Mite allergy
Mite major allergens Der p 1/Der f 1 and Der p 2/Der f 2 sensitize the
vast majority of mite allergic patients, being the double sensitization
to groups 1 and 2 strongly associated with asthma32. Group 1
sensitization is more prevalent in children than in adults, suggesting
an initiation role probably associated with its proteolytic properties73. Recently Der p 23
has been described to be associated with increased asthma risk74. Other mite species,
known as minor or storage mites, have a limited allergenic
cross-reactivity with major mites. Interestingly, they display a
significant cross-reactivity between them. Lep d 2 could be a good
marker for minor storage allergy sensitization75. Some patients
exposed to high mite allergen levels, and sensitized to storage mites,
develop anaphylactic reactions when exposed to foods contaminated with
mites 76.
Interestingly, these patients present NSAIDs intolerance and recently
they have been described to present extensive oral mucosa barrier damage8.
A post-hoc analysis of a study with AIT with D .pteronnysinus and D. farinae found no association between
the clinical efficacy and sensitization to different mite allergens77.
Recently, the antibody response to a SCIT preparation for mite allergy
has been examined at the molecular level in 24 mite-allergic patients78. A protective IgG
response has been observed for Der p 1 and Der p 2 and, to a lesser
extent, Der p 23. By contrast, patients did not develop a strong
response to other mite allergens. Interestingly, a better clinical
response to the AIT was observed in patients sensitized only to Der p 1
and/or Der p 2, when compared to patients with a broader IgE response78. This suggest that
the molecular profile of IgE sensitization may be useful in selecting
patients that may benefit from subcutaneous AIT78, as previously
hypothesized 79.
However, no studies are available so far to ascertain whether this
conclusion can be applied also to sublingual immunotherapy.