[Multicenter component-resolved study of inhalant allergen sensitization and cross-reactivity in airway allergic...

Objective: To investigate the molecular sensitization profiles of inhalant allergens in Chinese patients with airway allergies using component-resolved diagnosis (CRD) and to analyze their distributional characteristics. Methods: In this cross-sectional study, allergen component testing data were collected from 225 patients diagnosed with allergic rhinitis (AR) and/or allergic asthma (AS) across 20 medical centers in 13 provinces (Northern, Southern, and Northwestern China) between October 2019 and January 2023. Specific immunoglobulin E (sIgE) levels for 132 components were analyzed. Sensitization differences were compared across clinical phenotypes, age stratifications, and geographical regions. Spearman correlation analysis was employed to evaluate molecular cross-reactivity. Results: Among the 225 patients [mean age: (19.40±17.53) years; 119 males, 106 females], children aged 0-6 and 7-14 years accounted for 58.67% (132/225). Regarding overall distribution, the predominant sensitizing components were Artemisia vulgaris (Art v 1, 43.11%), dust mites (Der p 2, 39.11%; Der f 2, 38.22%), and Phleum pratense (Phl p 12, 39.11%). Phenotypically, while the AR combined with AS group exhibited the broadest polysensitization, the AR only group was distinct for its significantly higher sensitization to cat (Fel d 1, 68.42%) and dog (Can f 1,36.84%) dander (both P<0.05). Conversely, pollen sensitization was relatively lower in the AS only group. Regarding age, children (0-6 and 7-14 years) showed early sensitization to pan-allergens (e.g., Phl p 12, Bet v 2) and fungi (Alt a 1), whereas dust mite components (Der f 2, Der p 2, Der p 23) showed lower prevalence in the 0-6 group (23.19%, 23.19%, and 10.14%, respectively). Regional analysis highlighted a "Northern Pollen vs Southern Mite" dichotomy: weeds (Artemisia>60%) and tree pollen dominated the Northwest and North, whereas mites (>60%) and cockroaches dominated the South (P<0.001). Furthermore, extensive molecular cross-reactivity was confirmed within the Serum Albumin and Profilin families. Conclusions: Significant heterogeneity exists in sensitization profiles across phenotypes, ages, and regions. Mugwort and mites are core allergens. CRD facilitates the identification of cross-reactivity and guides precise, regionalized management.