Bullous allergic hypersensitivity to bed bug bites mediated by IgE against salivary nitrophorin.
In Central Europe, bites from the common bed bug (Cimex lectularius) are nowadays rather uncommon. Nevertheless, infestations are sometimes observed in old framehouses and by immigration due to international travel and migration. The clinical picture of bug bites substantially varies between individuals, depending upon previous exposure and the degree of an immune response. The host immune response and potential protein antigens present in the saliva of C. lectularius or specific antibodies have not been characterized thus far. We describe a patient with bullous bite reactions after sequential contact with C. lectularius over a period of 1 year. In skin tests, we observed immediate reactions to the salivary gland solution of C. lectularius, which were followed by a pronounced partially blistering late-phase response. Immunoblot analysis of the patient's serum with salivary gland extracts and recombinant C. lectularius saliva proteins revealed specific IgE antibodies against the 32 kDa C. lectularius nitrophorin, but not to 37 kDa C. lectularius apyrase. Our data demonstrate that bullous cimicosis may be the late-phase response of an allergic IgE-mediated hypersensitivity to C. lectularius nitrophorin.
Leverkus
Martin
M
Department of Dermatology, University of Würzburg, Würzburg, Germany. leverkus@medizin.uni-magdeburg.de
Jochim
Ryan C
RC
Schäd
Susanne
S
Bröcker
Eva-Bettina
EB
Andersen
John F
JF
Valenzuela
Jesus G
JG
Trautmann
Axel
A
D000328:Adult; D000818:Animals; D000906:Antibodies / Q000097:blood; D001511:Bedbugs; D001768:Blister / Q000276:immunology* / Q000473:pathology; D005260:Female; D006420:Hemeproteins / Q000032:analysis / Q000276:immunology*; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood*; D007299:Insect Bites and Stings / Q000276:immunology*; D012463:Saliva / Q000276:immunology; D012471:Salivary Proteins and Peptides / Q000032:analysis / Q000276:immunology*; D012882:Skin Tests
D000906:Antibodies; D006420:Hemeproteins; D012471:Salivary Proteins and Peptides; C090560:nitrophorin; D007073:Immunoglobulin E