Introduction: While a specific number and type of antigens are recognized to detect perennial inhalant allergies, the optimal number and combination of allergens to reliably identify seasonal allergic sensitization is unclear due to limited national data. This study analyzed aeroallergen testing data from a large US clinical reference laboratory to provide guidance for optimizing seasonal allergen test selection. Methods: The 2019 serum IgE tests for seasonal inhalant allergens were identified from the Quest Diagnostics database. Patients with results for at least 1 of 31 seasonal allergens across 4 allergen classes (11 trees, 7 weeds, 5 grasses, and 8 molds) were analyzed. A step-by-step conditional approach was employed to determine the minimum number and species of allergens needed to identify at least 98% of sensitized patients for each class. Results: Of 88,042 patients tested for ≥1 seasonal allergen, 1.5%, 1.8%, 1.3%, and 1.6% were tested for all trees, weeds, grasses, and molds, respectively. Of those tested for all allergens within a class, 40.4%, 38.6%, 29.5%, and 21.2% were sensitized to at least one tree, weed, grass, or mold allergen, respectively. Identification of ≥98% of sensitized patients within a class required 8 allergens for trees (mountain cedar, maple box elder, walnut, white ash, elm, birch, cottonwood, and hickory/pecan), 5 for weeds (common ragweed short, rough pigweed, English plantain, lamb's quarters/goosefoot, and Russian thistle), 3 for grasses (June/Kentucky blue grass, Johnson grass, and Bermuda grass), and 7 for molds (Alternaria alternata, Aspergillus fumigatus, Mucor racemosus, Epicoccum purpurascens, Penicillium notatum, Helminthosporium halodes, and Fusarium moniliforme). Conclusion: A minimum of 23 antigens is required to optimally detect sensitization to four classes of seasonal allergens (i.e., ≥98% identification). The addition of these allergens to unique perennial allergens (cat, dog, mouse, cockroach, and 2 dust mite species) results in a comprehensive elucidation of inhalant allergen sensitization. This knowledge provides a pivotal guide for clinical laboratories as they construct allergen panels to optimize diagnostic yield.

1.
O’Hehir
R
,
Holgate
S
,
Sheikh
A
,
Middleton
E
. Chapter 4. Middleton’s allergy essentials. essay:
Elsevier
;
2017
.
2.
Meltzer
EO
,
Blaiss
MS
,
Derebery
MJ
,
Mahr
TA
,
Gordon
BR
,
Sheth
KK
, et al
.
Burden of allergic rhinitis: results from the pediatric allergies in America survey
.
J Allergy Clin Immunol
.
2009
;
124
(
3 Suppl l
):
S43
S70
.
3.
Scadding
GK
,
Kariyawasam
HH
,
Scadding
G
,
Mirakian
R
,
Buckley
RJ
,
Dixon
T
, et al
.
BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007)
.
Clin Exp Allergy
.
2017
;
47
(
7
):
856
89
.
4.
Normansell
R
,
Walker
S
,
Milan
SJ
,
Walters
EH
,
Nair
P
,
Walker
S
.
Omalizumab for asthma in adults and children
.
Cochrane Database Syst Rev
.
2014
;
2014
(
1
):
CD003559
.
5.
Bernstein
IL
,
Li
JT
,
Bernstein
DI
,
Hamilton
R
,
Spector
SL
,
Tan
R
, et al
.
Allergy diagnostic testing: an updated practice parameter
.
Ann Allergy Asthma Immunol
.
2008
;
100
(
3 Suppl 3
):
S1
148
.
6.
Hamilton
RG
.
Clinical laboratory assessment of immediate-type hypersensitivity
.
J Allergy Clin Immunol
.
2010
;
125
(
2 Suppl 2
):
S284
96
.
7.
Cox
L
,
Williams
B
,
Sicherer
S
,
Oppenheimer
J
,
Sher
L
,
Hamilton
R
, et al
.
Pearls and pitfalls of allergy diagnostic testing: report from the American college of allergy, asthma and Immunology/American Academy of allergy, asthma and Immunology specific IgE test task force
.
Ann Allergy Asthma Immunol
.
2008
;
101
(
6
):
580
92
.
8.
Thorpe
M
,
Movérare
R
,
Fischer
C
,
Lidholm
J
,
Rudengren
M
,
Borres
MP
.
History and utility of specific IgE cutoff levels: what is the relevance for allergy diagnosis
.
J Allergy Clin Immunol Pract
.
2023
;
S2213-2198
(
23
):
00560-3
.
9.
Lou
H
,
Ma
S
,
Zhao
Y
,
Cao
F
,
He
F
,
Liu
Z
, et al
.
Sensitization patterns and minimum screening panels for aeroallergens in self-reported allergic rhinitis in China
.
Sci Rep
.
2017
;
7
(
1
):
9286
.
10.
Wang
J
,
Wu
Y
,
Li
J
,
Huang
X
,
Zhu
R
.
Eight aeroallergen skin extracts may Be the optimal panel for allergic rhinitis patients in Central China
.
Int Arch Allergy Immunol
.
2017
;
173
(
4
):
193
8
.
11.
Lee
JE
,
Ahn
JC
,
Han
DH
,
Kim
DY
,
Kim
JW
,
Cho
SH
, et al
.
Variability of offending allergens of allergic rhinitis according to age: optimization of skin prick test allergens
.
Allergy Asthma Immunol Res
.
2014
;
6
(
1
):
47
54
.
12.
Bousquet
PJ
,
Burbach
G
,
Heinzerling
LM
,
Edenharter
G
,
Bachert
C
,
Bindslev-Jensen
C
, et al
.
GA2LEN skin test study III: minimum battery of test inhalent allergens needed in epidemiological studies in patients
.
Allergy
.
2009
;
64
(
11
):
1656
62
.
13.
Sahiner
UM
,
Civelek
E
,
Yavuz
ST
,
Büyüktiryaki
AB
,
Tuncer
A
,
Şekerel
BE
.
Skin prick testing to aeroallergen extracts: what is the optimal panel in children and adolescents in Turkey
.
Int Arch Allergy Immunol
.
2012
;
157
(
4
):
391
8
.
14.
USDA Economic Research Service
.
Rural urban Continuum Codes
.
2013
. Available from: https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/documentation/#DataSources.
15.
von Elm
E
,
Altman
DG
,
Egger
M
,
Pocock
SJ
,
Gøtzsche
PC
,
Vandenbroucke
JP
, et al
.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
.
J Clin Epidemiol
.
2008
;
61
(
4
):
344
9
.
16.
Cox
L
,
Nelson
H
,
Lockey
R
,
Calabria
C
,
Chacko
T
,
Finegold
I
, et al
.
Allergen immunotherapy: a practice parameter third update
.
J Allergy Clin Immunol
.
2011
;
127
(
1 Suppl l
):
S1
55
.
17.
Weber
RW
.
Patterns of pollen cross-allergenicity
.
J Allergy Clin Immunol
.
2003
;
112
(
2
):
229
40
.
18.
Baxi
SN
,
Portnoy
JM
,
Larenas-Linnemann
D
,
Phipatanakul
W
;
Environmental Allergens Workgroup
.
Exposure and health effects of fungi on humans
.
J Allergy Clin Immunol Pract
.
2016
;
4
(
3
):
396
404
.
19.
Hu
H
,
Huang
H
,
Liao
C
,
Li
A
,
Zhang
T
,
Liang
X
, et al
.
A study of allergen detection panel in Guangzhou, southern China based on real-world data from the past 7 years
.
Sci Rep
.
2023
;
13
(
1
):
14855
.
20.
D'Amato
G
,
Liccardi
G
,
Frenguelli
G
.
Thunderstorm-asthma and pollen allergy
.
Allergy
.
2007
;
62
(
1
):
11
6
.
21.
Pulimood
TB
,
Corden
JM
,
Bryden
C
,
Sharples
L
,
Nasser
SM
.
Epidemic asthma and the role of the fungal mold Alternaria alternata
.
J Allergy Clin Immunol
.
2007
;
120
(
3
):
610
7
.
22.
Alvaro-Lozano
M
,
Akdis
CA
,
Akdis
M
,
Alviani
C
,
Angier
E
,
Arasi
S
, et al
.
EAACI allergen immunotherapy user’s guide
.
Pediatr Allergy Immunol
.
2020
;
31
(
Suppl 25
):
1
101
.
23.
Hemmings
O
,
Niazi
U
,
Kwok
M
,
Radulovic
S
,
Du Toit
G
,
Lack
G
, et al
.
Combining allergen components improves the accuracy of peanut allergy diagnosis
.
J Allergy Clin Immunol Pract
.
2022
;
10
(
1
):
189
99
.
24.
Dramburg
S
,
Hilger
C
,
Santos
AF
,
de Las Vecillas
L
,
Aalberse
RC
,
Acevedo
N
, et al
.
EAACI molecular allergology user’s guide 2.0
.
Pediatr Allergy Immunol
.
2023
;
34
(
Suppl 28
):
e13854
.
25.
Wise
SK
,
Lin
SY
,
Toskala
E
,
Orlandi
RR
,
Akdis
CA
,
Alt
JA
, et al
.
International consensus statement on allergy and rhinology: allergic rhinitis
.
Int Forum Allergy Rhinol
.
2018
;
8
(
2
):
108
352
.
26.
Kuzdak
M
,
Jerzynska
J
,
Stelmach
I
,
Podlecka
D
,
Majak
P
,
Janas
A
, et al
.
Associations between sensitization to perennial/seasonal allergens and childhood asthma
.
Allergol Select
.
2018
;
2
(
1
):
151
5
.
27.
Kwong
K
,
Robinson
M
,
Sullivan
A
,
Letovsky
S
,
Liu
AH
,
Valcour
A
.
Fungal allergen sensitization: prevalence, risk factors, and geographic variation in the United States
.
J Allergy Clin Immunol
.
2023
;
152
(
6
):
1658
68
.
28.
Salo
PM
,
Arbes
SJ
Jr
,
Jaramillo
R
,
Calatroni
A
,
Weir
CH
,
Sever
ML
, et al
.
Prevalence of allergic sensitization in the United States: results from the National Health and Nutrition Examination Survey (NHANES) 2005-2006
.
J Allergy Clin Immunol
.
2014
;
134
(
2
):
350
9
.
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