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Molecular allergen profiling of dual mite sensitization in severe allergic rhinitis

González-Pérez R1, Pineda F2, Poza-Guedes P1, Castillo M2, Matheu V1, Sánchez-Machín I1

1Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
2Diater Laboratory, Madrid, Spain

J Investig Allergol Clin Immunol 2020; Vol. 30(6)
doi: 10.18176/jiaci.0439

Background: Mites are the most prevalent source of indoor allergens. The aim of the present study is based on a component resolved diagnosis (CRD) model approach to
investigate the mite specific IgE sensitization profile to Dermatophagoides pteronyssinus and Blomia tropicalis and the performance outcomes of commercially available CRDin subjects with severe allergic rhinitis (SAR).
Methods: We selected 63 consecutive patients showing a dual sensitization to D. pteronyssinus and B. tropicalis with persistent severe rhinitis according to the ARIA Guidelines. Skin pricktest with standardized extracts and specific serum IgE to both mites along with serum specific IgE to Der p 1, Der p 2, Der p 23, Der p 10 and Blo t 5 was measured.
Results: Fifty-eight and 59 patients showed a positive sIgE to the whole extracts of D. pteronyssinus and B. tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE Der p 1, Der p 2 and/or Der p 23, specific IgE to Blo t 5 (≥0.3 ISU-E) was not detected in the majority (55%) of the serum samples.
Conclusions: Although the combination panel of the commercially available major allergens Der p 1, Der p 2 and Der p 23, identified more than 90% of the D. pteronyssinus allergic patients, Blo t 5 showed a very limited performance in those sensitized to B. tropicalis. Improvements in CRD and further research concerning the prevalence and clinical relevance of serodominant allergens are needed to achieve a genuine molecular diagnosis along with a patient-centred mite-allergy specific immunotherapy.

Key words: Allergen, Severe Allergic Rhinitis, Component Resolved Diagnosis, Skin Prick Test, House Dust Mites, Dermatophagoides pteronyssinus, Blomia tropicalis, Precision Medicine