Allergy Diagnostics Turn Regional as Asian and Tropical Sensitization Patterns Emerge

For decades, the commercial allergy test kit has been built on a quiet assumption: that the allergic patient anywhere in the world resembles the allergic patient in Europe or North America. A sweeping body of research now shows how misleading that assumption can be. In an editorial published in Frontiers in Allergy, a team of allergists from Yonsei University College of Medicine in Seoul, Chulalongkorn University in Bangkok, and The Chinese University of Hong Kong and The University of Hong Kong argue that accurate allergy diagnostics and immunotherapeutic approaches must account for regional differences in sensitization patterns. Their editorial introduces the second volume of a Frontiers Research Topic dedicated to allergens and allergic sensitization in Asia and the tropics, collecting five new studies from eastern China, Thailand, Colombia, and India that together reveal how profoundly geography shapes the allergic immune response.

The urgency behind this work stems from a dramatic rise in allergic disease across the Asia-Pacific region. Researchers attribute the rapid increase to a convergence of forces: global warming, extensive urbanization, the environmental pollution that accompanies it, and improved sanitation. Each of these factors alters exposure to allergens in distinct ways. Warming climates extend pollen seasons and introduce new plant species to regions that never encountered them before, while urbanization concentrates populations in polluted megacities where particulate matter interacts with inhaled allergens in ways that can amplify airway inflammation. Paradoxically, improved sanitation, which protects against infectious disease, may also skew immune development toward allergic responses, a phenomenon related to the hygiene hypothesis.

The geographical specificities of sensitization are striking. Cedar pollen stands as the main cause of hay fever in Japan, while the mite species Blomia tropicalis predominates in tropical regions. In Western countries, by contrast, sensitization to birch pollen and to the house dust mite Dermatophagoides pteronyssinus is far more prevalent. These differences are not merely academic; they determine which diagnostic panels are useful in a given region and which immunotherapeutic extracts will actually work. Yet many allergens in Eastern countries remain incompletely characterized, and most commercial diagnostic tools remain focused on Western sensitization profiles, leaving clinicians across Asia and the tropics to work with instruments that were never designed for their patients.

Food allergies add another layer of regional complexity. Certain foods consumed primarily in Asia may contribute to the development of region-specific food allergies. In Mongolia, horse milk allergy is relatively common, alongside lactose intolerance, because horse milk is often used as a substitute for children with cow’s milk allergy and fermented mare’s milk, known as airag, is a national staple. In Korea, some important allergens from fruits and vegetables that elicit pollen-food allergy syndrome have yet to be fully characterized. Individuals may also develop allergies to foods encountered for the first time in a foreign country, or to imported products, as a result of cross-reactivity with pollen allergens from their country of origin. The immune system, primed by one set of environmental proteins, can misidentify structurally similar proteins in unfamiliar foods as threats.

Perhaps most surprising is the discovery that allergenic components can be found in traditional and herbal medicines. Researchers have identified Pana g 1, a ginseng allergen homologous to the birch pollen allergen Bet v 1, in some ginseng beverages. Japanese hop, Humulus japonicus, is widespread in far east Asian countries and is now invasive in Western countries, meaning that a weed once confined to one hemisphere is becoming a pollinosis problem in the other. These examples underscore why the editorial’s authors emphasize the need to investigate the similarities and differences between regional particularities in Asia and the tropics and those observed in Western industrialized countries, since cross-reactivity networks span continents.

The five articles collected in the current Research Topic reflect both the rapid growth of knowledge and the critical need to characterize regionally important allergens. Two articles focused on sensitization patterns in eastern China, while three studies addressed molecular diagnosis in Thailand, Colombia, and India. In a retrospective analysis from eastern China, Dermatophagoides pteronyssinus emerged as the most common respiratory allergen source at 37.58 percent, followed by mold at 13.11 percent. Cashew nut was the most frequently identified food allergen at 15.57 percent, followed by cow’s milk at 10.99 percent and egg at 9.33 percent. These findings represent a distinct sensitization pattern that may reflect regional, lifestyle, and cultural differences, and they suggest that cashew nut, rather than peanut, may deserve greater attention in Asian food allergy screening.

One of the Chinese studies, led by Huang and colleagues, investigated differential food sensitization patterns among infants, toddlers, and children. Their results suggest that sensitization patterns emerge early in life, highlighting the need for differentiated allergy risk management and prevention strategies across different developmental stages. This finding carries significant implications for pediatric practice, because it suggests that the window for intervention may open much earlier than previously assumed, and that a one-size-fits-all prevention protocol may fail to protect children at different ages from different allergen threats.

The molecular diagnosis studies from Southeast Asia and South America demonstrate how component-resolved diagnostics can outperform traditional extract-based testing. Kulalert and colleagues in Thailand reported better diagnostic performance of specific IgE measurement for shrimp tropomyosin, the major shellfish allergen protein, than that of the skin prick test and specific IgE measurement using whole shrimp extract. This matters because tropomyosin is a highly cross-reactive protein found across crustaceans and mollusks, and measuring IgE against the purified component rather than a crude extract reduces false positives from IgE that binds irrelevant proteins in the extract. Marrugo and colleagues in Colombia demonstrated that molecular diagnosis using combinations of specific allergens can improve diagnostic accuracy, potentially supporting personalized allergy management in a tropical setting where allergen exposure differs markedly from temperate regions.

In India, Ghosh and colleagues evaluated the diagnostic value of recombinant Asp f 10, a secreted aspartic protease from Aspergillus fumigatus, and Asp f 10-specific IgG as a biomarker for allergic bronchopulmonary aspergillosis, a severe inflammatory lung disease caused by hypersensitivity to Aspergillus antigens in patients with asthma or cystic fibrosis. Identifying reliable molecular biomarkers for this condition is critical because current diagnostic criteria rely on a constellation of clinical, radiological, and immunological findings that can be difficult to interpret consistently across different healthcare settings. A specific molecular marker could standardize diagnosis and enable earlier treatment initiation.

Taken together, the studies in this second volume make clear that a rapidly growing body of knowledge is emerging regarding novel allergens from Asian and tropical regions. Certain sensitization patterns may be specific to these geographic areas, which encompass temperate to tropical climates and harbor diverse endemic flora and fauna. Although many of these allergens can exhibit cross-reactivity with allergens from similar sources in other regions, the integration of Asia- and tropics-specific components into diagnostic panels will improve the diagnosis of allergic sensitization in these regions of the world. For the billions of people living across Asia and the tropics, the message is unambiguous: allergy medicine must finally look like the populations it serves, and the molecular tools to make that possible are arriving at precisely the moment they are needed most.

Subject of Research: Editorial: Allergens and allergic sensitization in Asia and the tropics—volume II

Article Title: Editorial: Allergens and allergic sensitization in Asia and the tropics—volume II

Article References: Jeong, K. Y., Jacquet, A., Leung, T. F., & Li, P. H. (2026). Editorial: Allergens and allergic sensitization in Asia and the tropics—volume II. Frontiers in Allergy, 7, Article 1973136. https://doi.org/10.3389/falgy.2026.1973136

Image Credits: AI Generated

DOI: 10.3389/falgy.2026.1973136

Keywords: allergic sensitization, molecular diagnosis, Asia-Pacific allergy, tropical allergens, component-resolved diagnostics, food allergy, Frontiers in Allergy, Editorial, Allergens, allergic, sensitization, Asia