西班牙主要屋尘螨变应原的区域多样性：分子谱与临床相关性

文献信息

中文摘要

背景： 屋尘螨（HDM）是全球呼吸道过敏的主要原因。分子诊断使得致敏模式能够被更精确地表征，这可能具有临床和治疗相关性。然而，在西班牙真实世界环境中，关于HDM分子致敏谱的大规模数据仍然有限。
目的： 我们旨在确定西班牙不同地区HDM分子组分的血清阳性率和主要变应原，并探讨其与过敏表型（包括过敏性鼻炎（AR）和哮喘）的关联。
方法： 在西班牙5个地区开展了一项多中心横断面研究。使用多重分子诊断平台分析了来自疑似HDM过敏患者的458份血清样本。致敏定义为特异性IgE ≥ 0.3 kUA/L。患病率≥50%的变应原被视为主要变应原。通过患病率比值比（POR）和卡方检验评估与AR和哮喘的关联。
结果： 最普遍的HDM变应原为Der p 23（85.2%）、Der f 2（82.3%）、Der p 2（81.0%）、Der p 1（77.5%）和Der f 1（71.0%）。观察到区域差异，Galicia地区对Gly d 2和Lep d 2（均为57%）的致敏率高。在Canary群岛，超过50%的患者对Gly d 2、Lep d 2、Der p 21、Der p 5、Der p 7和Blot 5致敏。对Blot 5的致敏与哮喘呈中度关联（POR，3.64），而Tyr p 2与持续性AR相关（POR，2.33）。对Lep d 2的致敏与AR严重程度的关联在不同地区间存在差异。
结论： Der p 23、Der f 2、Der p 2、Der p 1和Der f 1是西班牙的主要HDM变应原，其区域变异性提示环境或遗传修饰因素。某些分子变应原与更严重或持续的过敏表型相关，凸显了组分解析诊断在风险分层和免疫治疗规划中的价值。

英文摘要

BACKGROUND: House dust mites (HDMs) are a major cause of respiratory allergies worldwide. Molecular diagnosis has allowed a more precise characterization of sensitization patterns, which may have clinical and therapeutic relevance. However, large-scale data on molecular HDM sensitization profiles in real-world settings remain limited in Spain.
OBJECTIVE: We aimed to determine the seroprevalence and major allergens of HDM molecular components across different Spanish regions and to explore their association with allergic phenotypes, including allergic rhinitis (AR) and asthma.
METHODS: A multicenter cross-sectional study was conducted in 5 Spanish regions. A total of 458 serum samples from patients with suspected HDM allergy were analyzed using a multiplex molecular diagnostic platform. Sensitization was defined as specific IgE ≥ 0.3 kUA/L. Allergens with a prevalence ≥50% were considered major allergens. Associations with AR and asthma were evaluated by prevalence odds ratios (PORs) and chi-square tests.
RESULTS: The most prevalent HDM allergens were Der p 23 (85.2%), Der f 2 (82.3%), Der p 2 (81.0%), Der p 1 (77.5%), and Der f 1 (71.0%). Regional differences were observed, with Galicia showing high sensitization to Gly d 2 and Lep d 2 (both 57%). In the Canary Islands, >50% of patients were sensitized to Gly d 2, Lep d 2, Der p 21, Der p 5, Der p 7, and Blot 5. Sensitization to Blot 5 showed a moderate association with asthma (POR, 3.64), whereas Tyr p 2 was linked to persistent AR (POR, 2.33). Sensitization to Lep d 2 had variable associations with AR severity across regions.
CONCLUSIONS: Der p 23, Der f 2, Der p 2, Der p 1, and Der f 1 are the major HDM allergens in Spain, with regional variability suggesting environmental or genetic modifiers. Certain molecular allergens are associated with more severe or persistent allergic phenotypes, highlighting the value of component-resolved diagnosis for risk stratification and immunotherapy planning.