The Allergy Crossroads of Subtropical Regions: Mites, Crustaceans, and the Rise of Edible Insects

<b>Background:</b> Edible insects (EIs) are increasingly recognized as a sustainable protein source, yet concerns persist regarding allergic reactions, even in individuals without prior known consumption. This study examines the immune response profile in patients from a subtropical area to improve understanding of mite-related cross-reactivity and emerging food sensitizations. <b>Methods:</b> To assess sensitization to edible insects, we analyzed 634 patients from a tertiary care allergy institution with high perennial exposure to house dust mites and storage mites. Sensitization patterns were assessed using the ALEX²^® MacroArray platform, a multiplex IgE diagnostic tool covering 282 allergens, including <i>Locusta migratoria</i> (Lm), <i>Acheta domesticus</i> (Ad), and <i>T. molitor</i> (Tm). Patients with IgE levels ≥0.3 kU/L were evaluated for cross-reactivity to both mite allergens and pan-allergens. <b>Results</b>: Of the 634 patients, 138 (21.76%) exhibited IgE sensitization to at least one EI extract. Tropomyosin was the most prevalent pan-allergen (63.76%), followed by troponin-C (28.98%) and arginine kinase (26.81%). Notably, 95.66% of EI-sensitized individuals also reacted to mite allergens. However, 23.18% lacked reactivity to common pan-allergens, suggesting alternative sensitization mechanisms. <b>Conclusions</b>: This investigation can highlight regional variations in EI sensitization, where high mite exposure in subtropical climates appears to influence IgE responses to insect proteins. The findings suggest that EI sensitization is not merely incidental but represents a distinct immunological phenomenon shaped by environmental factors and allergen cross-reactivity. Since the presence of food-specific IgE does not reliably indicate clinical allergy, and the lack of food challenge data constrains diagnostic certainty, acknowledging EI sensitization as a potential risk factor remains essential for ensuring food safety and protecting public health.