doi: 10.1111/j.1365-2222.2012.03993.x Clinical & Experimental Allergy, 42, 1129–1138 ORIGINAL ARTICLE Allergens © 2012 Blackwell Publishing Ltd Analysis of mite allergic patients in a diverse territory by improved diagnostic tools D. Barber 1 , J. Arias 2 , M. Boquete 3 , V. Cardona 4 , T. Carrillo 5 , G. Gala 6 , P. Gamboa 7 , J. C. Garcı ´a-Robaina 8 , D. Herna ´ndez 9 , M. L. Sanz 10 , A. I. Tabar 11 , C. Vidal 12 , H. Ipsen 1 , F. de la Torre 1 and M. Lombardero 1 1 Departamento de I+D, ALK-Abelló, Madrid/Hørsholm, Spain/Denmark, 2 Consulta Privada, Huelva, Spain, 3 Servicio de Alergia, Hospital Lucus Augusti, Lugo, Spain, 4 Sección de Alergia, Servicio de Medicina Interna, Hospital Vall d’Hebron, Barcelona, Spain, 5 Servicio de Alergia, Hospital Dr. Negrín, Las Palmas, Spain, 6 Consulta Privada, Gijón, Asturias, Spain, 7 Servicio de Alergia, Hospital de Basurto, Vizcaya, Spain, 8 Servicio de Alergia, Hospital Virgen de la Candelaria, Tenerife, Spain, 9 Servicio de Alergia, Ciudad Sanitaria la Fe, Valencia, Spain, 10 Departamento de Alergología, Clínica Universidad de Navarra, Pamplona, Spain, 11 Servicio de Alergia, Hosp. Virgen del Camino, Pamplona, Spain and 12 Servicio de Alergia, Hosp. de Conxo, Santiago de Compostela, Spain Clinical & Experimental Allergy Correspondence: Domingo Barber, Departamento I+D, ALK-ABELLO, S. A., Miguel Fleta, 19, 28037 Madrid, Spain. E-mail: domingo.barber@alk-abello. com Cite this as: D. Barber, J. Arias, M. Boquete, V. Cardona, T. Carrillo, G. Gala, P. Gamboa, J. C. Garcı ´a- Robaina, D. Herna ´ndez, M. L. Sanz, A. I. Tabar, C. Vidal, H. Ipsen, F. de la Torre and M. Lombardero, Clinical & Experimental Allergy, 2012 (42) 1129–1138. Summary Background There are few studies comparing the sensitization with mite allergens from different mite species which could potentially be the cause of allergy. Objective To improve the diagnosis of mite allergic patients from a diverse territory in which D. pteronyssinus/D. farinae mites together with storage mites could be present in the environment. Methods Four hundred and seventy-seven patients (both children and adults) from differ- ent regions, covering the main mite prevalent areas of Spain, were recruited. sIgE to eight allergens was measured together with SPT to whole mite extracts, level of mite allergen exposure, and specific IgG 4 . BAT and CAST was performed in a subgroup of patients. Results D. pteronyssinus and L. destructor were more prevalent in Atlantic areas, whereas D. farinae predominate in Mediterranean areas. About 90% of patients were sensitized to group 1 and/or group 2 allergens. Group 2 was the most prevalent, and the IgE response/ intensity of sensitization in BAT was higher. sIgE to Der p 2/Der f 2 was almost fully cross-reactive, but no cross-reactivity was detected with Lep d 2. Group 1 allergens were also cross-reactive, but in some patients a species-specific response was observed. sIgE to Lep d 2 was associated with SPT results to storage mites. Sensitization to Der p 1 was more frequent in children, whereas Lep d 2 sensitization was more frequent in adults. A higher ratio IgE/IgG 4 to Der p 2 was associated with the presence of allergic asthma. Conclusion An improved diagnosis algorithm has been established. Group 2 allergens seem to have a leading role in mite allergy, but as group 1 sensitization could be species- specific in some patients and its prevalence is higher in children, an adequate balance on major mite species and major allergens must be consider in the design of mite allergy vaccines. Keywords component-resolved diagnosis, Dermatophagoides, major mites, minor mites, mite allergy, tropomyosin Abbreviations SPT, skin prick test; BAT, basophil activation test; CRD, component- resolved diagnosis; sIgE, specific IgE; sIgG4, specific IgG4; ELISA, enzyme-linked immunosorbent assay. Submitted 22 September 2011; revised 28 February 2012; accepted 29 February 2012