When developing a panel for allergen detection, the inclusion of an excessive number of allergens is uneconomical. By contrast, an insufficient number of allergens will lead to incomplete detection. Our results revealed that, in the past 7 years, only the positive rates of allergens sIgE in D. farinae, D. pteronyssinus, milk, egg whites, B. germanica, C. pagurus, A. alternata, and P. monodon were > 10%, the other allergens were between 4–7%. Meanwhile, D. farinae, D. pteronyssinus, milk, and egg whites were among the top five allergens with the highest positive rate every year. This indicates that in the same region, common allergens have not changed greatly over time, similar to research from Qatar6,7. Our results also show that the main allergens causing different common allergic diseases in the same area are similar and still depend on the common local allergens. However, in our previous studies, even patients are allergic to the same allergen, the main sensitization components various among patients with different diseases8,9.
Besides, for children, milk was the main allergen, whereas mites, cockroaches, shrimps, and crabs were the allergens with higher positive rates for adults. Moreover, A. alternata was also one of the five main allergens in children aged < 14 years. This may be attributed to different lifestyle and physiological conditions of people with different age10. Therefore, age is an important factor to consider when establishing or selecting the panel of allergen detection.
Interestingly, > 38% of patients are polysensitized, and majority of patients were co-sensitized to both D. farina and D. pteronyssinus; C. pagurus, P. monodon, and B. germanica; or milk and egg whites. In previous studies, we reported an extensive cross-reaction between D. farina and D. pteronyssinus11; C. pagurus, P. monodon, and B. germanica12; milk and egg whites10,13. Thus, we can test positive for one of the above allergens and then easily deduce that the patient is also positive for the others14,15.
Based on currently commercially available allergenic reagents (ThermoFisher, USA), we propose a strategy to form an allergen detection panel in Guangzhou using 4–5 common allergens. Among the allergens with positive rates > 10%, owing to co-sensitization between D. farinae and D. pteronyssinus; milk and egg whites; B. germanica, C. pagurus, and P. monodon, we can select among them to avoid superfluous detection16. Accordingly, we recommend using D. farinae, milk, B. germanica, and A. alternata as the general screening panel in this region, which can detect > 93% of potential allergic population. Certainly, the detection of potential allergens, such as pollen and animal hair, can also be added according to the patient’s main complaint17,18.
There are some limitations to the research. First, this panel is only applicable to Guangzhou, China or areas with similar climatic conditions, species richness, and lifestyle. Second, the allergens included in the study are only based on the common allergens currently in present in the region, which is the main limitation of the study. We cannot rule out that some potential allergens that were not considered can also cause high sensitization rates, such as mango, cod, and French chrysanthemum19,20. This needs to be supplemented by the development of an allergen diagnosis technology in China in the future. Finally, due to the insufficient number of allergic patients with gastrointestinal symptoms, it is difficult to analyze the main food allergens that cause gastrointestinal symptoms.