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Review
. 2021 Aug 27:12:719573.
doi: 10.3389/fimmu.2021.719573. eCollection 2021.

The Molecular Allergen Recognition Profile in China as Basis for Allergen-Specific Immunotherapy

Nishelle D'souza  1 , Milena Weber  1 , Eszter Sarzsinszky  1 , Susanne Vrtala  1 , Mirela Curin  1 , Mirjam Schaar  1 , Victoria Garib  1 , Margarete Focke-Tejkl  1 , Yanqiu Li  2 , Richard Jones  2 , Hao Chen  3 , Rudolf Valenta  1   4   5   6 , Baoqing Sun  3
Affiliations
Review

The Molecular Allergen Recognition Profile in China as Basis for Allergen-Specific Immunotherapy

Nishelle D'souza et al. Front Immunol. .

Abstract

Approximately 30% of the world population suffers from immunoglobulin-E (IgE)-mediated allergy. IgE-mediated allergy affects the respiratory tract, the skin and the gastrointestinal tract and may lead to life-threatening acute systemic manifestations such as anaphylactic shock. The symptoms of allergy are mediated by IgE-recognition of causative allergen molecules from different allergen sources. Today, molecular allergy diagnosis allows determining the disease-causing allergens to develop allergen-specific concepts for prevention and treatment of allergy. Allergen-specific preventive and therapeutic strategies include allergen avoidance, vaccination, and tolerance induction. The implementation of these preventive and therapeutic strategies requires a detailed knowledge of the relevant allergen molecules affecting a given population. China is the world´s most populous country with around 1.4 billion inhabitants and an estimated number of more than 400 million allergic patients. Research in allergy in China has dramatically increased in the last decade. We summarize in this review article what is known about the dominating allergen sources and allergen molecules in China and what further investigations could be performed to draw a molecular map of IgE sensitization for China as a basis for the implementation of systematic and rational allergen-specific preventive and therapeutic strategies to combat allergic diseases in this country.

Keywords: AIT = allergen-specific immunotherapy; IgE; allergen; allergy; allergy vaccine; molecular diagnosis.

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Conflict of interest statement

RV has received research grants from HVD Life Science, Vienna Austria, Viravaxx, Vienna, Austria and Worg Pharmaceuticals, Hangzhou, China and serves as a consultant for Viravaxx and Worg. YL and RJ are employees of Worg Pharmaceuticals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Numbers of publications per year (y-axis) from 2007 to 2020 (x-axis) which can be retrieved from PubMed (https://pubmed.ncbi.nlm.nih.gov/) with the keywords “Allergy” and “Allergen” and “China”.
Figure 2
Figure 2
Territories inhabited mainly by a Chinese population and cities/areas for which allergen sensitization data have been obtained. Climate conditions according to the Köppen-Geiger climate classification system are indicated.
Figure 3
Figure 3
Frequencies (y-axes: percentages of positive subjects) of allergic sensitizations to different allergen extracts according to (26) (x-axes: Der p, Der f, Blo t, cat, dog, Per a, Bla g, Art v, Amb a, mixed grass pollen, mixed tree pollen, mixed mold I and mixed mold IV) as determined by skin prick testing in different areas of China (A): North China; (B): East China; (C): Southwest China; (D): Southern Coast). Depending on the tested region, frequencies of IgE sensitization varied approximately as follows: Der p: 39-78%; Der f: 40-79%; Blo t: 28-52%; cat: 8-12%; dog: 12-18%; Per a: 10-22%; Bla g: 10-12%; Art v: 3-25%; Amb a: 2-12%; mixed grass pollen: 2-7%; mixed tree pollen: 1-4%; mixed mold I: 3-10%; mold IV: 3-7%.
Figure 4
Figure 4
Frequencies (y-axes: percentages of positive subjects) of IgE sensitizations to different allergen extracts according to (35) (x-axes: HDM; dog; Bla g; tree pollen mix; egg white; milk; crab; shrimp) as determined by IgE serology in different areas of China ((A): North China; (B): Northeast China; (C): East China; (D): Central China; (E): Southwest China; (F): South China). Depending on the tested region, frequencies of IgE recognition varied approximately as follows: HDM: 11-40%; dog: 1-9%; Bla g: 7-30%; tree pollen mix: 3-14%; egg white: 8-17%; milk: 7-18%; crab: 4-19%; shrimp: 8-22%.
Figure 5
Figure 5
Venn diagram of pollen allergen sources (ragweed, mugwort, tree pollen, hop pollen and grass pollen) indicating cross-reactive allergens/IgE-reactive antigens (profilin, LTP, calcium-binding allergens and CCDs).
Figure 6
Figure 6
Venn diagram of invertebrate allergen sources (house dust mites, tropical mites, cockroach, crab, shrimp) indicating cross-reactive allergens (tropomyosin, arginine kinase).
Figure 7
Figure 7
Class 1 and class 2 food allergens/allergen sources with possible relevance for Chinese patients. Class 1 food allergens/allergen sources are indicated in red, class 2 food allergens in green whereas allergens which may behave as class 1 and 2 allergens contain red and green color.
Figure 8
Figure 8
Possible design of a multicenter study to determine the relevant allergen molecules in the different regions of China. Sex- and age matched groups of equal number with or without allergic symptoms according to ISAAC questionnaire are obtained from the regional population of each center. In subjects with allergic symptoms a detailed anamnesis of allergic symptoms is performed. Sera from the subjects with and without allergic symptoms are then analyzed in an anonymized and blinded manner to determine the molecular IgE sensitization profiles in a qualitative (i.e., nature of IgE-positive allergens) and quantitative (i.e., allergen-specific IgE levels) manner to define the relevant allergen molecules in each region of the country.
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