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International Journal of Zoology and Animal Biology Research Article 18 min read

House Dust Mite Allergy in Kolkata Metropolis in Response to Change in Lifestyle

Saha GK*
* Corresponding author
ISSN: 2639-216X  10.23880/izab-16000189  Received: November 27, 2019  Published: December 12, 2019
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Keywords
Dermatophagoides Lifestyle Change Asthma Stress IgE RAST Immuno Cap System
Abstract

House dust allergy is a fairly common problem among sensitive individuals, resulting in various types of allergic manifestations like allergic rhinitis, atopic eczema, bronchial asthma etc. Although the prevalence of allergic diseases is more common in westernized and developed countries, the incidence is increasing at a rapid pace in developing countries like India too. However, data in this regard is still fragmentary except few scattered information in Indian context. In a rough estimate, in India, 250 million people are suffering from one or more allergic manifestations and the country is the home to around 15-20 million asthmatics. To offer the patients with best possible diagnosis and treatment, the detection of offending allergens are of prime importance. At the same time, early detection of individuals who are genetically at risk of developing allergy to readily available indoor allergens is also an essential element to adopt effective avoidance strategies and to design appropriate therapies. House dust is a complex mixture of substances of plant and animal origin and consists of animal and human dander, debris from wool, feathers, hairs, insects, cotton, silk, jute and synthetic fibers, carpets, beddings, furniture and upholstery, fungal spores, bacteria, microorganisms and shedding from other house hold articles and long been known to cause sneezing and wheezing in sensitive subjects. However, the exact nature of the principal allergen in house dust was unknown for quite a long time. It is now well documented that the mites of the genus Dermatophagoides are the most potent allergens in house dust responsible for allergic manifestations. During last more than 30 years, studies on different aspects of house dust mite allergy have been carried out on Kolkata population including entomological, clinical and immunological findings. The study indicates that the house dust sample contains an allergen, secreted and excreted by the house dust mites and inhalation of this allergen along with dust particles initiates allergic manifestations. The genus Dermatophagoides alone constituted 60% of the total acarine fauna, predominated by D. pteronyssinus (47%) followed by D. farinae and interestingly both the mite species coexisted in the same habitat. Seasonal trend indicates mite counts was higher in pre-monsoon and minimum during winter and areabundant in beds than elsewhere in the house and mostly associated with pillows, blankets, mattresses, padded furniture and carpeted floors etc. and preferably feed on human dander. The study indicates that more than 80 % allergic asthma patients residing in Kolkata metropolitan areas are sensitive to dust mites, especially genus Dermatophagoides Spp. as evident from skin prick test and detection of allergen specific IgE antibodies by Immuno Cap system. It is assumed that changes in life style including diet and dietary habits, acquisition of western lifestyle, low standard of indoor environment, increasing air pollution and over all intolerable psychological stress are blamed for such an increased occurrence and frequent recurrences of allergic manifestations in Kolkata metropolitan areas. Increase use of padded furniture, sofa sets, heavy curtains, wall to wall carpeting, blankets without any cover instead of traditional quilt, use of foam mattress instead of conventional cotton mattress and soft toys favour the growth and multiplication of house dust mites, which ultimately increases the chances and duration of exposure to those indoor allergens. In more than 70% cases these may be attributed to the metamorphic change in lifestyle.

Introduction

House dust allergy being a serious threat among sensitive individuals, results in various types of allergic manifestations like allergic rhinitis, atopic eczema, bronchial asthma etc. About 4% of the world population suffers from different types of allergic disorders. The nasobronchial passage of susceptible individuals are sensitive to various external substances namely pollens, moulds, feathers, furs, animal dander, dust and house dust mites etc., repeated exposure to which may initiate allergic manifestations in sensitive individuals.

An increasing trend in the incidence of different respiratory allergic disorders including bronchial asthma have been reported from different parts of the world especially from developing countries like India, because of diverse factors such as change in ambient air quality, increased air pollution, metamorphic change in living habits and lifestyle, food and feeding habits and unexpected climate change. Several aeroallergens like pollens, fungi, etc. present in the air play a pivotal role in the pathogenesis of several allergic complaints including bronchial asthma. Although the prevalence of allergic diseases are more common in westernized and developed countries, the incidence is increasing at a rapid pace in developing countries including India, becoming doubled, tripled and even quadrupled in the last few decades. However, data in this regard is still fragmentary except few scattered information in Indian context. In a rough estimate 250 million people are suffering from one or more allergic manifestations in India. India is the home to around 15-20 million asthmatics and it is increasing day by day. To offer the patients with best possible diagnosis and treatment, the detection of offending allergens are of prime importance. At the same time, early detection of individuals who are genetically at risk of developing allergy to readily available indoor allergens is also an essential element to adopt effective avoidance strategies and to design appropriate therapies.

House dust is a complex mixture of substances of plant and animal origin and consists of animal and human dander, debris from wool, feathers, hairs, insects, cotton, silk, jute and synthetic fibers, carpets, beddings, furniture and upholstery and apparently responsible for sneezing and wheezing in most of the individuals. Besides, fungal spores, bacteria, microorganisms and shedding from other house hold articles also contribute to its composition. The association between inhalation of house dust and initiation of nasobronchial allergic manifestations like sneezing and wheezing in sensitive subjects has long been suspected. However, the exact nature of the principal allergen in house dust was unknown for quite a long time [1, 2]. highlighted the role of house dust in causing respiratory allergy and suggested the presence of distinct allergen in it. It was Voorhorst, et al. (1964) [3] who first pointed out that house dust mites belonging to the genus Dermatophagoides of the Family Pyroglyphidae are the most potent allergen in house dust responsible for various allergic manifestations. Subsequently allergy skin tests and nasal and bronchial challenge tests have clearly established that pyroglyphid mites are chiefly responsible for house dust allergy [3, 4]. These findings were further confirmed by the estimation of total serum IgE level and detection of mite specific IgE antibodies present in patient’s sera [5, 6, 7]. In India, Shivpuri, et al. [8] first of all claimed that the mite is perhaps the sole potent allergen responsible for precipitation of attack of bronchial asthma. Since then the studies on house dust mite fauna and their probable role on the aetiopathogenesis of different allergic disorders have been reported from different parts of India [9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24]. From Kolkata, Saha, [20, 21, 22] and Saha, et al. [23, 24] reported that more than 88% of the asthmatic patients are sensitive to Dermatophagoides mites as evidenced from analysis of house dust, allergy skin test and detection of allergen specific IgE antibodies by RAST method. Besides Euroglyphus maynei, Tyrophagus putrescentiae, Acarus siro and Glyciphagus domesticus are also known to produce allergens in house dust though with relatively low potency [25].

Mites (Arthropoda: Arachnida: Acari) are minute (0.5 to 2 mm in length) and are characterized by the absence of antennae and mandibles and the presence of simple eyes, four pairs of walking legs and two pairs of specialized mouthparts chelicerae and pedipalpi. More than 200 families, 1700 genera and 30,000 species have already been described and an estimated half a million species are on the line to increase the taxonomic burden of the group [26].

Figure 1: Common house dust mites: A: D. pteronyssinus (European House Dust Mite) and B: D. farinae (American House Dust Mite).
Click to enlarge
Figure 1: Common house dust mites: A: D. pteronyssinus (European House Dust Mite) and B: D. farinae (American House Dust Mite).

A vast majority of the identified mites are generally harmless to human. On the other hand only 250 mite species are considered to be associated with the health related problems of humans and domestic animals, thus inflicting great economic loss [27]. Due to their tremendous economic importance both as pest of agricultural crops as well as in veterinary and human health, the group has created worldwide attention among common people and medical entomologists and acarologists. Although majority of mite species are free living, a large number of them are known to parasitize both plants and animals including human beings. They may infest both internal organs of humans, preferably respiratory tract, lungs, intestine, ear passage etc. [28, 29] as well as outer skin [30, 31, 32]. At the same time, they often act as reservoir and or vector of several serious pathogens of human and veterinary importance [33, 34, 35, 36].

These tiny and delicate organisms exhibit extreme diversity in structure, habitat and behavior. Among them there is a taxonomically and ecologically defined assemblage called “House Dust Mite” chiefly consisting of Dermatophagoides spp. They are free living and occupy every niche of the house, being more abundant in beds than elsewhere in the house, because beds are rich in human scales on which they feed [37, 38] and provide the ideal microclimate such as temperature and humidity etc. Among several species of Dermatophagoides mites, D. pteronyssinus and D. farinae are most common and ubiquitous in distribution [39] as shown in Figure 1.

Allergy to house dust mites particularly the genus Dermatophagoides is a common feature in Kolkata metropolitan areas with a steady increase in their incidence in the recent past. A two fold increase in the prevalence of naso-bronchial allergic manifestations has been noted from the urban settings of Kolkata during last few decades. In India, mite associated allergy is a poorly researched area with insufficient quantum of knowledge. It is now well documented that the mites of the genus Dermatophagoides are the most potent allergens in house dust responsible for allergic manifestations. During last 30 years, we have studied the house dust mite fauna of West Bengal [7, 14, 15, 17, 20, 21, 22, 23, 24, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. A total of fourteen districts of West Bengal including Kolkata metropolis have been searched for mite fauna. A total of 68 species of mites belonging to 25 families under 44 genera and three orders namely, Astigmata, Prostigmata and Mesostigmata have been reported including a good number of unidentified cryptostigmatids. Among them six species appeared to be new to science while another 20 species were reported for the first time from Indian house dust samples. It is interesting to note that maximum number of mite species (47) were isolated from dust samples of Kolkata followed by Burdwan (40) and 24 Parganas (33) and least (6) from Birbhum district of West Bengal [44]. The genus Dermatophagoides alone constituted 60% of the total acarine fauna, predominated by D. pteronyssinus (47%) followed by D. farinae. Both D. pterinyssinus (DP) and D. farinae (DF) coexisted in the same habitat and maximum number of mites isolated from an individual dust sample was 13750/gm of dust. Seasonal trend indicates mite count was higher in pre- monsoon and minimum during winter and are abundant in beds than elsewhere in the house and mostly associated with pillows, blankets, mattresses, padded furniture and carpeted floors etc (Figure 2) and preferably feed on human danders. Tovey, et al. [56] showed that more than 95% of the allergens accumulating in mite cultures was associated with faecal particles and emphasized their role as the major source of house dust allergens. Excrement particles obtained from mite's intestines by microsurgery were found highly allergenic in patients, allergic to house dust as was reported also by Halmai, et al. and Muto, et al_. [57, 58] emphasized the role of house dust mite in the dwelling houses as a trigger of asthmatic attack, by measuring Anti-DP specific IgE antibodies and opined that allergy to house dust mites is a significant feature in the disease pathogenesis and is associated with modifications to traditional life styles by the recent introduction of blankets, foam mattresses and changes in sleeping habits that promoted a more fertile environment for growth and multiplication of mites. Preliminary screening through Skin Prick Test showed 83% patients reacted positively towards allergens of mites (either DP or DF), 92% patients had elevated levels of serum IgE and the mean value higher than control sera (p<<0.001). 85% patients of the study group showed allergen specific IgE antibodies against house dust and _Dermatophagoides mites. The study indicates that more than 80 % allergic asthma patients residing in Kolkata metropolitan areas are sensitive to dust mites, specially genus Dermatophagoides Spp. as evident from skin prick test and detection of allergen specific IgE antibodies by Immuno Cap system.

Figure 2: Mites on the blanket.
Click to enlarge
Figure 2: Mites on the blanket.

Estimation of total serum IgE level and detection of specific IgE antibodies against offending allergen, by Radio Immuno Assay (RIA), as an alternative and confirmative method for diagnosis of extrinsic allergy had been reported by Lal, et al. [9]. They estimated total and specific serum IgE concentration in patients of bronchial asthma in relation to house dust and house dust mites. Estimation of serum immunoglobulins including IgE in the sera and bronchial aspirates of children and adults with wheezy bronchitis, bronchial asthma and pulmonary eosinophilia was made by different authors [7, 19, 20, 59, 60, 61].

Though specific serum IgE antibodies against the offending allergens (pollen, Aspergillus and house dust) in patient of bronchial asthma had been estimated [16, 60, 61, 62], information with regard to the level of specific serum IgE antibodies against house dust, D. pteronysinus and D. farinae mite antigens was lacking for quite a long time in Indian context. Batabayal, et al_._ [62] however, presented some data on the diagnosis of allergic disorders involving skin testing, analysis of the serum for total IgE and allergen specific IgE antibodies against pollen grains and total house dust. Khatua, et al. [60] made an immunological study of bronchial asthma in children between 1 to 5 years of age, wherein a relation between asthma with total and specific IgE and the common allergens (mostly pollens) responsible to precipitate the attack was made. Saha, [20, 21, 22] Saha, et al. [63] and Poddar, et al. [46, 47] have carried out extensive research on different aspects of dust mite allergy in Kolkata, India including entomological, clinical and immunological parameters in a comprehensive manner since more than thirty years and established the role of house dust mites in house dust allergy [64].

**Allergy an Upcoming Lifestyle Disorder**

There are good numbers of diseases which may be initiated, maintained, aggravated and ultimately governed by lifestyle factors like cancer, cardiac disorders, diabetes, orthopedic problems, back pain etc. popularly known as lifestyle disorders. During recent past the most upcoming events related to changes in lifestyle pattern which has come to the surface in an unprecedented manner particularly in developing countries like India are different allergic manifestations due to inhalation of mite laden dust particles. The concern is that the incidence of allergic disorders are increasing in developing countries too, becoming doubled, even tripled in the last few decades. Interestingly, 75% of these are traced to change in lifestyle such as

  • Acquisition of Western lifestyle,
  • Changes in diet & dietary habits,
  • Consumption of processed food unhealthy, full of preservatives,
  • Increased air pollution, poor air quality, cities in particular.
  • Booming beauty business (indiscriminate use of cosmetics, lotions & creams).
  • Intolerable psychological stress.

At Home

  • Use of foam mattresses instead of traditional cotton mattresses.
  • Use of blanket without any cover instead of traditional quilt
  • Wall to wall room carpets
  • Use of soft toys, heavy curtains, upholstery and padded furniture.

All these factors support the growth and multiplication of house dust mites inside the bedroom, which ultimately increases the chance and duration of exposure to that indoor allergen.

**Control Measures**

There is no simple and effective way to cure mite borne allergic diseases, but the symptoms may be relieved or minimized and in best cases eliminated with the adoption of combination of suitable preventive as well as curative measures. If the patient can be maintained relatively free of symptoms, the chances of increasing the tolerance with time will improve and the risk of developing new allergies minimizes. However, the tendency towards spontaneous development of tolerance varies markedly with age and with the type of symptoms and allergens.

**Environmental Management**

Environmental control or management of entire home especially bedroom and bed in particular to minimize mite exposure.

  • Proper sanitation, hygiene and a general cleanliness of the bed and bedroom should be recommended.
  • Avoidance of suspected offending allergens as far as practicable.
  • House dust mites seem to thrive best on human skin scales; supply of food materials to the mites should be restricted.
  • Periodic shaking of bedroll and frequent washing of bed sheets and blankets should be done.
  • Avoid use of carpets, foam mattresses and other padded furniture in the patient’s bedroom.
  • Reduction of dampness and non-availability of moisture drastically reduces mite population. Keeping indoor moisture low (30-40%). Use an air conditioner or dehumidifier to decrease the humidity.
  • To reduce mite population, various acaricides have been recommended such as benzyl benzoate, pirimiphos methyl or lindane. Lindane impregnated in cloth @ 10gm/m² can effectively kill cent percent mites when exposed to it for 155 days.
  • Complete encasement of beds with plastic covers.
  • Keep pets out of the bed-room.
  • Applying tannic acid solution to neutralize the allergen in mite droppings.

**Recommendation**

It is assumed that changes in lifestyle including diet and dietary habits, acquisition of western lifestyle, low standard of indoor environment, increasing air pollution and over all intolerable psychological stress are blamed for such an increased occurrence and frequent recurrences of allergic manifestations in Kolkata metropolitan areas. Besides, increase use of padded furniture, sofa sets, heavy curtains, wall to wall carpeting, blankets without any cover instead of traditional quilt, use of foam mattress instead of conventional cotton mattress and soft toys favor the growth and multiplication of house dust mites and thus chances of inhalation of mites along with the dust particles are increased for a longer period of time. Thus, in more than 70% cases these may be attributed to the metamorphic change in lifestyle.

Change your lifestyle to improve allergies. Simply follow some good health practices:

  • Bedroom should be under environmental management
  • Eat a well-balanced diet avoid unhealthy diet specially junk and processed food to avoid obesity. It is now well documented that diet is related to weight and affects asthma. Children, who mostly eat a “Western” diet with high amounts of fat and processed foods, have been shown to have higher asthma prevalence rates.
  • Minimise stress and anxiety
  • Exercise regularly. - be physically active, avoid sedentary lifestyle and obesity.

Acknowledgements

Author expresses his deep sense of gratitude to Late Prof. D. K. Choudhuri, Prof. Amiya Kr. Hati, Dr. Neelam Tandon, Dr. A. Modak, Dr. Arijit Das, Dr. Saibal Maitra, Dr. Indrani Choudhuri. Author is also thankful to Dr. Gautam Aditya, Dr. Amlan Ghosh, Dr. Sanjay Podder, Dr. Soumi Nandi, Dr. Shampa Dutta, Dr. Debarati Dey, Dr. Swarnali Mukherjee, Arghya and Priti for providing necessary data. Special thanks to management and staff members of Allergy and Asthma Research Centre, Kolkata.

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@article{saha2019,
  title   = {House Dust Mite Allergy in Kolkata Metropolis in Response
to Change in Lifestyle},
  author  = {Saha GK},
  journal = {International Journal of Zoology and Animal Biology},
  year    = {2019},
  volume  = {2},
  number  = {6},
  doi     = {10.23880/izab-16000189}
}
Saha GK (2019). House Dust Mite Allergy in Kolkata Metropolis in Response
to Change in Lifestyle. International Journal of Zoology and Animal Biology, 2(6). https://doi.org/10.23880/izab-16000189
TY  - JOUR
TI  - House Dust Mite Allergy in Kolkata Metropolis in Response
to Change in Lifestyle
AU  - Saha GK
JO  - International Journal of Zoology and Animal Biology
PY  - 2019
VL  - 2
IS  - 6
DO  - 10.23880/izab-16000189
ER  -