Aeroallergen sensitisation in maltese children with allergic rhinitis: Implications for diagnostic panel optimisation

Background Allergic rhinitis (AR) is common in Maltese children, yet aeroallergen testing within the national health service has historically relied on imported panels not validated for the local environment. Country-specific sensitisation data are required to optimise diagnostic efficiency and support future allergy service development.Objective To characterise aeroallergen sensitisation patterns in Maltese children with AR and develop a locally relevant exploratory first-line aeroallergen testing panel.Methods In this cross-sectional single-centre study, children aged 2-16 years with symptoms consistent with AR were recruited from the national paediatric respiratory and allergy clinic. Sensitisation was assessed using serum specific IgE to an extended aeroallergen panel informed by local aerobiology, Mediterranean data, and the GA2LEN panel. Sensitisation rates with 95% confidence intervals were calculated. A conditional stepwise approach was used to identify the minimum allergen set required to detect ≥95% of sensitised children.Results Fifty-one children were included, of whom 38 (74.5%) were sensitised to at least one aeroallergen. House dust mite (Dermatophagoides pteronyssinus/farinae) was the predominant allergen (64.7%), followed by cat (39.2%), Parietaria (25.4%), and olive (23.5%). Sensitisation rates increased with age across allergen groups. Three allergens (D. pteronyssinus, cat, and olive) identified ≥95% of sensitised children. Interpretation is limited by the small sample size and recruitment from a single tertiary paediatric clinic.Conclusion This exploratory study identified a sensitisation profile dominated by house dust mite and Mediterranean pollens. The findings informed development of a locally relevant first-line testing panel and a candidate minimum allergen battery requiring prospective validation before routine clinical or epidemiological implementation.