Allergen Sensitization Patterns And Pollen Components Analysis Of Patients With Allergic Rhinitis In China

ObjectiveAllergic rhinitis(AR)is characterized by distinct clinical heterogeneity and allergic sensitization patterns.We aimed to quantify the severity of symptoms in patients with allergic rhinitis according to the potential sensitization patterns for inhalation allergens in China.Pollen is an important inhalation allergen in China,but there are few studies on the cross-reaction between some limited but important pollens.This study also aimed to explore the sensitization and cross-reactivity of mugwort,timothy,birch,and their major allergen components.Methods1.Based on the skin response of 16 inhalation allergens,we used a data-driven method,latent category analysis(LCA),to divide patients with allergic rhinitis into independently clusters with different atopic sensitization patterns.Visual analogue scale was used to quantify the severity of AR symptoms.Finally,we evaluated the association between the severity of AR and the allergen sensitization pattern.2.160 patients with respiratory allergic disease who were positive for at least one allergen sIgE in mugwort,timothy and birch were enrolled.Serum specific Ig E(sIgE)levels of mugwort and its components(Art v 1/ 3),birch and its components(Bet v 1/4),timothy and its components(Phl p 1/4/5/7)and cross-reactive carbohydrate determinants(CCD)were detected via EUROBlot Master system.In addition,the Ig E levels of Phl p12(Timothy profilin),r Bet v 2(Birch profilin)and Art v 4(Mugwort profilin)were measured.Skin prick testing was utilized to assess the allergic reaction of grass,weed,and tree allergens.Latent class analysis was used to identify underlying patterns of sensitization to a series of allergen components and their corresponding crude extracts.Results1.LCA revealed three phenotypes of atopic sensitization among 1293 patients with AR.We labeled latent classes as: Class A,"High level Pollen sensitization Group"(n=168[13%]);Class B,"Medium level Pollen sensitization Group"(n=501[38.7%]);Class C,"House dust mite sensitization Group"(n=624[48.3%]);In northwest and north China,patients in the "Medium/High Pollen sensitization Group " are mainly present,while patients in the " House dust mite sensitization Group" are more common in south,southwest,and south China.The "High level Pollen sensitization Group" is often combined with the multi-sensitization of pollen allergens(trees,grass,weeds)among different genera.The patients in the "Medium level pollen sensitization group" were commonly sensitized by weeds.Patients in the "Medium/High Pollen sensitization Group" have more severe nasal and eye symptoms than those in the "House dust mite sensitization Group",indicating that seasonal allergic rhinitis has more severe upper respiratory tract symptoms than perennial allergic rhinitis patients.2.Of the 160 patients with allergic rhinitis and/or asthma,88.8% were positive for mugwort-sIgE,30% for timothy-sIgE,and 32.5% for birch-sIgE.142 mugwort sIgE positive patients showed positive reactions to Art v 1(59.2%),Art v 3(43.7%),and Art v 4(43.7%);48 Timothy sIgE positive patients showed Ig E responses to Phl p1(33.3%)and Phl p12(50.0%);The sensitization rates of 52 birch sIgE positive patients to Bet v1(44.2%)and Betv 2(42.3%)were comparable.By using the LCA model,three sensitization patterns as "Mugwort,Art v 4,Bet v 2 and Phl p 12 mainly sensitization","Timothy,mugwort,and CCD mainly sensitization","Mugwort and Art v 1 mainly sensitization" were revealed based on optimal statistical fit in this study.The spearman’s coefficient between CCD and timothy was larger than the corresponding values of CCD with mugwort or birch.Compared with other patterns,participants in "Mugwort,Art v 4,Bet v 2 and Phl p 12 mainly sensitization" pattern were associated with higher sensitization rates of common grass and tree pollen allergens.Conclusions1.There are three potential sensitization patterns for inhaled allergens in patients with allergic rhinitis,namely "High level pollen sensitization group","Medium level pollen sensitization group" and "Mite sensitization group".There were regional differences in allergic rhinitis sensitization patterns.In Northwest and North China,"Medium/High level pollen sensitization group" was the dominant group,while in South China,Southwest and South China,"Mite sensitization group" was the dominant group.We identified three sensitization patterns in AR patients with different geographical distribution and symptom severity.In China,patients with seasonal allergic rhinitis often have positive SPT results to multiple pollens.2.Compared with the patients with "Mite sensitization group",the symptoms of allergic rhinitis in the patients with "Middle level pollen sensitization group" and "High level pollen sensitization group" are more serious,indicating that the symptoms of upper respiratory tract in patients with seasonal allergic rhinitis are more serious.3.Patients with seasonal allergic rhinitis often have positive skin prick test results sensitized to various pollen,which may be related to the cross-reaction caused by CCD and profilin.Compared with CCD,patients sensitized by Profilin often have more positive skin prick results,which interferes with clinicians’ interpretation and immunotherapy choice.4.There may be cross reactions caused by CCD and profilin among allergens of Artemisia,birch and Artemisia.In addition,CCD has greater interference to sIgE detection of timothy,and less interference to mugwort and birch.