title: Cockroach sensitization mitigates allergic rhinoconjunctivitis symptom severity in patients allergic to house dust mites and pollen.
abstract: BACKGROUND
  Modifiers of symptom severity in patients with allergic rhinoconjunctivitis (AR) are imprecisely characterized. The hygiene hypothesis implicates childhood microbial exposure as a protective factor. Cockroach sensitization (C+) might be a proxy for microbial exposure.
  
  
  OBJECTIVE
  We sought to determine whether C+ assayed by means of skin prick tests influenced AR symptom severity in controlled and natural settings.
  
  
  METHODS
  Total symptom scores (TSSs) were recorded by 21 participants with house dust mite allergy (M+) in the natural setting and during repeated exposures of 3 hours per day to house dust mite allergen in an allergen challenge chamber (ACC). In M+ participants the peripheral blood and nasal cells were assayed for T-cell activation and transcriptomic profiles (by using RNA sequencing), respectively. Participants allergic to mountain cedar (n = 21), oak (n = 34), and ragweed (n = 23) recorded TSSs during separate out-of-season exposures to these pollens (any pollen sensitization [P+]) in the ACC; a subset recorded TSSs in the pollination seasons.
  
  
  RESULTS
  The hierarchy of TSSs (highest to lowest) among M+ participants tracked the following skin prick test sensitization statuses: M+P+C- > M+P+C+ > M+P-C- > M+P-C+. In nasal cells and peripheral blood the immune/inflammatory responses were rapidly resolved in M+P+C+ compared with M+P+C- participants. Among those allergic to pollen, C+ was associated with a lower TSS during pollen challenges and the pollination season. After aggregated analysis of all 4 ACC studies, C+ status was associated with a 2.8-fold greater likelihood of a lower TSS compared with C- status (odds ratio, 2.78; 95% CI, 1.18-6.67; P = .02).
  
  
  CONCLUSIONS
  C+ status is associated with mitigation of AR symptom severity in adults with AR.
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Weijing
authors.initials: W
authors.lastname: He
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Biomedical Research Foundation of South Texas, San Antonio, Tex.
authors.forename: Fabio
authors.initials: F
authors.lastname: Jimenez
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Biomedical Research Foundation of South Texas, San Antonio, Tex.
authors.forename: Hernan
authors.initials: H
authors.lastname: Martinez
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Biomedical Research Foundation of South Texas, San Antonio, Tex.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Harper
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Muthu Saravanan
authors.initials: MS
authors.lastname: Manoharan
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Andrew
authors.initials: A
authors.lastname: Carrillo
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Puraskar
authors.initials: P
authors.lastname: Ingale
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Ya-Guang
authors.initials: YG
authors.lastname: Liu
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Seema S
authors.initials: SS
authors.lastname: Ahuja
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Clark
authors.affiliation: Biogenics Research Chamber, San Antonio, Tex.
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Rather
authors.affiliation: Biogenics Research Chamber, San Antonio, Tex.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Ramirez
authors.affiliation: Biogenics Research Chamber, San Antonio, Tex.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Andrews
authors.affiliation: Biogenics Research Chamber, San Antonio, Tex.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Jacobs
authors.affiliation: Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Biochemistry, University of Texas Health Science Center at San Antonio, San Antonio, Tex. Electronic address: ahujas@uthscsa.edu.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D000485:Allergens / Q000008:administration & dosage* / Q000737:chemistry / Q000276:immunology; D031164:Ambrosia / Q000737:chemistry / Q000276:immunology; D000818:Animals; D003058:Cockroaches / Q000737:chemistry / Q000276:immunology*; D003233:Conjunctivitis, Allergic / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011058:Pollen / Q000737:chemistry / Q000276:immunology*; D039981:Pyroglyphidae / Q000737:chemistry / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D012621:Seasons; D012720:Severity of Illness Index; D012882:Skin Tests
chemical_list: D000485:Allergens
keywords: Cockroach sensitization; T-cell activation; aeroallergens; allergen challenge chamber; allergic rhinoconjunctivitis; house dust mite; pollen; skin prick test