Type:
Whole Allergen
Whole Allergen
d201 Blomia tropicalis
d201 Blomia tropicalis Scientific Information
Display Name:
Blomia tropicalis
Route of Exposure:
Inhalation
Family:
Glycyphagidae
Species:
Blomia tropicalis
Latin Name:
Blomia tropicalis
Other Names:
Storage mite, Flour mite, Grain mite
Summary
House dust mites (HDM) are the most important causes of allergic sensitization and diseases. Blomia tropicalis is one of the most prevalent species of HDM, found worldwide. It is predominantly found in tropical and subtropical regions and is known to coexist with Dermatophagoides pteronyssinus and/or Dermatophagoides farinae. Fecal particles of Blomia tropicalis HDM are considered as the major source of allergen carrier in air, that causes allergic reactions post-inhalation. Among the different allergens characterized for B. tropicalis, Blo t 1, Blo t 5 and Blo t 21 are the major allergens found. The most common clinical manifestations of B. tropicalis allergy, include allergic rhinitis, asthma, and atopic dermatitis. Allergens from B. tropicalis have been found to be cross-reactive to Dermatophagoides species and Tyrophagus putrescentiae. Cross-reactivity exists between Blo t 1 and Der p 1, Blo t 5 and Sui m 5 (Suidasia medanensis), Blo t 10 and Group 10 mites molecules, Blo t 21 and Tyr p 21, Blo t 13 and human fatty-acid binding proteins. Allergen immunotherapy and vaccines can be used as a treatment regime for patients with B. tropicalis allergy. Controlling the growth of dust mites, eliminating major reservoirs of dust mites, and maintaining proper hygiene is generally advised to prevent an allergic reaction to dust mites in sensitized individuals.
Allergen
Nature
House dust mites (HDMs) are the most important causes of allergic sensitization and diseases. These mites are reported to colonize to the indoor environment, and the allergens of HDM target the epithelium of humans, hence demonstrating the unique characteristics of HDMs (1).
The three species of HDMs, namely Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Blomia tropicalis, are considered as the most prevalent allergen sources, found globally (2).
The B. tropicalis was formerly classified as a storage dust mite, since it was widely found in storage facilities for grains, and as contaminants in grain-based processed foods. However, it has now been also recognized as a HDM, due to its high prevalence noted in the dusts of many subtropical and tropical homes (3). This species is also considered as the most prolific, non-pyroglyphid HDM (4). The characteristic feature of these mites includes the body length, measuring 0.23-0.47 mm, with globule-shaped, wrinkled, hairy body. Further, the male species have legs that contain flexed tarsus IV, with no anal suckers to it (5).
Habitat
House dust mites are highly prevalent in the indoor environment of every household, located in the temperate areas. It is reported that mites survive dry winters with humid, temperate climate. High levels of mite allergens are reported in older homes, and in homes that are devoid of air-conditioning, as compared to those with air-conditioners (1).
B. tropicalis is one such mite species, that is commonly found in the tropical and subtropical countries and grows best in warm and humid climatic conditions (6). The average lifespan of the male species is about 30.9 days, whereas it is 32.2 days for mated females (5).
Taxonomy
| Taxonomic tree of Blomia Tropicalis (7) | |
|---|---|
| Domain | Eukaryota |
| Kingdom | Metazoa |
| Phylum | Arthropoda |
| Subphylum | Chelicerata |
| Class | Arachnida |
| Order | Sarcoptiformes |
| Family | Echimyopodidae |
| Genus | Blomia |
| Species | Blomia tropicalis |
| Taxonomic tree of Blomia Tropicalis (7) |
|---|
Tissue
Fecal particles of HDM (including B. tropicalis) are the major source of allergen carrier in air, causing allergic reactions post-inhalation (8). The particle size of fecal pellets are extremely small, ranging between 10-40 µm, hence making it easier to be inhaled (5). Further, the pellets become transiently airborne during disturbance brought about by human activities, such as sweeping, dusting, vacuuming, or changing bedding (9).
Among B. tropicalis allergens, Blo t 5 and Blo t 21 exist in the mite bodies (hindgut, midgut) as well as in fecal particles (3, 10).
Epidemiology
Worldwide distribution
According to various evidence, an increase in the sensitization of B. tropicalis allergy has been reported, over the last few decades (3).
A retrospective study was conducted in Taiwan that involved 1145 patients with allergic sensitization and a history of receiving allergen-specific immunoglobulin E (IgE) tests. Based on the evaluation of allergic sensitization, it was found that the sensitization to B. tropicalis was found to be higher in older-age patients as compared to the younger ones (younger patients [3-6 years]: 15.1% vs. older patients [≥19 years]: 33.4%; p<0.001). Furthermore, the sensitization rate to B. tropicalis was more prevalent in coastal regions than in the city (coastal: 34.2% vs. city: 29.5%; p=0.091) (11).
Large number of studies conducted in Singapore have identified 90-96% of atopic patients, being sensitized to HDMs, including B. tropicalis (4).
An International study was conducted to assess the prevalence of sensitization to B. tropicalis, among 297 asthmatic patients (including both adults and children), living in Latin American countries. The prevalence of sensitization to B. tropicalis was reported to be 47% in Mexico, while it was 93.7% in Brazil (12).
A study from Florida, USA, involving 167 patients with rhinitis and/or asthma, revealed that the prevalence of B. tropicalis was reported to be 38%, based on skin prick test (SPT) (13). Furthermore, B. tropicalis was found to be a vital sensitizer, in a study conducted among 148 asthmatic patients from Cuba. It was reported that 85% of patients demonstrated a positive SPT to B. tropicalis (14).
A study was conducted that assessed sensitization to allergens among pediatric asthmatics (n=84; age range: 2-14 years), adult asthmatics (n=71; 16-80 years) and adult controls (n=71; age range: 20-61 years) in Thailand. The results revealed that the sensitization to B. tropicalis was found to be 9.5% in asthmatic children, 4.2% in adult asthmatics and 2.8% in healthy adults. Furthermore, co-sensitization to Dermatophagoides was observed in all children, sensitive to B. tropicalis (15).
A high level of specific IgE to two species of Blomia i.e. B. tropicalis and B. tjibodas has been documented in a study conducted in Germany, that involved farmers and city dwellers, sensitive to Blomia allergens (16).
Risk factors
Sensitization to B. tropicalis allergen can be a risk factor for the occurrence of allergic rhinitis (AR) (4). Similarly, exposure to B. tropicalis has shown to cause aggravation of allergic symptoms in patients with atopic dermatitis (AD) (17). Strong evidence has been reported regarding B. tropicalis, triggering the allergic nasal symptoms and inflammation of the mucosa in sensitized individuals (18).
Pediatric issues
Certain risk factors have been reported to cause aggravation of sensitivity to B. tropicalis in children. A cross-sectional study was conducted in 175 patients (mean age: 7.9 years) with sensitization to environmental allergens (including B. tropicalis) and subsequent clinical symptoms for at least 2 months. The results revealed that older age i.e., >5 years and breastfeeding <3 months were considered as the significant risk factors associated with sensitization to B. tropicalis (p<0.05) (19).
Furthermore, Group 21 mite allergens, such as Blo t 21 (B. tropicalis) and Der p 21 (D. pteronyssinus) have reported a high frequency of sensitization in allergic children (20).
Environmental Characteristics
Worldwide distribution
Dust mites are found worldwide, except in the Arctic and Antarctic (1). Mites dominate in the environment, that has temperate climate, with damp and humid dwellings (20).
B. tropicalis has majorly been reported in countries, such as Taiwan, Brazil, Venezuela, Colombia, Egypt, Spain, United States (21), with greater prevalence seen in countries, like Singapore, Malaysia, Hong Kong and the Philippines (22).
Interestingly, even though Jakarta is close to Singapore and Malaysia, B. tropicalis accounted for only 14.1% of all HDMs. This was reported in a study, where the dust samples were collected from 102 homes of patients suffering from AR, bronchial asthma, and other respiratory allergies (22, 23).
Furthermore, different isoforms of B. tropicalis allergen, Blo t 12 have been reported in Singapore and Colombia (20).
Route of Exposure
Main
Airway inhalation is the main route of exposure to HDMs (24). The inhalation of mite fecal particles has reported eliciting allergic reactions in sensitized individuals (20). The mite fecal allergen, after being inhaled, reduces the mucociliary clearance, which in turn increases the deposition of inhaled particles, causing allergic sensitization (24).
Further, it has been reported that exposure of HDM allergen can act as a trigger in exacerbating the existing condition of asthma (1).
Secondary
In addition to inhalation (asthma, AR, eczema), mite allergens can trigger allergic symptoms in a sensitized person through additional routes, including ingestion (anaphylaxis, urticaria), and through direct contact (conjunctivitis, eczema) (1).
Clinical Relevance
Mite-allergic patients with asthma might also have symptoms of AR. This supports the “unified airway” concept that asthma and AR may not be separate entities, but rather linked manifestations of allergic inflammation, occurring throughout the upper and lower airways (25).
A 13-month, multicenter survey reported HDM as the main cause of irritability, tiredness, disturbed sleep and troublesome professional life, in patients with severe/very severe burden of asthma and AR (26).
Allergic rhinitis
In a study conducted among 110 Brazilian adult patients with AR and/or asthma, 56.4% (n=62) showed positive SPT results to B. tropicalis. Among these, 67.7% reported positive IgE to B. tropicalis (42 out of 62). These results show the important role of B. tropicalis sensitization in patients suffering from AR. Interestingly, more than half of the patients found positive to B. tropicalis (>50%), were sensitized to major high-molecular weight allergens (54, 66, 68 kDa), as compared to low-molecular weight allergens (14 and 11-13 kDa components), found in other studies (27).
In a survey study, of 229 sera obtained from adult patients in Singapore, 124 were diagnosed as having persistent rhinitis. Among these patients, 73% were found positive to B. tropicalis allergens (91 out of 124), whereas 50% were positive to Blo t 5 allergens, specifically (62 out of 124). Furthermore, 43% (53 out of 124) and 36% (45 out of 124) of patients were found positive to Der p 1 and Der p 2 allergens, respectively. This showed that increased percentage of patients were found sensitized to Blo t 5, in comparison to Der p 1 and 2 allergens (28).
Asthma
Sensitization to HDMs is highly correlated with asthma (4). According to a study conducted, the nasal allergen challenge with B. tropicalis have reported to provoke allergic reactions and inflammation in the mucosa of sensitized subjects. Furthermore, its impact was observed in patients with existing asthma, wherein, the asthmatic symptoms were stimulated in the late phase (18).
In a cross-sectional study, involving 85 South-African children (age range: up to 18 years; 50 from KwaZulu-Natal [KZN] province and 35 from Johannesburg) with AR and/or asthma and positive SPT for aeroallergens, revealed that sensitization to B. tropicalis was found to be 52% in KZN and 2.9% in Johannesburg patients (29).
In another case-control study conducted in Brazil, 42 patients diagnosed with asthma (age range: 1-49 years) and 24 nonallergic patients (age range: 1-45 years) were identified. The results revealed that 83.3% of patients with asthma were found positive to B. tropicalis extracts on SPT, while only 12.5% of patients were sensitized to B. tropicalis in control group (30).
In a study conducted on 131 patients with asthma, 44% of patients were found sensitized to B. tropicalis (31).
Atopic dermatitis
The prevalence of sensitization to mites can be very high in patients with AD. The increase in the permeability of atopic skin and the ability of mite proteases to decrease skin barrier function, may allow more effective sensitization with aeroallergens, initiating a vicious cycle of inflammation and further allergen exposure (1).
In a case-control study, involving 36 AD patients (age range: 1- 49 years) and 25 nonallergic subjects (age range: 1-45 years), positive correlation was reported between AD patients and skin reactivity to B. tropicalis extracts (p <0.05). The study concluded that exposure to B. tropicalis can be considered as a risk factor in the development of AD (17).
In another case-control study conducted in Brazil, 34 patients diagnosed with AD (age range: 1-49 years) and 24 nonallergic patients (age range: 1-45 years) were identified. The results revealed that 61.7% of patients with AD were found positive to B. tropicalis extracts on SPT. Furthermore of 34 patients, 14 patients with AD and respiratory allergy reported 3.6-fold higher skin reactivity along with significantly greater IgE levels to B. tropicalis, as compared to 20 patients with AD alone (30).
Other diseases
Blo t 5 allergens have reportedly been found in several foods, such as wheat, rice, beans, corn, as well as in processed food items, such as pasta, pancakes, and rusk. Contamination of food items with Blo t 5 allergens can pose an increased risk of sensitization in individuals, due to long-term ingestion of infested food and exacerbation of symptoms in patients with an existing allergy (21).
In a case study identified, severe anaphylaxis was reported upon ingestion of pancake, contaminated with B. tropicalis allergens (32).
Prevention and Therapy
Allergen immunotherapy
Allergen specific immunotherapy has reported to be safe and effective immunotherapy, as per certain literatures.
In a double-blind, placebo-controlled, Phase II clinical trial conducted in Cuba, 35 asthmatic patients (age range: 16-45 years) were exposed and sensitized to B. tropicalis. According to the results, it was reported that subcutaneous AIT with standardized B. tropicalis extracts, was found to be both, safe as well as effective in these patients (33). In a study, hypoallergenic hybrid molecule of Blo t 5 and Blo t 21 was found to be a potential vaccine candidate for the treatment of allergic reactions caused by B. tropicalis (34).
Prevention strategies
Dust mites poorly thrive in extremely dry climates, and hence controlling the humidity can limit the growth of these mites (8). Exposure of HDMs can be prevented or reduced by wrapping the mattresses, pillows, and box springs in coverings, that are allergen-proof, washing the bedding with hot water in a week, cleaning the house, wearing an appropriate mask while cleaning, changing furnace and air-conditioner filters, and using a dehumidifier, that help in decreasing the humidity in homes (9). Furthermore, use of air-conditioning, freezing, heat treatment, harsh chemicals can be effective methods in minimizing the growth of dust mites (8).
In mite-sensitized asthmatic patients, bronchial hyperreactivity and bronchospasm was found to be aggravated, upon exposure to mites, however, the symptoms got improved in mite-free environment (1). Decreased exposure to mites can be useful technique in managing allergic patients, such as asthma (35).
Molecular Aspects
Allergenic Molecules
The recognition of HDM-specific allergens helps in the diagnosis and treatment of allergic diseases, associated with HDM, especially identification and characterization of novel HDM allergens (36). The World Health Organization (WHO) and International Union of Immunological Societies’ Allergen Nomenclature Sub-Committee (IUIS) have characterized the following 14 allergens from B. tropicalis (as shown in the table below) (37).
| Allergen | Biochemical name | Molecular Weight (kDa) | Allergenicity |
|---|---|---|---|
| Blo t 1 | Cysteine protease | 39 |
|
| Blo t 2 | ML-domain protein | 14.5 |
|
| Blo t 3 | Trypsin | 23.8 |
|
| Blo t 4 | α-amylase | 56 |
|
| Blo t 5 | Unknown | 14 |
|
| Blo t 6 | Chymotrypsin | 25 |
|
| Blo t 7 | Bacterial permeability-increasing like protein | 25 |
|
| Blo t 8 | Glutathione-S- transferase | 27 |
|
| Blo t 10 | Tropomyosin | 33 |
|
| Blo t 11 | Paramyosin | 110 |
|
| Blo t 12 | Unknown | 14 |
|
| Blo t 13 | Fatty acid-binding protein | 14.8 |
|
| Blo t 19 | Anti-microbial peptide homologue | 7 |
|
| Blo t 21 | Unknown | 13 |
|
| Allergen | Biochemical name | Molecular Weight (kDa) | Allergenicity |
|---|
AR: Allergic rhinitis; B. tropicalis: Blomia tropicalis; ELISA: enzyme-linked immunosorbent assay; IgE: Immunoglobulin E; SPT: Skin prick test
Of interest, the major allergen, Blo t 5 is the best-characterized allergen, found in the tropical and sub-tropical areas (3, 41). Blo t 5 and its similar allergen, Blo t 21, are the most predominant allergens found in the B. tropicalis (44).
Cross-reactivity
The allergic sensitivity, following the ingestion of HDMs, show symptoms in two different forms - the ingestion of invertebrates demonstrating cross-reactivity with mite allergens, and the ingestion of foods that are contaminated with dust mites (1).
A high degree of cross-reactivity is noted between Dermatophagoides pteronyssinus and Dermatophagoides farinae extracts, however, the reactivity between Dermatophagoides and Blomia tropicalis is low (20).
In a study, co-sensitization and cross-reactivity had been reported between B. tropicalis and two Dermatophagoides species, i.e. Der p and Der f. In this study, 70.14% of allergenic patients (1050 out of 1497 patients) were found to be co‐sensitized to B. tropicalis, Der p, and Der f. However, the cross-reactivity between B. tropicalis and the other mites was limited (45).
A moderate degree of cross-reactivity has been shown between B. tropicalis and D. pteronyssinus, using inhibition assays. From sera of 12 allergic Venezuelan patients, 5 reacted to extracts of both mite species, while 4 reacted to only D. pteronyssinus and only 3 to B. tropicalis. In 2 of the 5 sera reactive to both mite species, it was seen that D. pteronyssinus could inhibit the binding of B. tropicalis, and vice-versa (12).
Amino acid sequence similarity of 30-50% has been reported between Blo t 1, Blo t 2 and Blo t 5, and Der p 1, Der p 2 and Der p 5 (D. pteronyssinus), hence suggesting low-to-moderate cross-reactivity between D. pteronyssinus and B. tropicalis (31).
Furthermore, between Blo t 3 and Der p 3, limited cross-reactivity has been reported. Blo t 3 showed a 54.8% amino acid sequence similarity with Der p 3 (trypsin-like serine protease) allergen in D. pteronyssinus (3). Blo t 11 has shown 90% similarity with Der f 11 (D. farinae) and 89% with Der p 11 (D. pteronyssinus) (3). Blo t 13 demonstrated moderate-to-high cross-reactivity with human fatty acid binding-proteins (FABPS) (46). Furthermore, Blo t 21 shares close to 40% of sequence homology with Blo t 5, however despite the similarities, Blo t 5 and Blo t 21 do not cross-react (3).
Marked cross-reactivity has been noted between Sui m 5 (from Suidasia medanensis) and Blo t 5 (2).
Tropomyosin from B. tropicalis has demonstrated 95% homology with allergens from Group 10 mites. The Blo t 10 showed high homology with tropomyosin from Lepidoglyphus destructor (Lep d 10), D. pteronyssinus (Der p 10) and D. farinae (Der f 10) (42).
Tropomyosin is a large family of heat-resistant, alpha-helical proteins. These proteins form a coiled-coil structure of two parallel helices, that includes two sets of seven alternating actin-binding sites. This feature plays a vital role in regulating the function of actin filaments (47).
One of the main important causes of cross-reactivity, among mites, shellfish, helminths, and cockroaches is the tropomyosin, although, glutathione transferase may also be included. In cases where genuine sensitization is unclear, specific allergen components can be useful to identify the primary allergy (20).
Tropomyosin allergens from HDMs are reported to show cross-reactivity with tropomyosin allergens of invertebrates, such as crustaceans (shrimp, lobster, crab, crayfish), mollusks (mussel, oyster, scallop, clams, abalone, snails, squid, octopus, cuttlefish) and insects (cockroaches) (1, 47).
Tyr p 5 (from Tyrophagus putrescentiae) showed 52.9% amino acid identity with Blo t 5. It also exhibited a 55.8% identity with Tyr p 21 and Blo t 21. Der f 21 was inhibited by both, group 5 and group 21 allergens (Tyr p 5, Tyr p 21, Blo t 5 and Blo t 21), reflecting cross-reactivity between the three (48).
Compiled By
Author: Turacoz Healthcare Solutions
Reviewer: Dr. Christian Fischer
Last reviewed: January 2021
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