samples were collected twice from living- and bedrooms and the concentration of the HDM allergens Der p 1 and Der p 2 determined. Results More severe airway hyperresponsiveness (lower PC₂₀ histamine) during autumn was only found in patients sensitized to HDM(n= 32; autumn: 2.05mg/mL, spring: 4.51mg/mL (geometric means), P <0.0 1), whereas in patients not sensitized to HDM (n= 11) similar values were observed in both seasons (3.44 and 4.52 mg/mL. respectively, P= 0.56). More severe airway hyperresponsiveness of HDM sensitized patients in autumn was significantly associated with higher Der p 1 concentrations in floor dust. Aside from airway hyperresponsiveness, seasonal changes in serum total IgE and number of peripheral blood eosinophils were seen in patients sensitized to HDM, Conclusions In allergic asthmatic patients, airway hyperresponsiveness may increase during autumn, depending on sensitization to HDM and an increase of exposure to HDM allergen.     

The use ofdomestic steam cleaning for the control of house dust mites

Background Control of dust mites using extremes of temperature is un alternative to the use of acaricides. In ihe past we have attempted control by freezing with liquiid nitrogen. The present paper deals with the opposite exlrcnic, the use of steam.
Objective To assess the feasibility inid effectiveness of a domestic steam cleaner for the control of dust mites. its effect on mite populations and concentrations of the allergen Der p I.
Methods A domestic steam cleaner was used to treat earpet squares that had been seeded in the laboratory with known numbers of dust mites ( Dermatophagoides pterpmussomis ). The number of live mites was monitored for a period of 4 months in eight treated earpet squares and eight controls. Dust samples were taken from 12 standardized areas of carpet in a tenement flat in Glasgow, UK., before and after steam cleaning treatmet. and the concentration of allergen Der p 1 was compared with 12 adjacent. control areas.
Results No live mites were found at any time in the treated carpet squares, whereas in the control squares geometric mean mite population density rose frotn 11 after 3 days to 39 after 1 month, 66 after 2.122 after 3 and 185 after 4 months. There was a mean reduetion of 8.7% in Der p I concentration (3.3-0.44 μg/g) compared with a reduction of 4.7% (2.22-2.l16μg/g) in control areas, a difference that was statistically significant at the 5% level.
Conclusion These data indicate that steam cleaning has considerable potential as an highly effective and efficient method of killing dust mites and reducing concentrations of Der p 1 in domestic premises.     

Characterization of Der p 21, a new important allergen derived from the gut of house dust mites

Background: The house dust mite (HDM) Dermatophagoides pteronyssinus is a major allergen source eliciting allergic asthma. The aim of the study was to identify new important HDM allergens associated with allergic asthma. Methods: A cDNA coding for a new mite allergen, designated Der p 21, was isolated using immunoglobulin E (IgE) antibodies from patients with allergic asthma out of a D. pteronyssinus expression cDNA library and expressed in Escherichia coli. Results: Circular dichroism analysis of the purified allergen showed that rDer p 21 (14 726 Da) is one of the few mite allergens with an α‐helical secondary structure. The protein exhibited high thermal stability and refolding capacity, and, as determined by small angle X‐ray scattering, formed a dimer consisting of two flat triangles. rDer p 21 bound high levels of patients’ IgE antibodies and showed high allergenic activity in basophil activation experiments. Rabbit anti‐Der p 21 IgG antibodies inhibited mite‐allergic patients’ IgE binding and allowed the ultrastructural localization of the allergen in the midgut (epithelium, lumen and faeces) of D. pteronyssinus by immunogold electron microscopy. Der p 21 revealed sequence homology with group 5 mite allergens, but IgE and IgG reactivity data and cross‐inhibition studies identified it as a new mite allergen. Conclusions: Der p 21 is a new important mite allergen which is liberated into the environment via faecal particles and hence may be associated with allergic asthma.     

House dust mites and their allergens at selected locations in the homes of house dust mite-allergic patients

BACKGROUND: Knowledge of the occurrence of house dust mites (HDM) and their allergens in domestic locations is important when planning intervention. OBJECTIVE: The aim of this study was to describe the distribution of HDMs and their allergens before intervention in multiple locations in the homes of newly diagnosed HDM-allergic patients with a known high Der 1 concentration in their mattress dust. METHODS: Dust was collected from ten locations in the homes of eight HDM-allergic patients. Dust was analysed for allergen content with ELISAs for Der f 1, Der p 1 and Der m 1; and HDM were counted. Total allergen concentrations ( micro g Der 1/g dust) were expressed as the sum of Der f 1, Der p 1 and Der m 1. RESULTS: On mattresses the median concentration was 86 micro g Der 1/g dust (range 30-288) and 188 mites/g dust (range 12-1910). Der 1 exceeded 10 micro g/g dust in mattresses (8/8), duvets/pillows (3/8), a bedroom carpet (1/1), a living room carpet (1/6), upholstered furniture (2/8) and a curtain (1/5). Uncarpeted floors, upholstered furniture, bookshelves and walls had significantly lower Der 1 concentration than the mattresses. The relative contribution of Der p 1, Der f 1 or Der m 1 to Der 1 was related to homes, rather than to the location. Der m 1 only occurred in minute amounts. CONCLUSION: For HDM intervention, our results indicate that priority should be given to the removal of allergens from mattresses, and in addition from carpets, duvets/pillows and upholstered furniture. Dust from walls, uncarpeted floors, bookshelves and curtains appear to contribute insignificantly to the domestic HDM allergen load.     

The control of house dust mites in rugs through wet cleaning

Nine rugs from the bedrooms of seven private homes were cut into strips. Half of the strips were wet-cleaned according to a commercial procedure, and the others were kept as controls. Subsequently the cleaned and noncleaned strips were stitched together again and returned to their respective bedrooms. After 0, 1, and 3 months, parts of the strips were taken to the laboratory for tests. The tests were designed to measure the suitability of the rugs as a habitat for house dust mites. To do this, a number of house dust mites were introduced into fragments of the rugs, and the number of survivors and offspring after 4 weeks was determined. Immediately after cleaning, the habitat was markedly less suitable than before. After 1 month, the habitat suitability was partly but not totally recovered. After 3 months, no effect of cleaning could be discerned. (J ALLERGY CLIN IMMUNOL 1996;97:1214-7.)     

哮喘患儿家庭内尘螨过敏原分布特征及其临床意义

目的了解北京地区尘螨过敏性哮喘患儿家庭环境内尘螨过敏原含量分布特征,初步探讨尘螨过敏原暴露水平的临床意义。方法选取54例尘螨过敏性哮喘患儿,其中男性37例,女性17例;年龄3～16岁,平均年龄8岁2个月。采集患儿家庭中床垫、枕头、卧室地板、客厅地板及沙发的灰尘,采用酶联免疫吸附分析（ELISA）测定以上灰尘样本中户尘螨1组过敏原（Der p1）和粉尘螨1组过敏原（Der f1）的含量;应用荧光ELISA测定患儿血清尘螨特异性IgE浓度;评估患儿哮喘临床控制情况,应用化学发光法测定患儿呼出气一氧化氮浓度（FeNO）。结果采集灰尘样本255份,以中位数（最小值～最大值）表示尘螨过敏原含量,床垫、枕头和沙发灰尘样本中Derf1和Derp1的含量显著高于卧室地板和客厅地板灰尘样本中尘螨过敏原含量。Derf1平均含量为0.13μg/g,显著高于Derp1平均含量0.02μg/g（P〈0.05）。Derp1和Derf1联合暴露的最高含量平均为2.18（0.07～54.59）μg/g。Der p1和Der f1联合最高暴露含量≥10.00μg/g、2.00～10.00μg/g、0.05～2.00μg/g的例数分别为4例（7.4%）、24例（44.4%）、26例（48.1%）。其中未控制组患儿家庭内尘螨过敏原最高暴露水平为27.41（0.23～54.59）μg/g,均显著高于部分控制组和控制组哮喘患儿尘螨过敏原最高暴露水平1.66（0.07～26.27）μg/g、2.90（0.37～33.75）μg/g（P〈0.05）。不同sIgE浓度分级组间尘螨过敏原最高暴露水平的差异、不同FeNO浓度范围组间尘螨过敏原最高暴露水平差异均无统计学意义。结论北京地区尘螨过敏性哮喘患儿家庭尘螨以Der f1为主,床垫、枕头及沙发灰尘样本是Der p1和Der f1的主要来源;哮喘未控制者的尘螨过敏原最高暴露水平明显增高。     

Sensitization to house dust mites in Reykjavik, Iceland, in the absence of domestic exposure to mites

BACKGROUND: House dust mites are common sources of indoor allergens. In Reykjavik, Iceland, 9% of the young adult population had serum-specific IgE to Dermatophagoides pteronyssinus. Sensitization to mites is usually assumed to be due to exposure to house dust mites in the indoor environment. This investigation was carried out to measure the concentrations of house dust mite allergens and to investigate which species of mites were present in beds in Iceland. METHODS: A total of 197 randomly selected adults were visited at home using the European Community Respiratory Health Survey (ECRHS) II Indoor protocol. Dust samples were collected from mattresses for measurement of house dust mite allergen concentrations and to estimate the number and type of house dust mites. Additional samples from mattresses and floors were collected from the homes of 10 patients with positive skin prick tests (SPT) to D. pteronyssinus. House dust mite allergen concentrations were measured using ELISA and examination of mite species was carried out using microscopy. Climatic parameters were assessed using psychrometer readings in the bedrooms and outdoors. RESULTS: We found two single mite specimens, both D. pteronyssinus, in two dust samples. Mite allergen analyses indicated that two other dust samples had Der f 1 results close to the cut-off of 0.1 microg/g of dust. No samples were positive for Der p 1. In an additional collection of dust from the homes of 10 SPT-positive patients no Dermatophagoides spp. were found. CONCLUSIONS: Reykjavik citizens are exposed to extremely low amounts of house dust mite allergens in their homes. Possible alternative sources for sensitization are discussed, such as bird nests, exposure from travelling abroad, or other mites or invertebrates that cross-react with house dust mite allergens. Our findings suggest that exposures other than to house dust mites indoors are possible sources of mite allergen exposure.     

New mattresses: how fast do they become a significant source of exposure to house dust mite allergens?

Background Sensitization and exposure to mile allergens is a major risk factor for asthma. Little is known about the rate of build-up of allergens in the mite microhabitats. Objectives To investigate the rate of increase in mite allergen levels in new mattresses. Methods Der p 1 was measured in the dust samples collected from six identical new single mattresses over a period of 2 years. Results Der p 1 increased significantly at 4 months as compared with baseline level (P < 0.01), but no difference was found between the concentrations at 4. 8, 12 and 24 months. There was a significant correlation between Der p 1 concentration in mattresses at 4.8, 12 and 24 months and Der p 1 levels in the bedroom carpet at the beginning of the study. Conclusions New mattresses can become a significant source of exposure to mite allergens after a short period of time (< 4 months). There is little justification for advising mite sensitive patients to replace their mattresses as a part of avoidance regime.     

T-cell sensitization to epitopes from the house dust mites Dermatophagoides pteronyssinus and Euroglyphus maynei

Background Dermatophagoides pteronyssinus and Euroglyphus maynei frequently occur in house dust but little is known about primary sensitization to the less abundant E. maynei. Objective To determine the occurrence of primary sensitization to E. maynei by T-cell responses and the crossreactivity to D. pteronyssinus. Methods The proliferative response ot peripheral blood cells to overlapping peptides from Derp I and Eur m 1 were measured as well as to peptides from Der f 1, an allergen not found in the study environment. Results The most frequent and strongest responses were to Der p 1 peptides especially in the region 105–133. However, 3/17 responders to mite peptides were stimulated predominantly by Eur m 1 peptides and a further two had their highest response to an Eur m 1 peptide. There was very little crossreactivity between Der p 1 and Eur m 1 peptides and very little response to peptides from Der f 1. Conclusion E. maynei group 1 allergens are a significant source of primary T-cell sensitization and have little T-cell crossreactivity with D. pteronyssinus or D. farinae.     

Disodium octaborate tetrahydrate (DOT) application and vacuum cleaning,a combined strategy to control house dust mites

BACKGROUND: The effectiveness of acaricides in homes is controversial. OBJECTIVE: To determine whether disodium octaborate tetrahydrate (DOT) combined with vacuuming lowers dust mite numbers and their allergens in carpets and sofas. METHODS: A 6-month study was carried out with 93 homes, which were randomized into three groups: (i). active, received DOT; (ii). placebo, received water; and (iii). control, received no application. Active and placebo homes were vacuumed weekly. Dust was collected from carpets and sofas at the start of the study and every 2 months thereafter and quantified for live, total mites, and mite allergen levels. RESULTS: At 2 months, live mite numbers in active carpets were 3 +/- 1, in placebo carpets 129 +/- 48, and in control carpets 177 +/- 39 mites/g. The corresponding numbers in sofas were 3 +/- 2, 81 +/- 31, and 134 +/- 45 mites/g, respectively (P < 0.001 active vs placebo and vs. control). Live mites in carpets and sofas remained lower in the active group at 6 months (P < 0.001). Total mites in active carpets decreased from 555 +/- 69 at baseline to 223 +/- 32 mites/g at 6 months (P < 0.001) and mite allergen levels from 1.36 +/- 0.13 to 0.85 +/- 0.16 microg/g (P < 0.001). Total mites in active sofas remained unchanged, but mite allergen levels decreased from 1.48 +/- 0.25 at baseline to 0.7 +/- 0.15 microg/g at month 6 (P < 0.05). CONCLUSION: DOT kills mites in carpets and sofas, and, combined with vacuuming, effectively reduces total mites in carpets and mite allergen levels in carpets and sofas.     

The efficacy of sublingual immunotherapy for house dust mites respiratory allergy: results of a GA²LEN meta-analysis

Recent meta-analyses documented the efficacy and safety of sublingual immunotherapy (SLIT) in patients with allergic rhinitis (AR) and asthma (AA). Although SLIT appeared globally effective, the sub-analyses for single allergens provided uncertain results. This study is aimed to investigate the efficacy of SLIT with house dust mite (HDM) extracts in AR and AA through an updated reassessment of randomized controlled trials. Electronic databases were searched up to March 31, 2008, for randomized DBPC trials, assessing the efficacy of SLIT in AR and AA due to HDM sensitization. Outcomes were symptom scores and rescue medications use. For AR, eight studies fulfilled the selection criteria. A significant reduction in symptoms of AR (SMD −0.95; CI 95%−1.77 to −0.14 P  = 0.02) was found in 194 patients (adults and children) receiving SLIT compared to 188 receiving placebo. For AA, with nine studies, similar results were found for symptoms (SMD −0.95; CI 95%−1.74 to −0.15 P  = 0.02) in 243 patients (adults and children) receiving SLIT compared to 209 receiving placebo. A reduction in rescue medication use was found for AR (SMD −1.88; CI 95%−3.65 to −0.12 P  = 0.04) in 89 patients, and AA (SMD −1.48; CI 95%−2.70 to −0.26 P  = 0.02) in 202 patients. A relevant inter-study heterogeneity was detected. Promising evidence of efficacy for SLIT, using mite extract in allergic patients suffering from AR and AA, are herein shown. These findings suggest that more data are needed, derived from large-population-based high quality studies, and corroborated by objective outcomes, mainly for AA.     

Der p 1 and Der p 2 induce less severe late asthmatic responses than native Dermatophagoides pteronyssinus extract after a similar early asthmatic response

Background The models for exposure to house dust in research and clinical practice are selected with respect to their role in IgE‐mediated immediate hypersensitivity. The use of isolated major allergens instead of complex allergen extracts is becoming increasingly popular as it offers some important advantages for quantitative measures in diagnosis and research. Objective To compare house dust mite extract and isolated mite major allergens with respect to their ability to induce early and late asthmatic responses and bronchial hyperreactivity. Methods Bronchial responses to house dust mite (HDM, Dermatophagoides pteronyssinus) extract and isolated major allergens from HDM (Der p 1 and Der p 2) were compared in a double‐blind, randomized, cross‐over study in 20 patients with mild to moderate asthma who were allergic to HDM. Allergen was titrated to a standardized early asthmatic response. Bronchial hyper‐responsiveness to histamine (PC₂₀histamine) was determined before and after allergen inhalation to assess allergen‐induced bronchial hyper‐responsiveness and IL‐5 was measured in serum. In addition, the allergens were applied in intracutaneous skin tests and activation of basophil leucocytes and proliferation of peripheral blood mononuclear cells was tested in vitro. Results After a similar early asthmatic response (mean Δforced expiratory volume in 1 s (FEV₁)_,max?29.4 (SD 7.2) vs. ?33.1 (8.6) %; mean difference 3.6 (95% CI ?0.9 to 8.2) %), the late asthmatic response (mean ΔFEV_1,max?45.9 (21.9) vs. ?32.7 (22.3) %; mean difference 13.2 (3.8–22.3) %), the degree of allergen‐induced bronchial hyper‐responsiveness (mean ΔPC₂₀histamine, 1.8 (1.0) vs. 1.2 (0.9) doubling dose; mean difference 0.6 (0.2–1.1) doubling dose) and serum IL‐5 at 6 h were found to be significantly higher after bronchial challenge with HDM extract than after challenge with an isolated HDM major allergen. Likewise, there was an increased late skin reaction with HDM compared with isolated major allergen after a similar early skin reaction. Conclusion Constituents of HDM extract, other than Der p 1 or Der p 2, with no significant influence on the IgE‐mediated early asthmatic response contribute significantly to the allergen‐induced late asthmatic response and bronchial hyper‐reactivity.     

Birth month and sensitization to house dust mites in asthmatic children

Background: Early exposure to high quantities of allergen has an important role in the incidence of atopic sensitization. In fact, subjects sensitized to house dust mites (HDMs) have a significantly higher proportion of births in the season when HDMs are most abundant. Objective: The aim of this study was to investigate whether birth month patterns differ for asthmatic patients sensitized only to HDMs and for those sensitized to HDMs and other allergen(s). Methods: Among 2225 patients with asthma, aged 10–16 years, 1642 sensitized to HDMs were identified by skin prick testing. This group was composed of patients sensitized only to HDMs (n = 715) and patients sensitized to HDMs and other allergen(s) (n = 927). The birth month distributions of the group of HDM-sensitive asthmatics or its subgroups were compared with that of a reference population (total live births in the same years as the studied subjects). The risk ratio of a given birth month in relation to all the other months was calculated as an odds ratio (OR) with the corresponding 95% confidence interval (CI). Results: A significant difference in birth month distribution was observed for HDM-sensitive asthmatics (χ² = 23.6, P = 0.015), with higher rates of birth in August (OR: 1.23, 95% CI: 1.04–1.46) and September (1.24, 1.04–1.46). When the two subgroups were analyzed separately, significantly more births were noted in August (1.34, 1.06–1.71) and September (1.34, 1.05–1.70) for those sensitized only to HDMs, whereas no such birth month preference was observed for those sensitized to HDMs and other allergen(s). Conclusions: The HDM-positive asthmatics showed a greater proportion of births in August and September, which correspond to high HDM exposure. However, this birth month pattern was evident in asthmatic-sensitive only to HDMs, but was not observed in those sensitive to HDMs and other allergen(s).     

Asthma and allergic symptoms in relation to house dust endotoxin: Phase Two of the International Study on Asthma and Allergies in Childhood (ISAAC II)

Background Several studies have consistently reported inverse associations between exposure to endotoxin in house dust and atopy. With regard to the association between house dust endotoxin and asthma, the results are inconsistent. Objectives To study the association between house dust endotoxin levels and respiratory symptoms and atopy in populations from largely different countries. Methods Data were collected within the International Study on Asthma and Allergies in Childhood Phase Two, a multi‐centre cross‐sectional study of 840 children aged 9–12 years from six centres in the five countries of Albania, Italy, New Zealand, Sweden and the United Kingdom. Living room floor dust was collected and analysed for endotoxin. Health end‐points and demographics were assessed by standardized questionnaires. Atopy was assessed by measurements of allergen‐specific IgE against a panel of inhalant allergens. Associations between house dust endotoxin and health outcomes were analysed by logistic regression. Odds ratios (ORs) were presented for an overall interquartile range increase in exposure. Results Many associations between house dust endotoxin in living room floor dust and health outcomes varied between countries. Combined across countries, endotoxin levels were inversely associated with asthma ever [adjusted OR (95% confidence interval (CI)) 0.53 (0.29–0.96) for endotoxin levels per m² of living room floor] and current wheeze [adjusted OR (95% CI) 0.77 (0.64–0.93) for endotoxin levels per gram of living room floor dust]. There were inverse associations between endotoxin concentrations and atopy, which were statistically significant in unadjusted analyses, but not after adjustment for gender, parental allergies, cat and house dust mite allergens. No associations were found with dust quantity and between endotoxin exposure and hayfever. Conclusion These findings suggest an inverse association between endotoxin levels in living room floor dust and asthma in children.     

Molecular characterization of Der p 10: a diagnostic marker for broad sensitization in house dust mite allergy

Background Tropomyosins represent clinically relevant seafood allergens but the role of mite tropomyosin, Der p 10, in house dust mite (HDM) allergy has not been studied in detail. Objective To express and purify a recombinant Der p 10 with equivalent IgE reactivity as natural Der p 10 and to evaluate its IgE reactivity and allergenic activity in HDM‐allergic patients. Methods rDer p 10 was expressed in Escherichia coli, purified and characterized by mass spectrometry and circular dichroism. It was tested for IgE reactivity in 1322 HDM‐allergic patients. Detailed IgE‐reactivity profiles to six HDM allergens (Der p 1, 2, 5, 7, 10, 21) were established for subgroups of Der p 10‐positive and ‐negative patients. The allergenic activity of rDer p 10 was evaluated in basophil degranulation experiments. Results rDer p 10 is an α‐helical protein sharing IgE epitopes with nDer p 10. It is recognized by 15.2% of HDM‐allergic patients. Der p 10‐negative patients were primarily sensitized to Der p 1 and/or Der p 2, whereas Der p 10‐positive patients reacted to several other HDM allergens besides the major allergens (Der p 1, Der p 2) or showed a rather selective Der p 10 reactivity. The allergenic activity of Der p 10 was generally low but patients could be identified who suffered from clinically relevant HDM allergy due to Der p 10 sensitization. Conclusion and Clinical Relevance Der p 10 may be a diagnostic marker for HDM‐allergic patients with additional sensitization to allergens other than Der p 1 and Der p 2. Such patients may require attention when allergen‐specific immunotherapy is considered. Cite this as: Y. Resch, M. Weghofer, S. Seiberler, F. Horak, S. Scheiblhofer, B. Linhart, I. Swoboda, W. R. Thomas, J. Thalhamer, R. Valenta and S. Vrtala, Clinical & Experimental Allergy, 2011 (41) 1468–1477.