①背景：不同种类的螨虫可能是引起过敏的潜在原因，对它们之间的致敏性的比较研究很少。②目的：提高对不同地域尘螨过敏患者的诊断水平，在这些地区的环境中屋尘螨/粉螨与贮藏螨可能同时存在。③方法：研究队列包含来自不同地区的477名患者(包括儿童和成人)，覆盖了西班牙主要的螨虫流行地区。全螨提取物的SPT、螨变应原暴露水平、对8种过敏原的sIgE和特异性IgG4测定。在一组患者中进行BAT和CAST。结果Dp和L. destructor在大西洋地区较为常见，而D. farinae在地中海地区居多。大约90%的患者对第一组和/或第二组过敏原过敏。第2组最常见且BAT中IgE反应/致敏强度较高。sIgE与Der p2 /Der f2几乎完全交叉反应，但与lepd2没有交叉反应。第一组过敏原也具有交叉反应性，但在一些患者中观察到种类特异性反应。lepd2特异性IgE的表达与对仓储螨的SPT结果有相关性。儿童对Der p1的敏感性较高，而成人对lepd2的敏感性较高。对Der p2的IgE/IgG4比值较高与过敏性哮喘的发生有关。④结果：建立了一种改进的诊断方法，第二组变应原似乎在螨虫过敏中起着主导作用，但由于第一组变应原致敏在某些病人中可能具有特异性，而且在儿童中发病率较高，因此在设计螨虫过敏疫苗时必须考虑到对主要的螨类和主要的变应原的充分平衡。
Analysis of mite allergic patients in a diverse territory by improved diagnostic tools DOI: doi: 10.1111/j.1365-2222.2012.03993.x
There are few studies comparing the sensitization with mite allergens from different mite species which could potentially be the cause of allergy.
To improve the diagnosis of mite allergic patients from a diverse territory in which D. pteronyssinus/D. farinae mites together with storage mites could be present in the environment.
Four hundred and seventy-seven patients (both children and adults) from different regions, covering the main mite prevalent areas of Spain, were recruited. sIgE to eight allergens was measured together with SPT to whole mite extracts, level of mite allergen exposure, and specific IgG4. BAT and CAST was performed in a subgroup of patients. Results D. pteronyssinus and L. destructor were more prevalent in Atlantic areas, whereas D. farinae predominate in Mediterranean areas. About 90% of patients were sensitized to group 1 and/or group 2 allergens. Group 2 was the most prevalent, and the IgE response/ intensity of sensitization in BAT was higher. sIgE to Der p 2/Der f 2 was almost fully cross-reactive, but no cross-reactivity was detected with Lep d 2. Group 1 allergens were also cross-reactive, but in some patients a species-specific response was observed. sIgE to Lep d 2 was associated with SPT results to storage mites. Sensitization to Der p 1 was more frequent in children, whereas Lep d 2 sensitization was more frequent in adults. A higher ratio IgE/IgG4 to Der p 2 was associated with the presence of allergic asthma.
An improved diagnosis algorithm has been established. Group 2 allergens seem to have a leading role in mite allergy, but as group 1 sensitization could be speciesspecific in some patients and its prevalence is higher in children, an adequate balance on major mite species and major allergens must be consider in the design of mite allergy vaccines.
D. Barber1 , J. Arias2 , M. Boquete3 , V. Cardona4 , T. Carrillo5 , G. Gala6 , P. Gamboa7 , J. C. Garcı´a-Robaina8 , D. Herna´ndez9 , M. L. Sanz10, A. I. Tabar11, C. Vidal12, H. Ipsen1 , F. de la Torre1 and M. Lombardero