Allergen Sensitization Profiles and Co-Sensitization Networks in Children with Allergic Rhinitis and Asthma: A Propensity Score-Matched Retrospective Study

Background: The sensitization mechanisms driving allergic airway disease progression from allergic rhinitis (AR) to asthma (AS) in children remain incompletely understood. This study investigated age-related patterns and topological network heterogeneity of allergen sensitization between these airway phenotypes. Methods: In this retrospective cross-sectional study, 2193 children with AR or AS were enrolled. Propensity score matching (PSM) was utilized to control for age, yielding a 1:1 matched cohort of 1206 patients. The topological architecture of allergen co-sensitization was reconstructed using an Ising probability graphical model. Independent risk factors for lower airway involvement were identified via multivariable logistic regression. Results: House dust mites mix (41%), cat dander (17%), and tree pollen mix (9.5%) dominated inhalant sensitizations. Egg white (22%), cow’s milk (20%), and lamb (19%) were the most prevalent food sensitizations. While inhalant sensitization exhibited homogenous age-dependent increases in both groups, foodborne immune tolerance showed profound heterogeneity. By adolescence (≥ 12 years), the risk of sensitization to milk and egg white was 5.64-fold (OR = 5.64, 95% CI: 1.47– 21.69, p = 0.010) and 3.40-fold (OR = 3.40, 95% CI: 1.07– 10.07, p = 0.029) higher than in the AR group. Ising network analysis revealed a highly compartmentalized modular structure in AR, whereas the AS network exhibited significant complexity and deep cross-system connectivity, with peanut acting as a topological hub bridging core indoor inhalants. Multivariable regression demonstrated cockroach (aOR: 2.70; 95% CI: 1.11– 7.57; p=0.039) and peanut (aOR: 1.86; 95% CI: 1.02– 3.47; p=0.046) sensitizations were independent risk factors for lower airway involvement. Conclusion: Children with AS demonstrate a more complex cross-sensitization network than those with AR, rather than simply a higher burden of inhalant allergies. The delayed resolution of food sensitizations serves as a critical differentiator for the AS phenotype, highlighting the necessity of monitoring food allergies in pediatric airway disease management.