Mite Molecular Profile in the Th2-Polarized Moderate-to-Severe Persistent Asthma Endotype Subjected to High Allergen Exposure

Int Arch Allergy Immunol. 2021;182(1):21-31. doi: 10.1159/000510118. Epub 2020 Sep 14.


Background: The association among the IgE responses to prevailing groups of house dust mite (HDM) allergens in the concurrent asthma phenotypes has not been determined.

Objective: The aim of the present study lays on a component-resolved diagnosis (CRD) model to investigate the mite molecular signature in subjects with type-2 inflammation asthma.

Methods: We selected patients showing a clinically relevant sensitization to HDMs with moderate-to-severe persistent asthma. Skin prick test (SPT) with standardized mite extracts, a broad customized CRD serum sIgE panel including 9 Dermatophagoides pteronyssinus allergens and the related protein allergenic characterization, was investigated in all serum samples.

Results: Ninety out of 93 (96.77%) patients with a positive SPT to HDM showed a concordant sIgE (≥0.35 kUA/L) to the crude extract of D. pteronyssinus. Major allergens (Der p 2, Der p 23, and Der p 1) were present in >70% of all subjects, with mid-tier allergens (Der p 5, Der p 7, and Der p 21) reaching up to 51% in the present cohort. A complex pleomorphic repertoire of HDM molecules recognized by IgE was depicted, including 38 distinct profiles.

Conclusions and clinical relevance: The proposed CRD panel approach, containing the most prevalent HDM allergens, appeared to be sufficient to obtain a precise D. pteronyssinus molecular diagnosis in asthmatics with a climate-dependent high-mite allergen exposure and coexisting sensitization. A dominant role of both major and mid-tier allergens has been confirmed in moderate and severe persistent asthmatics with the preponderant Th2-high endotype.

Keywords: Airborne allergens; Allergen exposure; Asthma; Dermatophagoides pteronyssinus; Th2.

MeSH terms

  • Allergens / immunology*
  • Animals
  • Antigens, Dermatophagoides / immunology*
  • Asthma / diagnosis*
  • Asthma / immunology*
  • Cytokines / metabolism
  • Dermatophagoides pteronyssinus / immunology*
  • Female
  • Humans
  • Immunoglobulin E / blood
  • Immunoglobulin E / immunology
  • Lymphocyte Activation / immunology
  • Male
  • Severity of Illness Index
  • Skin Tests
  • Th2 Cells / immunology*
  • Th2 Cells / metabolism


  • Allergens
  • Antigens, Dermatophagoides
  • Cytokines
  • Immunoglobulin E