Unveiling Art v 3-Driven Cross-Sensitization Profiles in Mugwort and Food Allergens: A Multi-Regional Analysis in China

Background: Allergic diseases have increased worldwide, with food and respiratory allergies affecting large populations. This surge is driven by common immunological mechanisms, including IgE-mediated cross-reactivity between pollen and food allergens, particularly non-specific lipid transfer proteins (nsLTPs). Despite the high prevalence of Artemisia pollen allergy in northern China, data regarding Art v 3 sensitization and its cross-reactivity with other nsLTPs remains scarce. Materials and Methods: We enrolled 225 patients from 20 medical centres across 15 provinces in China. Total IgE and specific IgE to 49 allergens, including Art v 3, were quantified using the ALEX 2 Allergy Xplorer microarray. Hierarchical clustering and Spearman correlation analyses were applied to characterise regional and disease-specific sensitization patterns. Results: Artemisia pollen exhibited a positivity rate of 52.44%, with Art v 1 at 42.67% and Art v 3 at 28.00%. Significant regional variations were identified, with the northwest region exhibiting the highest positivity rates to Art v 3 (17.78%) and cross-reactive components such as Mal d 3 (17.33%) and Cor a 8 (16.89%), indicating pronounced mugwort–fruit/nut cross-allergy patterns. Patients diagnosed with both AR and AS exhibited higher and more complex sensitisation profiles compared with those with AR or AS alone, particularly in relation to Art v 1, Art v 3, and Cuc m 2. Co-sensitisation analysis showed that 36.08% of patients with mugwort or food allergy were sensitised to all seven nsLTP components. Clustering further demonstrated distinct regional patterns, with stronger pollen–food interactions in the northwest and north and substantially weaker interactions in southern regions. Conclusion: Art v 3–positive patients displayed significantly higher sensitization to other nsLTPs, underscoring the central role of Art v 3 in pollen–food allergy syndrome. These findings provide important implications for molecular diagnostics and personalised allergy management in China.