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Hypersensitivity to Chironomidae (non-biting midges) has been a problem in the Sudan since about 1927 and appears to be due to increased breeding of a single chironomid species, Cladotanytarsus lewisi (Freeman). Mass emergence of the midges in thought to be related to the larval diet of algae and diatoms, the numbers of which are greatly enhanced by the retention of plant nutrients in lacustrine conditions resulting from interruption to the natural flow of the Nile by the construction of dams. Immunological studies in allergic individuals using an allergen extract prepared from C. lewisi indicate that the concentration of specific immunoglobulin E ("allergic antibody") directed against C. lewisi is raised in patients with established hypersensitivity to the midge but not in control subjects. The concentration of specific IgE is also related to the severity of clinical symptoms. These results indicate that this widespread and important "man made" hypersensitivity in the Sudan has the features of well recognized immediate-type allergy commonly associated with pollens and other air-borne allergens.

Skin 'prick' tests with an extract of the 'green nimitti' midge, Cladotanytarsus lewisi (Freeman), a potent airborne allergen associated with asthma and rhinitis in the Khartoum area, were undertaken on asthmatic subjects in several localities in the Sudan and Egypt in order to provide further information on the extent of this allergic problem. In the Sudan skin-test-positive individuals were identified in the Khartoum area, Kosti, Sennar, Wad Medani, Shendi and Atbara, and in Egypt at Aswan, Luxor and Qena. A number of asthmatic individuals giving a positive reaction to C. lewisi were also tested with extracts of seven sub-dominant species of Nilotic Chironomidae. There appeared to be a limited degree of cross-reactivity with these species, particularly Dicrotendipes fusconotatus (Kieffer), Procladius noctivagus (Kieffer) and Conchapelopia cygnus (Kieffer). The numbers of C. lewisi sensitive subjects giving positive skin-tests to these other species were ten out of 20, 12 out of 28 and 12 out of 29 respectively. In contrast, only five out of 31 reacted to Paracladopelma graminicolor (Kieffer), five out of 24 to Cladotanytarsus pseudomancus (Goetghebuer), three out of 32 to Nanocladius vitellinus (Kieffer) and two out of 28 to Cryptochironomus neonilicola (Freeman). These results indicate that Cladotanytarsus lewisi is a major source of chironomid allergen(s) in these asthmatic subjects and that hypersensitivity to C. lewisi is probably far more widespread than originally envisaged.