Rare allergen sources are clinically relevant sensitizers in Central Europe.
Wöhrl Julia J, Hemmer Wolfgang W, Lang Roland R, Moritz Katharina K et al.
In recent times, diagnosing allergies apart from house dust mite (HDM), birch tree, and grass pollen has become increasingly difficult because allergen manufacturers have withdrawn many commercial skin prick test (SPT) solutions for rare allergen sources. A cohort of 5,857 patients (mean age 35.9 ± 20.3 years, 60.5% female) was tested with standardized SPT panels comprising 46 inhalant and food allergens at a large allergy outpatient clinic in Vienna. Cases with positive tests and allergen-specific history were judged as "relevant", those without as "latent". In the patient cohort, 48.8% presented with a history of allergic rhinoconjunctivitis (ARC), 16.7% with bronchial asthma (BA), 13.2% with atopic dermatitis (AD), and 28.9% with food allergy (FA). Of 113,893 SPTs, 7.0% were relevant, 5.3% were latent, and 87.7% remained negative. The 3 most frequent allergen sources - grass, birch, and HDM - showed the highest ratio of 22.2% relevant compared to 7.1% latent SPTs. The 6 other non-rare allergen sources - European ash tree, mugwort, ragweed, Alternaria alternata, cat, and dog - yielded 9.5% positive and 7.4% latent SPT results. The other 34 rare allergen sources resulted in 1.8% positive and 3.9% latent tests. Plantain, horse, hazelnut (food), soymilk, peanut, plane tree, and nettle ranked top among the rare allergens. Among rare allergens, relevant SPTs to horse/rabbit, Alternaria alternata, oat flour, and rye flour were associated with an increased risk for BA including work-related asthma. 15.4% (1,230/7,985) of all relevant SPTs were observed in "rare allergens". This demonstrates the necessity of including rare allergens in standard allergy workups.