Association of allergen stability and epithelial barrier function in sensitized patients

Panallergen families differ in their stability to heat and pH, which affects both the severity and clinical manifestations of allergic reactions. The extent of epithelial barrier dysfunction is thought to influence sensitization to different allergens. This study aimed to investigate associations between patient characteristics, epithelial barrier-related markers, and distinct sensitization profiles.

Specific immunoglobulin E (sIgE) against stable (2S albumins, 7/8S and 11S globulins) and unstable allergens (PR-10 proteins, profilins) was assessed in 216 patients recruited in South Tyrol, Italy, using the multiplex assay ALEX² and correlated with patient demographics, allergic symptoms, Investigator Global Assessment Score (IGA score), Transepidermal Water Loss (TEWL), and Fractional exhaled Nitric Oxide (FeNO).

Patients sensitized to stable allergens were younger, showed more frequently eczema, higher IGA scores, and higher TEWL. Gastrointestinal symptoms combined with skin symptoms were more common. Respiratory symptoms alone were more frequent in patients sensitized to unstable allergens but were associated with higher FeNO values only in the case of co-sensitizations to stable allergens.

Sensitization to stable allergens is associated with distinctive epithelial barrier impairment. Children with respiratory symptoms may benefit from multiplex testing for co-sensitizations to stable food allergens and early initiation of specific immunotherapy to aeroallergens to prevent asthma in positive cases.