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.