Allergen Spectrum and House Dust Mite Component-Resolved Sensitization Patterns in Children with Allergic Rhinitis: A Two-Stage Study

House dust mite (HDM) is the predominant indoor allergen in children with allergic rhinitis (AR), but conventional binary reporting obscures both sensitization intensity and component-specific profiles.

This two-stage retrospective cross-sectional study enrolled 2036 children (1-15 years) with AR. Serum sIgE against 19 allergens was measured by immunoblot (≥0.35 kU/L positive). D. pteronyssinus-positive samples were stratified into six sensitization grades. In Stage 2, 110 HDM-positive children underwent component-resolved diagnostics for Der p 1, Der p 2, Der f 1, Der f 2, Der p 23, and Der p 10.

D. pteronyssinus was the most prevalent allergen (43.91%, 894/2036; 95% CI 41.77-46.07%). Boys had higher positivity than girls (46.34% vs 39.50%; OR 1.32, 95% CI 1.10-1.59), but among sensitized children, high-grade sensitization (≥grade 4) was similar between sexes (69.08% vs 66.43%, P=0.427). In cross-sectional analyses, the proportion of grade 6 sensitization (>100 kU/L) increased with age, from 15.00% at age 3 to 25.51% at age 5 and 34.58% at age 6. Component positivity rates were: Der f 1 72.73% (80/110), Der p 1 70.91% (78/110), Der f 2 64.55% (71/110), Der p 2 62.73% (69/110), Der p 23 41.82% (46/110), and Der p 10 11.82% (13/110). Co-sensitization between Der p 1 and Der p 23 occurred in only 53.85% of Der p 1-positive children. Exclusive sensitization to D. farinae (0.91%; 95% CI 0.16-4.97%) or Der p 23 (0.91%; 95% CI 0.16-4.97%) was rare.

HDM is the leading allergen in pediatric AR in East China. Cross-sectional analyses identified an age-associated increase in the proportion of high-grade sensitization that was most evident around 5-6 years of age. CRD revealed Der p 23 as a major sensitizing component whose sensitization frequently occurred independently of group 1 allergens. Because clinical allergy phenotypes and AIT outcomes were not assessed, the utility of component-resolved profiles for guiding AIT selection requires prospective validation.