Multifactorial analysis of allergen-specific IgE sensitization in children with allergic diseases in Suzhou, China

BACKGROUND: Allergic diseases represent a major public health challenge among children. Allergen sensitization patterns may be influenced by factors such as age, gender, season, and disease phenotype. This study aimed to systematically evaluate the associations of these factors with allergen sensitization patterns in children. METHODS: We studied 2,434 symptomatic children who underwent allergen testing at a district-level hospital in Suzhou, China, using the ImmunoCAP Phadia 250 system. Seventeen common airborne allergens (AAs) and food allergens (FAs) were assessed. The primary definition of sensitization was sIgE ≥ 0.35 IU/mL, whereas robustness analyses were additionally performed at thresholds of ≥ 0.70 and ≥ 3.50 IU/mL. Multivariable logistic regression models were used to evaluate associations with age, gender, and season, with false-discovery rate correction using the Benjamini-Hochberg method. RESULTS: Positivity rates varied systematically according to the sIgE threshold. As thresholds increased from grade ≥ 1 to ≥ 2 and ≥ 3, absolute positivity rates decreased as expected, whereas the direction of age-, gender-, and season-related patterns remained consistent. AA sensitization was more common than FA sensitization, with Dermatophagoides pteronyssinus and Dermatophagoides farinae representing the predominant sensitizers, whereas milk and egg were the leading food allergens. With increasing age, AA sensitization increased whereas FA sensitization declined; these patterns persisted after multivariable adjustment and at higher positivity thresholds. Males showed higher odds of sensitization, particularly for mite allergens. Seasonal variation was most evident for mite allergens, with higher positivity during summer-autumn than winter, broadly paralleling local humidity patterns. Across disease phenotypes, AA sensitization was more common in asthma and rhinitis, whereas FA sensitization was relatively more common in atopic dermatitis and the food-allergy group; mixed diseases showed a higher overall sensitization burden. CONCLUSIONS: In this single-center referred cohort, the findings describe allergen test positivity among clinically tested children rather than population-level prevalence. Age, gender, season, and disease phenotype were associated with distinct sensitization patterns, supporting greater attention to mite-focused assessment and environmental control from school age onward, particularly during humid seasons, as well as milk and egg evaluation during early childhood. The overall findings remained consistent at stricter sIgE positivity thresholds.