From Sensitization to Immunotherapy: Global Patterns of IgE Sensitization and Barriers to Allergen Immunotherapy Initiation and Adherence

The field of allergy and immunotherapy confronts significant heterogeneity in both allergic sensitization patterns and the real-world use of allergen immunotherapy (AIT) across global regions. This heterogeneity has become increasingly consequential as precision medicine (including component-resolved diagnostics) approaches raise expectations for individualized care that most health systems are not yet positioned to deliver. While IgE sensitization is recognized as the immunological pathway leading to allergic disease, recent large-scale, population-based studies underscore pronounced variations in specific allergen sensitization driven by local climate, biodiversity, urbanization, diet, and environmental exposures. In parallel, the availability, regulatory framework, uptake, and delivery of AIT are unevenly distributed across health systems, with most clinical experience and published outcomes stemming from Europe and North America. This geographic skew in the evidence base means that clinical practice guidelines reflect a narrow slice of the global allergy burden. Despite an expanding body of evidence on region-specific allergy epidemiology, little research brings together these “allergy maps” with practical AIT access, utilization, and health-system barriers worldwide. As a result, it remains unclear whether regional patterns of sensitization are adequately matched by relevant diagnostic tools, AIT products, and equitable access to care—especially in underrepresented areas such as Central and South America, Southeast Asia, the Middle East, and parts of Africa.This Research Topic aims to bridge the gap between population-level IgE sensitization profiles and the real-world implementation of AIT across diverse regions. It is timely given converging developments: the expansion of molecular allergy diagnostics, the introduction of biologics, and growing policy attention to health equity in non-communicable disease management. The goal is to synthesize evidence on (1) how sensitization and allergen exposure patterns translate into AIT prescribing and clinical pathways, (2) where the greatest mismatches and treatment gaps exist between allergy burden and disease-modifying therapy, and (3) what health system or policy solutions can address these inequalities. By integrating epidemiologic, molecular, clinical, and health-systems research, the collection seeks to identify actionable strategies to align diagnostics, products, and organizational models to regional needs, and to advance equitable allergy care in the precision medicine era.Key questions include: How do component-resolved sensitization profiles vary across regions? Does diagnostic and therapeutic AIT capacity match disease burden? What are the specific regulatory, reimbursement, and implementation constraints limiting AIT adoption in different global settings? What is the comparative value of subcutaneous versus sublingual AIT routes in resource-constrained settings? What patient-level factors, including fear of injections, visit burden, health literacy, and cultural attitudes toward long-term preventive therapy, drive non-initiation and early dropout? What provider- and system-level factors, such as allergist workforce density, training gaps, and cold chain requirements, constitute the most modifiable barriers to AIT scale-up?The Scope of this Research Topic includes multicenter or regional studies, systematic reviews, policy analyses, clinical audits, and implementation research that explicitly link IgE sensitization epidemiology to AIT access and utilization worldwide. Studies examining barriers to AIT at the patient level (initiation, adherence, dropout) and the provider level (prescribing behaviour, referral patterns, training) are equally within scope. Submissions should focus on the intersection of molecular or population allergy mapping with real-world AIT practice, access, and health policy. We especially encourage manuscripts from or about underrepresented regions, and analyses of health-system barriers or facilitators beyond traditional therapeutic and mechanistic studies. Authors from low- and middle-income countries are particularly encouraged to submit, and the guest editorial team will actively support prospective contributors from these regions in framing their work to meet journal standards. Purely experimental, preclinical, or single-mechanism studies that do not address comparative regional patterns or implementation will be considered out of primary scope.To gather further insights into how sensitization patterns inform real-world AIT access and use, we welcome articles addressing, but not limited to, the following themes:- Mapping of regional or global IgE sensitization profiles and associated risk factors- Links between component-resolved diagnostics and AIT product relevance or uptake by region- Comparison of AIT regulation, reimbursement, prescribing, and product availability across health systems- Implementation barriers to AIT, including health workforce, infrastructure, supply chain, and policy determinants- Patterns of underutilization and strategies to address gaps in AIT delivery in resource-limited or underserved settings- Health equity and outcomes related to allergy care and AIT access across different populations- Patient-reported outcomes, reasons for non-initiation, and determinants of adherence and dropout in AIT across different cultural and health-literacy contexts- Comparative effectiveness and feasibility of subcutaneous versus sublingual AIT routes in low-resource settings- Allergist and primary care workforce capacity for AIT prescribing and follow-up across health systems- Digital health and telemedicine approaches to improving AIT initiation rates and long-term adherenceAppendix: Article types considered include Original Research, Systematic Reviews, Mini Reviews, Perspectives, Policy and Practice Reviews, Clinical Studies/Audits, and Implementation Research.Rudolf Valenta serves as Lecturer for HVD Biotech, Vienna, Austria.Péter Csonka has received speaker fees and/or honoraria for advisory board participation from ALK, Orion Pharma, Sanofi/Regeneron, and Thermo Fisher Scientific. Dr. Csonka has received financial support for research as an investigator in sponsored clinical trials from ALK, Boehringer Ingelheim, GSK, Pfizer, and Stallergenes. The other Topic Editors report no competing interests related to this Research Topic. Topic editors: Rudolf Valenta, Birgit Linhart, Péter Csonka Source: https://www.frontiersin.org/research-topics/80155/from-sensitization-to-immunotherapy-global-patterns-of-ige-sensitization-and-barriers-to-allergen-immunotherapy-initiation-and-adherence