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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) : 421-429
doi: 10.18176/jiaci.0439

Background: Mites are the most prevalent source of indoor allergens. The present study used a component-resolved diagnosis (CRD) approach to investigate the mite-specific IgE sensitization profile for Dermatophagoides pteronyssinus and Blomia tropicalis. We also assessed the performance of a commercially available CRD approach in patients with severe allergic rhinitis.
Methods: We selected 63 consecutive patients with dual sensitization to D pteronyssinus and B tropicalis and persistent severe rhinitis according to the ARIA guidelines. We performed skin prick tests with standardized extracts and determined 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.
Results: Fifty-eight and 59 patients had positive sIgE to the whole extracts of D pteronyssinus and B tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE to 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 most of the serum samples (55%).
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 performed somewhat poorly 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, as well as patient-centered 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