The house dust mite (HDM), especially Dermatophagoides pteronyssinus, is a primary cause of allergic diseases worldwide, including asthma, allergic rhinitis, and atopic dermatitis. Sensitization occurs through the production of specific lgE antibodies against mite-derived proteins. Among the numerous allergens identified, four are of major clinical importance: Der p 1 (a cysteine protease) and Der p 2 (an NPC2 family protein) are the classic major allergens, with over 80% of HDM-allergic individuals sensitized to at least one of them. Crucially, the status of Der p 23 (a peritrophin-like protein found in mite feces) is now recognized as a third major allergen, exhibiting lgE reactivity in 70-90% of patients in some cohorts and showing a strong association with asthma severity. Additionally, Der p 21 (a paramyosin) is a significant allergen linked to more severe clinical phenotypes.

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