Polysensitisation is associated with more severe symptoms: The reality of patients with allergy.
aeroallergens
molecular diagnosis
personalised immunotherapy
polysensitisation
Journal
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
ISSN: 1365-2222
Titre abrégé: Clin Exp Allergy
Pays: England
ID NLM: 8906443
Informations de publication
Date de publication:
27 Apr 2024
27 Apr 2024
Historique:
revised:
03
04
2024
received:
05
02
2024
accepted:
12
04
2024
medline:
27
4
2024
pubmed:
27
4
2024
entrez:
27
4
2024
Statut:
aheadofprint
Résumé
Studying the sensitisation profiles of patients with allergies allows for a deeper understanding of the disease which may facilitate the selection of the best-personalised allergen immunotherapy. This observational, cross-sectional, multicentre study aimed to demonstrate the heterogeneity of the German population with allergies by analysing specific immunoglobulin E (sIgE) patterns towards aeroallergens and exploring the relationship between sensitisation and clinical symptoms. In total, 500 patients with allergies from different regions of Germany were recruited based on their case histories, clinical allergic symptoms and skin prick test data for aeroallergens. Serum samples were analysed using ImmunoCAP assays to determine sIgE levels for 33 allergenic sources and 43 molecular allergens. Most patients (81%) were polysensitised. Betula verrucosa pollen was the most common cause of sensitisation (59%), followed by Phleum pratense (58%) and Dermatophagoides pteronyssinus (44%). The highest prevalence rates of molecular allergens were observed for Bet v 1 (84%) from birch pollen, Phl p 1 from grass pollen (82%), Der p 2 (69%) from mites and Fel d 1 (69%) from cat. Polysensitisation was significantly associated with the presence of asthma and the severity of rhinitis symptoms. Our findings show a high rate of polysensitisation and emphasise the importance of molecular diagnosis for more precise and comprehensive insights into sensitisation patterns and their association with clinical symptoms. These data may help improve personalised diagnosis and immunotherapy adapted to the needs of individual patients in the region.
Sections du résumé
BACKGROUND
BACKGROUND
Studying the sensitisation profiles of patients with allergies allows for a deeper understanding of the disease which may facilitate the selection of the best-personalised allergen immunotherapy. This observational, cross-sectional, multicentre study aimed to demonstrate the heterogeneity of the German population with allergies by analysing specific immunoglobulin E (sIgE) patterns towards aeroallergens and exploring the relationship between sensitisation and clinical symptoms.
METHODS
METHODS
In total, 500 patients with allergies from different regions of Germany were recruited based on their case histories, clinical allergic symptoms and skin prick test data for aeroallergens. Serum samples were analysed using ImmunoCAP assays to determine sIgE levels for 33 allergenic sources and 43 molecular allergens.
RESULTS
RESULTS
Most patients (81%) were polysensitised. Betula verrucosa pollen was the most common cause of sensitisation (59%), followed by Phleum pratense (58%) and Dermatophagoides pteronyssinus (44%). The highest prevalence rates of molecular allergens were observed for Bet v 1 (84%) from birch pollen, Phl p 1 from grass pollen (82%), Der p 2 (69%) from mites and Fel d 1 (69%) from cat. Polysensitisation was significantly associated with the presence of asthma and the severity of rhinitis symptoms.
CONCLUSIONS
CONCLUSIONS
Our findings show a high rate of polysensitisation and emphasise the importance of molecular diagnosis for more precise and comprehensive insights into sensitisation patterns and their association with clinical symptoms. These data may help improve personalised diagnosis and immunotherapy adapted to the needs of individual patients in the region.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 John Wiley & Sons Ltd.
Références
Demoly P, Passalacqua G, Pfaar O, Sastre J, Wahn U. Management of the polyallergic patient with allergy immunotherapy: a practice‐based approach. Allergy Asthma Clin Immunol. 2016;12:2.
Scala E, Abeni D, Asero R. Disease‐specific molecular profiles highlighted by radar graphic display. Int Arch Allergy Immunol. 2020;181(7):536‐539.
Nelson HS. To mix or not to mix in allergy immunotherapy vaccines. Curr Opin Allergy Clin Immunol. 2021;21(6):583‐589.
Bahceciler NN, Yuruker O. Planning and approach to allergen‐specific immunotherapy in polyallergic patients. Immunotherapy. 2020;12(8):577‐585.
Alba P, Moreno V, Arias‐Irigoyen J, et al. Safety evaluation of a multiallergen immunotherapy treatment in polyallergic patients. APOLO observational study. Immunotherapy. 2020;12(1):75‐87.
Schwarz A, Panetta V, Cappella A, et al. IgG and IgG4 to 91 allergenic molecules in early childhood by route of exposure and current and future IgE sensitization: results from the multicentre allergy study birth cohort. J Allergy Clin Immunol. 2016;138(5):1426‐1433.e12.
Matricardi PM, Dramburg S, Potapova E, Skevaki C, Renz H. Molecular diagnosis for allergen immunotherapy. J Allergy Clin Immunol. 2019;143(3):831‐843.
Ogulur I, Pat Y, Ardicli O, et al. Advances and highlights in biomarkers of allergic diseases. Allergy. 2021;76(12):3659‐3686.
Luengo O, Galvan‐Blasco P, Cardona V. Molecular diagnosis contribution for personalized medicine. Curr Opin Allergy Clin Immunol. 2022;22(3):175‐180.
Luengo O, Labrador‐Horrillo M. Molecular allergy diagnosis in clinical practice: frequently asked questions. J Invest Allergol Clin Immunol. 2022;32(1):1‐12.
Barber D, Diaz‐Perales A, Escribese MM, et al. Molecular allergology and its impact in specific allergy diagnosis and therapy. Allergy. 2021;76(12):3642‐3658.
Heffler E, Puggioni F, Descalzi D, Racca F, Canonica GW, Melioli G. Microarray immunodiagnostics for aeroallergens. Curr Allergy Asthma Rep. 2019;19(1):10.
Izmailovich M, Semenova Y, Abdushukurova G, et al. Molecular aspects of allergen‐specific immunotherapy in patients with seasonal allergic rhinitis. Cells. 2023;12(3):383.
Ridolo E, Incorvaia C, Heffler E, Cavaliere C, Paoletti G, Canonica GW. The present and future of allergen immunotherapy in personalized medicine. J Pers Med. 2022;12(5):774.
Gonzalez‐Perez R, Poza‐Guedes P, Pineda F, Sanchez‐Machin I. Advocacy of precision allergy molecular diagnosis in decision making for the eligibility of customized allergen immunotherapy. Curr Issues Mol Biol. 2023;45(12):9976‐9984.
Callery EL, Keymer C, Barnes NA, Rowbottom AW. Component‐resolved diagnostics in the clinical and laboratory investigation of allergy. Ann Clin Biochem. 2020;57(1):26‐35.
Hatzler L, Panetta V, Lau S, et al. Molecular spreading and predictive value of preclinical IgE response to Phleum pratense in children with hay fever. J Allergy Clin Immunol. 2012;130(4):894‐901.e5.
Posa D, Perna S, Resch Y, et al. Evolution and predictive value of IgE responses towards a comprehensive panel of house dust mite allergens during the first 2 decades of life. J Allergy Clin Immunol. 2017;139(2):541‐549.e8.
Gan H, Luo W, Huang Z, et al. House dust mite components sensitization profile in China, a multi‐centre study. Clin Exp Allergy. 2023;53(2):226‐229.
Becker S, Schlederer T, Kramer MF, et al. Real‐life study for the diagnosis of house dust mite allergy – the value of recombinant allergen‐based IgE serology. Int Arch Allergy Immunol. 2016;170(2):132‐137.
Stemeseder T, Klinglmayr E, Moser S, et al. Cross‐sectional study on allergic sensitization of Austrian adolescents using molecule‐based IgE profiling. Allergy. 2017;72(5):754‐763.
Melioli G, Marcomini L, Agazzi A, et al. The IgE repertoire in children and adolescents resolved at component level: a cross‐sectional study. Pediatr Allergy Immunol. 2012;23(5):433‐440.
Jimenez‐Feijoo R, Pascal M, Moya R, et al. Molecular diagnosis in house dust mite‐allergic patients suggests that Der p 23 is clinically relevant in asthmatic children. J Invest Allergol Clin Immunol. 2020;30(2):127‐132.
Ciprandi G, Incorvaia C, Frati F. Management of polysensitized patient: from molecular diagnostics to biomolecular immunotherapy. Expert Rev Clin Immunol. 2015;11(9):973‐976.
Canis M, Gröger M, Becker S, Klemens C, Kramer MF. Recombinant allergen profiles and health‐related quality of life in seasonal allergic rhinitis. Allergy Asthma Proc. 2010;31(3):219‐226.
de Jong AB, Dikkeschei LD, Brand PL. Sensitization patterns to food and inhalant allergens in childhood: a comparison of non‐sensitized, monosensitized, and polysensitized children. Pediatr Allergy Immunol. 2011;22(2):166‐171.
Migueres M, Fontaine JF, Haddad T, et al. Characteristics of patients with respiratory allergy in France and factors influencing immunotherapy prescription: a prospective observational study (REALIS). Int J Immunopathol Pharmacol. 2011;24(2):387‐400.
Villalta D, Asero R. Analysis of the allergenic profile of patients hypersensitive to pollen pan‐allergens living in two distinct areas of northern Italy. Eur Ann Allergy Clin Immunol. 2011;43(2):54‐57.
Soyyiğit Ş, Öksüzer ÇD. Characterization of clinical features of monosensitized and polysensitized allergic rhinitis patients with pollen allergy. Eur Respir J. 2023;9:1‐10.
Valero A, Ferrer M, Baró E, et al. Discrimination between moderate and severe disease may be used in patients with either treated or untreated allergic rhinitis. Allergy. 2010;65(12):1609‐1613.
Reddel HK, Bacharier LB, Bateman ED, et al. Global initiative for asthma strategy 2021: executive summary and rationale for key changes. Eur Respir J. 2022;59(1):2102730.
R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2016. Available at: https://www.R‐project.org/
Ansotegui IJ, Melioli G, Canonica GW, et al. IgE allergy diagnostics and other relevant tests in allergy, a world allergy organization position paper. World Allergy Organ J. 2020;13(2):100080.
Beitia JM, López‐Matas MA, Alonso A, et al. Allergenic profile to Phleum pratense and immunological changes induced after grass allergen‐specific immunotherapy. Int Arch Allergy Immunol. 2014;165(1):9‐17.
Darsow U, Brockow K, Pfab F, et al. Allergens. Heterogeneity of molecular sensitization profiles in grass pollen allergy – implications for immunotherapy? Clin Exp Allergy. 2014;44(5):778‐786.
Gangl K, Niederberger V, Valenta R. Multiple grass mixes as opposed to single grasses for allergen immunotherapy in allergic rhinitis. Clin Exp Allergy. 2013;43(11):1202‐1216.
García BE, Martínez‐Aranguren R, Bernard Alonso A, et al. Is the ISAC 112 microarray useful in the diagnosis of pollinosis in Spain? J Invest Allergol Clin Immunol. 2016;26(2):92‐99.
Mothes‐Luksch N, Jordakieva G, Hinterhölzl L, et al. Allergy diagnosis from symptoms to molecules, or from molecules to symptoms: a comparative clinical study. World Allergy Organ J. 2018;11(1):22.
Passalacqua G, Melioli G, Bonifazi F, et al. The additional values of microarray allergen assay in the management of polysensitized patients with respiratory allergy. Allergy. 2013;68(8):1029‐1033.
Bergmann KC, Heinrich J, Niemann H. Current status of allergy prevalence in Germany: position paper of the environmental medicine Commission of the Robert Koch Institute. Allergo J Int. 2016;25:6‐10.
Haftenberger M, Laußmann D, Ellert U, et al. Prevalence of sensitisation to aeraoallergens and food allergens: results of the German health interview and examination survey for adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5–6):687‐697.
Langen U, Schmitz R, Steppuhn H. Prevalence of allergic diseases in Germany: results of the German health interview and examination survey for adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5–6):698‐706.
Beutner C, Werchan B, Forkel S, et al. Sensitization rates to common inhaled allergens in Germany – increase and change patterns over the last 20 years. J Dtsch Dermatol Ges. 2021;19(1):37‐44.
Linneberg A, Nielsen NH, Madsen F, Frølund L, Dirksen A, Jørgensen T. Increasing prevalence of specific IgE to aeroallergens in an adult population: two cross‐sectional surveys 8 years apart: the Copenhagen allergy study. J Allergy Clin Immunol. 2000;106(2):247‐252.
Park HJ, Lim HS, Park KH, Lee JH, Park JW, Hong CS. Changes in allergen sensitization over the last 30 years in Korea respiratory allergic patients: a single‐center. Allergy Asthma Immunol Res. 2014;6(5):434‐443.
Warm K, Lindberg A, Lundbäck B, Rönmark E. Increase in sensitization to common airborne allergens among adults – two population‐based studies 15 years apart. Allergy Asthma Clin Immunol. 2013;9(1):20.
Nelson HS. Allergen immunotherapy (AIT) for the multiple‐pollen sensitive patient. Expert Rev Clin Pharmacol. 2016;9(11):1443‐1451.
Schmitz R, Ellert U, Kalcklösch M, Dahm S, Thamm M. Patterns of sensitization to inhalant and food allergens – findings from the German health interview and examination survey for children and adolescents. Int Arch Allergy Immunol. 2013;162(3):263‐270.
Panzner P, Vachová M, Vítovcová P, Brodská P, Vlas T. A comprehensive analysis of middle‐European molecular sensitization profiles to pollen allergens. Int Arch Allergy Immunol. 2014;164(1):74‐82.
Ciprandi G, Comite P, Mussap M, et al. Profiles of birch sensitization (bet v 1, bet v 2, and bet v 4) and oral allergy syndrome across Italy. J Invest Allergol Clin Immunol. 2016;26(4):244‐248.
Canis M, Groger M, Becker S, Klemens C, Kramer MF. Recombinant marker allergens in diagnosis of patients with allergic rhinoconjunctivitis to tree and grass pollens. Am J Rhinol Allergy. 2011;25(1):36‐39.
Hemmer W, Focke M, Wantke F, et al. Ash (Fraxinus excelsior)‐pollen allergy in central Europe: specific role of pollen panallergens and the major allergen of ash pollen, Fra e 1. Allergy. 2000;55(10):923‐930.
Niederberger V, Purohit A, Oster JP, Spitzauer S, Valenta R, Pauli G. The allergen profile of ash (Fraxinus excelsior) pollen: cross‐reactivity with allergens from various plant species. Clin Exp Allergy. 2002;32(6):933‐941.
Heinzerling LM, Burbach GJ, Edenharter G, et al. GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe. Allergy. 2009;64(10):1498‐1506.
D'Amato G, Cecchi L, Bonini S, et al. Allergenic pollen and pollen allergy in Europe. Allergy. 2007;62(9):976‐990.
Johansen N, Weber RW, Ipsen H, Barber D, Broge L, Hejl C. Extensive IgE cross‐reactivity towards the Pooideae grasses substantiated for a large number of grass‐pollen‐sensitized subjects. Int Arch Allergy Immunol. 2009;150(4):325‐334.
Scaparrotta A, Verini M, Consilvio NP, et al. Sensitization to timothy grass pollen allergenic molecules in children. Multidiscip Respir Med. 2013;8(1):17.
Dezfouli SG, Mothes‐Luksch N, Jensen AN, Untersmayr E, Kundi M, Jensen‐Jarolim E. Linking cross‐reactivity clusters of food and respiratory allergens in PAMD@ to asthma and duration of allergy. World Allergy Organ J. 2020;13(12):100483.
Sekerkova A, Polackova M, Striz I. Detection of Phl p 1, Phl p 5, Phl p 7 and Phl p 12 specific IgE antibodies in the sera of children and adult patients allergic to Phleum pollen. Allergol Int. 2012;61(2):339‐346.
Forkel S, Beutner C, Heetfeld A, et al. Allergic rhinitis to weed pollen in Germany: dominance by plantain, rising prevalence, and polysensitization rates over 20 years. Int Arch Allergy Immunol. 2020;181(2):128‐135.
Kiewiet MBG, Lupinek C, Vrtala S, et al. A molecular sensitization map of European children reveals exposome‐ and climate‐dependent sensitization profiles. Allergy. 2023;78:2007‐2018.
Stemeseder T, Hemmer W, Hawranek T, Gadermaier G. Marker allergens of weed pollen – basic considerations and diagnostic benefits in the clinical routine: part 16 of the series molecular allergology. Allergo J Int. 2014;23(8):274‐280.
Ebner C, Feldner H, Ebner H, Kraft D. Sensitization to storage mites in house dust mite (Dermatophagoides pteronyssinus) allergic patients. Comparison of a rural and an urban population. Clin Exp Allergy. 1994;24(4):347‐352.
Jakubas‐Zawalska J, Asman M, Solarz K. Sensitization to the storage mites Lepidoglyphus destructor and Tyrophagus putrescentiae (Acari, Sarcoptiformes, Astigmatina) in a suburban population in southern Poland. Ann Parasitol. 2017;63(3):183‐188.
Korsgaard J, Dahl R, Iversen M, Hallas T. Storage mites as a cause of bronchial asthma in Denmark. Allergol Immunopathol (Madr). 1985;13(2):143‐149.
Macan J, Kanceljak‐Macan B, Zuskin E, Milković‐Kraus S. Sensitization to storage mites in urban working environment. Arh Hig Rada Toksikol. 1998;49(1):27‐32.
Liao EC, Ho CM, Lin MY, Tsai JJ. Dermatophagoides pteronyssinus and Tyrophagus putrescentiae allergy in allergic rhinitis caused by cross‐reactivity not dual‐sensitization. J Clin Immunol. 2010;30(6):830‐839.
Luczynska CM, Griffin P, Davies RJ, Topping MD. Prevalence of specific IgE to storage mites (A. siro, L. destructor and T. Longior) in an urban population and crossreactivity with the house dust mite (D. Pteronyssinus). Clin Exp Allergy. 1990;20(4):403‐406.
Carnés J, Iraola V, Cho SH, Esch RE. Mite allergen extracts and clinical practice. Ann Allergy Asthma Immunol. 2017;118(3):249‐256.
Cheong N, Soon SC, Ramos JD, et al. Lack of human IgE cross‐reactivity between mite allergens Blo t 1 and Der p 1. Allergy. 2003;58(9):912‐920.
Fernández‐Caldas E, Puerta L, Caraballo L. Mites and allergy. Chem Immunol Allergy. 2014;100:234‐242.
Jõgi NO, Kleppe Olsen R, Svanes C, et al. Prevalence of allergic sensitization to storage mites in northern Europe. Clin Exp Allergy. 2020;50(3):372‐382.
González‐Pérez R, Pineda F, Poza‐Guedes P, Castillo M, Matheu V, Sánchez‐Machín I. Molecular allergen profiling of dual mite sensitization in severe allergic rhinitis. J Invest Allergol Clin Immunol. 2020;30(6):421‐429.
Mueller GA, Randall TA, Glesner J, et al. Serological, genomic and structural analyses of the major mite allergen Der p 23. Clin Exp Allergy. 2016;46(2):365‐376.
Thomas WR. Hierarchy and molecular properties of house dust mite allergens. Allergol Int. 2015;64(4):304‐311.
Barber D, Arias J, Boquete M, et al. Analysis of mite allergic patients in a diverse territory by improved diagnostic tools. Clin Exp Allergy. 2012;42(7):1129‐1138.
Bronnert M, Mancini J, Birnbaum J, et al. Component‐resolved diagnosis with commercially available D. pteronyssinus Der p 1, Der p 2 and Der p 10: relevant markers for house dust mite allergy. Clin Exp Allergy. 2012;42(9):1406‐1415.
Batard T, Baron‐Bodo V, Martelet A, et al. Patterns of IgE sensitization in house dust mite‐allergic patients: implications for allergen immunotherapy. Allergy. 2016;71(2):220‐229.
Matos Semedo F, Dorofeeva Y, Pires AP, et al. Der p 23: clinical relevance of molecular monosensitization in house dust mite allergy. J Invest Allergol Clin Immunol. 2019;29(4):314‐316.
Hemmer W, Sestak‐Greinecker G, Braunsteiner T, Wantke F, Wöhrl S. Molecular sensitization patterns in animal allergy: relationship with clinical relevance and pet ownership. Allergy. 2021;76(12):3687‐3696.
Konradsen JR, Fujisawa T, van Hage M, et al. Allergy to furry animals: new insights, diagnostic approaches, and challenges. J Allergy Clin Immunol. 2015;135(3):616‐625.
Käck U, Asarnoj A, Grönlund H, et al. Molecular allergy diagnostics refine characterization of children sensitized to dog dander. J Allergy Clin Immunol. 2018;142(4):1113‐1120 e9.
Özuygur Ermis SS, Borres MP, Basna R, et al. Sensitization to molecular dog allergens in an adult population: results from the West Sweden asthma study. Clin Exp Allergy. 2023;53(1):88‐104.
Roger A, Lazo C, Arias N, et al. Using component‐resolved diagnosis to characterize the sensitization to specific cat and dog allergens in patients with allergic respiratory diseases in Catalonia, Spain. Int Arch Allergy Immunol. 2023;184(5):440‐446.
Suzuki S, Nwaru BI, Ekerljung L, et al. Characterization of sensitization to furry animal allergen components in an adult population. Clin Exp Allergy. 2019;49(4):495‐505.
López Couso VP, Tortajada‐Girbés M, Rodriguez Gil D, Martínez Quesada J, Palacios PR. Fungi sensitization in Spain: importance of the Alternaria alternata species and its major allergen alt a 1 in the allergenicity. J Fungi (Basel). 2021;7(8):631.
Chen Q, Zhong X, Acosta L, et al. Allergic sensitization patterns identified through latent class analysis among children with and without asthma. Ann Allergy Asthma Immunol. 2016;116(3):212‐218.
Mittermann I, Wikberg G, Johansson C, et al. IgE sensitization profiles differ between adult patients with severe and moderate atopic dermatitis. PLoS ONE. 2016;11(5):e0156077.
Ahmed H, Ospina MB, Sideri K, Vliagoftis H. Retrospective analysis of aeroallergen's sensitization patterns in Edmonton, Canada. Allergy Asthma Clin Immunol. 2019;15:6.
Ha EK, Baek JH, Lee SY, et al. Association of polysensitization, allergic multimorbidity, and allergy severity: a cross‐sectional study of school children. Int Arch Allergy Immunol. 2016;171(3–4):251‐260.
González‐Pérez R, Poza‐Guedes P, Pineda F, et al. Molecular mapping of allergen exposome among different atopic phenotypes. Int J Mol Sci. 2023;24(13):10467.
Siroux V, Ballardini N, Soler M, et al. The asthma‐rhinitis multimorbidity is associated with IgE polysensitization in adolescents and adults. Allergy. 2018;73(7):1447‐1458.
d'Alessandro M, Bergantini L, Perrone A, et al. House dust mite allergy and the Der p1 conundrum: a literature review and case series. Allergies. 2021;1(2):108‐114.
Käck U, van Hage M, Grönlund H, Lilja G, Asarnoj A, Konradsen JR. Allergic sensitization to lipocalins reflects asthma morbidity in dog dander sensitized children. Clin Transl Allergy. 2022;12(5):e12149.
Bjerg A, Winberg A, Berthold M, Mattsson L, Borres MP, Rönmark E. A population‐based study of animal component sensitization, asthma, and rhinitis in schoolchildren. Pediatr Allergy Immunol. 2015;26(6):557‐563.
Bousquet J, Melén E, Haahtela T, et al. Rhinitis associated with asthma is distinct from rhinitis alone: the ARIA‐MeDALL hypothesis. Allergy. 2023;78(5):1169‐1203.
Valero A, Quirce S, Dávila I, Delgado J, Domínguez‐Ortega J. Allergic respiratory disease: different allergens, different symptoms. Allergy. 2017;72(9):1306‐1316.
Shrestha SK, Katelaris C, Dharmage SC, et al. High ambient levels of grass, weed and other pollen are associated with asthma admissions in children and adolescents: a large 5‐year case‐crossover study. Clin Exp Allergy. 2018;48(11):1421‐1428.
Gradman J, Halken S. Preventive effect of allergen immunotherapy on asthma and new sensitizations. J Allergy Clin Immunol Pract. 2021;9(5):1813‐1817.