Prepared by Salima Thobani, MD, LAC+USC Medical Center, and John Seyerle, MD, Ohio State University

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1 Allergy and Immunology Review Corner: Chapter 33 of Middleton s Allergy Principles and Practice, Seventh Edition, edited by N. Franklin Adkinson, et al. Chapter 33: Indoor Allergens Prepared by Salima Thobani, MD, LAC+USC Medical Center, and John Seyerle, MD, Ohio State University 1. The average child or adult spends on average how many hours outside every day? A. One B. Two C. Three D. Four 2. Fel d 1, the primary allergen from cats, is derived from which part of the cat? A. Saliva B. Skin C. Hair D. Urine 3. In the National Cooperative Inner City Asthma Study (NCICAS), what allergen concentration in children s bedrooms was found to have the highest correlation with hospitalization for asthma? A. Cat B. Dog C. Cockroach D. Dust mite 4. In some studies, as many as what percentage of children who develop IgE antibodies to cat have never lived in a house with a cat? A. 25% B. 50% C. 75% D. 100% 5. Allergens from which of the following sources would likely have the smallest particle size? A. Mouse B. Dust mite C. Grass D. Fungi 6. How long does it take after removal of cat to see a reduction in Feld 1 levels? A. 24 hrs B. 7 days C. 4 months

2 D. 24 months 7. Which of the following is ineffective in controlling cockroach levels in the home? A. Poison bait B. Careful housekeeping to enclose all sources of foods C. Cleaning to remove any accumulated allergen D. Spraying with insecticides E. Sealing all possible points of access into house 8. Which allergen can stimulate Toll-like receptor 9? A. Cat B. Rodent C. Dust mite D. Cockroach 9. In the US dust mite extracts are made from? A. Isolated mite bodies B. Whole culture C. Mite bodies and culture D. None of the above 10. Which is true of dust mite allergen levels in the absence of artificial humidifiers? A. Levels rise during the summer months and remain elevated until well into the winter B. Levels rise in spring and decline in the summer, only to rise again in the fall C. Levels are highest in late winter, gradually declining until early fall when they begin to rise again D. Levels increase in late winter and reach a peak in late spring Answers 1. A, page 539 At the beginning of the twenty-first century, normal behavior patterns include spending 23 hours per day indoors and correspondingly little time outdoors. 2. B, page 545 While at one point it seemed likely that Fel d 1 was a salivary protein, when cats were restrained from licking themselves, Fel d 1 accumulated on shaved skin, and it became clear that the primary site of synthesis of this allergen was in the skin. 3. C, page 546 In the NCICAS study, it was the concentration of cockroach allergen in children s bedrooms that correlated with the risk of hospitalization. 4. C, page 547 In some studies, as many as 75% of children who develop IgE antibodies to cat have never lived in a house with a cat. Thus, the dose-response relationship between cat allergens and sensitization is not linear.

3 5. A, page.552 Generally, mammalian allergens have a smaller particle size than particles from nonmammalian sources. 6. C, page 550 Removing the cat is the only effective way to control exposure to cat allergen. Removal of the cat from home leads to progressive reduction in concentration of Fel d 1 in the house, it may take as long as 4 months for levels in carpet dust to fall < 8 micrograms/grams. 7. D, page 551 Spraying with insecticides is generally ineffective and has the additional problem that the volatile organic substances used are often irritating to patients with asthma. 8. C, pages 545 & 552 Recent studies have shown that in addition to endotoxin, mite fecal particles contain both mite DNA and bacterial DNA, specifically unmethylated, and would therefore stimulate Toll-like receptor A, page 544 In the USA all extracts are made from isolated mite bodies, whereas in Europe both types of extracts are available. Extract made from bodies have close to equal concentration of group 1 and group 2 mite allergen. While whole culture typically contains 10 fold more group 1 than group A, pages Although it is common practice to measure ambient humidity, it is the humidity within carpets, sofas, mattresses or clothing that is relevant. As humidity falls, it may take months for mites to die and longer for allergen levels to decrease in carpets, sofas or mattresses. See figure 33.3 Allergy and Immunology Review Corner: Chapter 35 of Middleton s Allergy Principles and Practice, Seventh Edition, edited by N. Franklin Adkinson, et al. Chapter 35: The Structure and Function of Allergens Pages Prepared by Jeremy Katcher, MD, University of Tennessee, and Christopher R. Martin, M.D., Walter Reed Army Medical Center 1. A clinically important species of the Panicoideae family of grasses is? A. Rye B. Timothy C. Kentucky blue D. Bermuda

4 2. Which of the following is true? A. Amb a 1 is an Asteraceae major allergen that functions as a profilin B. Par o 1 is an Urticaceae major antigen that functions as a lipid transfer protein C. Profilins are proteins commonly implicated in oral allergy syndrome D. Hel a 2 is an Asteraceae major antigen that functions as a profilin 3. The major antigens for Alternaria alternata are: A. Alt a 1, 3, 10 B. Alt a 3, 4, 9 C. Alt a 1, 2, 3 D. Alt a 1, 2, In which animal do non-lipocalin proteins appear to be the major antigens? A. Horse B. Cat C. Dog D. Mouse E. Rat 5. Which is a correct pairing of allergen with source? A. Wasp Api m 2 B. Dust Mite Bos d 2 C. Cockroach Bos d 2 D. Mouse Mus m 1 E. Horse Bla g 2 6. Which of the following allergens falls in the herbaceous dicotyledon category? A. Lol p 1 B. Amb a 1 C. Bet v 1 D. Jun a 2 7. The majority of allergens from grass, weeds, and tree pollens belong to those proteins involved in: A. Cell wall remodeling B. Stress or defense responses C. Signal transduction D. Protein synthesis 8. The major dust mite allergens, Der p 1 and Der f 1, are what type of enzyme? A. Chitinase B. Trypsin C. Cysteine protease D. Chymotrypsin 9. The major allergen contained in egg yolk is:

5 A. Ovomucoid, Gal d 1 B. Ovalbumin, Gal d 2 C. Conalbumin, Gal d 3 D. -livitin (chicken albumin), Gal d Shellfish, dust mites, and cockroaches share which immunologically cross-reactive protein allergens? A. Parvalbumins B. Tropomyosins C. 2S albumins D. Profilins Answers 1. D, page 571 The first three are all members of the Pooideae subfamily of grasses (along with rice grass). Other members of the Panicoideae subfamily include maize and Johnson. While it may be useful to know the different sub-family names (and their members), the key to this question is a recognition that the first three have cross-reactivity and belong to the same sub-family. 2. B, pages Amb a 1 is a Pectate lyase. Hel a 2 is a minor antigen. Lipid transfer proteins represent the important cross-reacting fruit allergens in oral allergy syndrome. 3. D, page 578 The A. alternata major antigens are Alt a 1, 2, 13. There exists very low cross-reactivity between A. alternata and the rest of the clinically important fungi species (Aspergillus, Penicillium, and Cladosporium). 4. B, page 583 The remaining animals have lipocalins (calycines) as their major antigens. 5. D, page 60 Wasp is Ves v #. Dust mite is Der p # and Der f #. Cockroach is Bla g #. Horse is Equ c #. 6. B, pages Herbaceous dicotyledons are weeds. Amb a 1 is one of the most clinically significant short ragweed antigens. Bet v 1 is a birch antigen, Jun a 2 is mountain cedar antigen, and Lol p 1 is a common antigen in the northern pasture grasses (e.g. rye grass). 7. A, page 574 Though allergenic proteins participate in the other processes listed, cell wall remodeling is the most common. 8. C, page 584

6 Though other dust mite allergens are chitinases, trypsins, and chymotrypsins, Der p 1 and Der f 1 are cysteine proteases. 9. D, page 585 Ovomucoid, ovalbumin, and conalbumin (as well as lysozyme, Gal d 4) are found in the egg white. -livitin (chicken albumin) is found in the egg yolk. The most frequently recognized egg allergens are conalbumin and -livitin. 10. B, page 590 Shellfish, dust mites, and cockroaches all contain cross-reactive tropomyosin allergens. Tropomyosin is the major allergen in shellfish. Parvalbumin is the major allergen in fish. 2S albumins are seed storage proteins. Profilins are present in certain fruits, vegetables, trees, grasses, and weeds and can be responsible for oral allergy syndrome.

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