Molecular sensitisation patterns to aeroallergens in a Mediterranean paediatric population and their clinical implications.

Background: Environmental exposures, climate change, and lifestyle factors are key contributors to respiratory allergies. Understanding the connection between allergen exposure and the development of allergic diseases in early life is essential for identifying sensitization patterns and optimizing diagnostic and therapeutic strategies.

Objective: This study aims to characterize the allergic sensitization profile in a Mediterranean paediatric population using a component-resolved diagnosis (CRD) approach. Specifically, we analyse the prevalence and serodominance of aeroallergens, examine age-related sensitization patterns, and assess their implications for personalized allergen immunotherapy. Additionally, we highlight the need to incorporate the identified molecular allergens into standardized allergenic extracts to improve diagnostic accuracy and immunotherapy efficacy.

Methods: We conducted an observational, cross-sectional study including paediatric patients (0-15 years) diagnosed with allergic rhinitis, with or without asthma. Patients were classified according to disease severity following international guidelines. Skin prick tests were performed using standardized extracts, and specific IgE levels were determined with the multiplex assay Allergy Explorer 2 (ALEX2-MADX).

Results: A total of 47 patients were included (mean age: 7.5 years). Sensitization to house dust mites (HDM) was the most prevalent (74.5%), followed by pollen (57.4%) and animal epithelia (44.6%). The most frequently recognized allergens were Der p 23 (59.57%) for HDM, Ole e 1 (36.17%) for olive pollen, and Fel d 1 (27.7%) for cat epithelium. The highest IgE levels were observed in children aged 6-10 years. Polysensitization was present in 66% of patients, with frequent co-recognition of allergens from different sources. The findings emphasize the need to ensure that allergenic extracts used in diagnosis and immunotherapy contain relevant molecular components to enhance treatment precision.

Conclusion: A detailed molecular characterization of allergic sensitization in paediatric patients provides valuable insights into aeroallergen exposure and its clinical implications. Our findings reinforce the importance of incorporating relevant molecular allergens into standardized diagnostic and therapeutic extracts to optimize patient management and improve the efficacy of allergen-specific immunotherapy.