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House dust mite allergy in Italy—Diagnostic and clinical relevance of Der p 23 (and of minor allergens): A real‐life, multicenter study
Author(s) -
Celi Giorgio,
Brusca Ignazio,
Scala Enrico,
Villalta Danilo,
Pastorello Elide,
Farioli Laura,
Cortellini Gabriele,
Deleonardi Gaia,
Galati Pietro,
Losappio Laura,
Manzotti Giuseppina,
Pirovano Barbara,
Muratore Lionello,
Murzilli Francesco,
Cucinelli Francesco,
Musarra Antonino,
Cilia Marcello,
Nucera Eleonora,
Aruanno Arianna,
Ria Francesco,
Patria Maria Francesca,
Varin Elena,
Polillo Battista Roberto,
Sargentini Vittorio,
Quercia Oliviero,
Gabriela Uasuf Carina,
Zampogna Stefania,
Carollo Michela,
Graci Stefania,
Amato Stefano,
Mistrello Gianni,
Asero Riccardo
Publication year - 2019
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13776
Subject(s) - allergy , minor (academic) , relevance (law) , multicenter study , mite , house dust mite , medicine , respiratory allergy , immunology , allergen , ecology , biology , humanities , philosophy , political science , law , randomized controlled trial
To the Editor, House dust mites (HDM) are a major cause of respiratory al‐ lergy and of perennial asthma worldwide. Thirty‐two allergens for Dermatophagoides farinae (D2) and 21 for Dermatophagoides pteron‐ yssinus (D1) have been detected so far, and novel allergens are still being reported.1 Der p 23, a gut‐derived peritrophin present in the outer membrane of mite feces,2 has been recognized as a major aller‐ gen.2,3 Der p 1, Der p 2, Der p 23, and Der p 10 (tropomyosin) are the only allergens currently available for the component‐resolved diag‐ nosis of HDM allergy on ImmunoCAP. The clinical relevance of Der p 23 is only partially defined, and the prevalence and relevance of the exclusive sensitization to allergens other than groups 1, 2, 10, and 23 has received little attention so far. We addressed these aspects in a large multicenter study. Seventeen Italian allergy centers (Figure 1 in Data S1) partici‐ pated in this real‐life, cross‐sectional study. Consecutive HDM‐al‐ lergic patients, diagnosed on the basis of history of perennial rhinitis with or without asthma and of positive SPT with commercial ex‐ tracts of either D1 or D2, were enrolled between September 1, 2017, and June 30, 2018. Rhinitis and asthma were classified following the ARIA4 and GINA5 guidelines, respectively. Patients underwent SPT also with commercial extracts of an array of other airborne aller‐ gens (see Data S1). IgE specific for D1, D2, Der p 1, Der p 2, Der p 10, and Der p 23 was measured by ImmunoCAP (Thermo‐Fisher Scientific, Uppsala, Sweden). Levels > 0.35 kU/L were considered positive. Sera from patients scoring D1/D2‐positive but negative for all 4 allergens underwent immunoblot analysis at Lofarma (Milan, Italy) (details in Data S1); the 100 kDa allergen recognized by one of these patients was characterized by mass spectrometry (details in Data S1). Statistical methods as well as ethical issues are detailed in the Data S1; probability levels < 5% were considered statistically significant. A total of 519 patients (M/F: 256/263; mean age 28.4 years, range 4‐79) were studied; 221 were monosensitized to HDM, while 298 were co‐sensitized to other airborne allergens. Two hundred and ten (40.5%) had asthma. The prevalence of rhinitis and/or asthma did not show gender differences although both severe rhinitis and moderate/severe asthma prevailed in males. Asthma prevalence was similar in the four age groups (0‐19, 20‐39, 40‐59, and 60‐79 years), and asthmatic and nonasthmatic patients showed a similar mean age. Patients co‐sensitized to other allergens showed a higher preva‐ lence of moderate/severe rhinitis (171/298 [57%] vs 104/221 [47%]; P < 0.05) and of asthma of any severity (132/298 [44.3%] vs 78/221 [35.3]; P < 0.05) than HDM monosensitized ones. In vitro, 411/457 (89.9%) scored D1/D2‐positive, 16 (3.5%) and 5 (1.1%) monosensitized to D1 or D2, respectively, and 23 (5%; F/M 12/11; 9 with asthma; 8 monosensitized to HDM; 1 with shrimp al‐ lergy) both D1‐ and D2‐negative. In positive patients, the median IgE level was 38.3 and 44.6 kU/L for D1 and D2, respectively. Rhinitis severity did not correlate with IgE levels, while asthma severity did (P < 0.0001 for both D1 [Figure 1] and D2). IgE to Der p 1, Der p 2, Der p 10, and Der p 23 was detected in 58.6%, 67.9%, 11.9%, and 59.8% of patients, respectively. Sixty‐seven (12.9%; 53 and 67 positive for D1 and D2, respectively, 35 with moderate/severe rhi‐ nitis, 23 with asthma, and 3 with shrimp allergy) patients did not recognize any molecule, whereas 17 (3.3%), 48 (9.3%), 13 (2.5%), and 42 (8.1%) were monosensitized to Der p 1, Der p 2, Der p 10, and Der p 23, respectively. Mean IgE levels to Der p 1 (19.5 kU/L) and Der p 2 (24.1 kU/L) were significantly higher than IgE to Der p 23, which were nonetheless substantial (9.7 kU/L; P < 0.001) (for complete data and comparisons, see Table 2 in Data S1). Der p 23 sensitization prevalence dropped significantly with age, being 73%, 55%, 49%, and 35% in the four subgroups, respectively; accordingly, Der p 23 reactors were younger than negative ones (mean age [SD]: 25.6 [14.8] vs 32.6 [17.2]; P < 0.0001). Of the 23 D1/D2‐negative pa‐ tients, 12 reacted to one component: Der p 23 in 10 cases and Der p 2 in 2 cases; none bound more than one component. Sensitization to