Q:

7/6/2012
Are you aware of any testing to confirm bed bug allergy since I know that bed allergy does exist. I am roughly aware of a discussion presented in the acaai Phoenix meeting also but not the details. A patient inquired about this but I couldn't find any ImmunoCap IgE offered for bed bug.

A:

Thank you for your inquiry.

There is no commercially available in vitro tests for specific IgE to bed bug (Cimex lectularius). However, one is presently under study (1). In addition, there have been reports of IgE-mediated reactions to bed bugs (see abstract copied below).

Also, you are correct, there was a workshop at the College meeting that was led by Dr. Richard DeShazo. Dr. DeShazo has also published an article regarding the potential for multiple bed bug bites to sensitize humans (I have copied below a link to this article which will pull up the entire paper).

The article in The Journal of Allergy and Clinical Immunology will give you the contact information of the authors, and it is possible that they might be able to perform a test using serum from your patient, but of course you would need to contact them and inquire regarding their ability to do so. As noted, the address of Dr. Price can be found in this article which was published as a letter to the editor.

Finally, since Dr. DeShazo is knowledgeable in this area, I have asked him to share his comments regarding the topic in general for you and our readership. When I hear from Dr. DeShazo, I will forward his response to you.

Thank you again for your inquiry and we hope this response is helpful to you.

J Invest Dermatol. 2006 Jan;126(1):91-6.
Bullous allergic hypersensitivity to bed bug bites mediated by IgE against salivary nitrophorin.
Leverkus M, Jochim RC, Schäd S, Bröcker EB, Andersen JF, Valenzuela JG, Trautmann A.
Source
Department of Dermatology, University of Würzburg, Würzburg, Germany.
Abstract
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.

Multiple Feeding by the Common Bed Bug, Cimex lectularis, without Sensitization

Reference:
Price JB, et al. IgE against bed bug (Cimex lectularius) allergens is common among adults bitten by bed bugs. J Allergy Clin Immunol 2012; 129(3):863.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Richard deShazo regarding your Ask the Expert inquiry. Thank you again for your inquiry and we hope this response is helpful.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Richard deShazo:
The info provided is correct. The bullous reactions are a hybrid of several different response to BB proteins but are vasculitc. The immediate reactions are probably IgE mediated since they look like it on path. The biphasic reactions are probably IgE mediated, but we have not studied them. We think whole body extract might be OK for diagnostic testing. Since these are blood carriers, we have not gotten by an IRB to try it out. We will try to set up a RAST in the future. Hopes this helps.

Regards,
Rick deShazo

AAAAI - American Academy of Allergy Asthma & Immunology