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Molecular diagnosis in house dust mite allergic patients suggests clinical relevance of Der p 23 in asthmatic children

Jiménez-Feijoo R1, Pascal M2,*, Moya R3, Riggioni C1, Domínguez O1, Lózano J1, Álvaro-Lozano M1, Piquert M1, Machinena A1, Folque M1, Dias M1, Carnés J3,*, A M Plaza1

1Department of Pediatric Allergy and Clinical Immunology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona
2Immunology Department, CDB, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, ARADyAl
3R&D Department, Laboratorios LETI, Tres Cantos, Spain

J Investig Allergol Clin Immunol 2020; Vol. 30(4)
doi: 10.18176/jiaci.0431

Background: Sensitization patterns to dust mites depend on the geographic area and are important in clinical practice. However, the role of molecular diagnosis is not currently defined. We sought to characterize a pediatric population focusing on sensitization to different mite species and major mite components, to assess the clinical relevance of sensitization to allergenic components in our practice.
Methods: Consecutive children with respiratory allergy sensitized to house dust mites by skin prick test were recruited. Specific IgE to nDer p 1, rDer p 2, rDer p 23 by ImmunoCAP, and sIgE by ImmunoCAP-ISAC microarray was determined. Subjects were followed-up for three years.
Results: A total of 276 children were recruited. Sensitization was 86.6% to nDer p 1, 79.3% to rDer p 2 and 75.8% to rDer p 23. Lepidoglyphus was the most common storage mite detected by SPT. Twenty-six patients (9.4%) were not sensitized to Der p 1 and Der p 2; noteworthy, 14 of them (53.8%) had positive IgE binding to Der p 23.
Asthmatic patients, and especially those with a persistent moderate and severe phenotype, recognized more often the three major allergens.
Conclusions: Most of our population with mite allergy is sensitized to Der p 1, Der p 2 and Der p 23 major allergens; however, 5% were sensitized only to Der p 23 of the allergens evaluated. Sensitization to Der p 23 should be considered in the diagnosis and treatment of mite allergy, especially in patients with moderate and severe asthma because it may worsen the clinical phenotype. 

Key words: Asthma, Component resolved diagnosis, Der p 1, Der p 2, Der p 10, Der p 23, House dust mites, Storage mites, Tropomyosin