Allergen‐specific immunotherapy with apples: selected cultivars could be a promising tool for birch pollen allergy

Abstract

Background Most birch pollen-allergic patients develop allergic cross-reactions to the major allergen found in apples Mal d1, known as pollen-related food allergy (prFA). This is due to a strong clinically relevant homology between the major allergen in birch Bet v 1 and Mal d 1. Daily apple consumption induces oral tolerance in prFA, but its effect on the inhalational allergy has not been investigated. Objectives As continuous apple consumption might also mitigate the inhalational allergy, this study aimed to uncover apple cultivars suitable for treatment of birch pollen rhinoconjunctivitis and apple allergy in a controlled and established dosage. Methods Patients (n = 52) with birch pollen allergy and prFA to apples were subjected to a prick-to-prick test (SPT) with 23 cultivars (red-fleshed, old traditional and new commercial). By SPT, the apple parts flesh, peel equatorial and peel apical near the stalk were compared for their reactivity. One apple cultivar of each allergenicity class (low, middle and high) was subsequently tested in an oral provocation test (OPT). Results According to the SPTs, we provide a ranking of all 23 cultivars. Red-fleshed apples displayed the lowest reactivity, followed by old and new cultivars. Four cultivars showed disagreement from their allergenicity class: Santana and Pink Ladyâ, new cultivars that provoked only low to moderate. In contrast, White Rosemary and Goldparm€ ane, two old cultivars, induced strong reactions. Skin reactivity increased from flesh to peel to stalk, and SPT results could predict the severity of prFA of each allergenicity class. Conclusions Herein, we propose a treatment protocol for allergen immunotherapy to birch pollen and prFA with daily apple consumption. Red-fleshed, old and the new cultivars Santana and Pink Ladyâ provoke less allergic reactions and are suitable for initial induction. After a controlled and well-tolerated increase of intake, also moderate and finally high allergenic apple cultivars should be integrated into treatment of birch pollen allergenic patients.

Oral birch pollen immunotherapy with apples: Results of a phase II clinical pilot study

“…Up to date, birch‐AIT has shown to be largely ineffective in treating prFA 13,14 . In contrast, oral immunotherapy with fresh apples achieved transient tolerance and SLIT with rMal d 1 was also effective for the treatment of birch prFA to apples 14,15,17 . This study indicates for the first time that continuous consumption of apples by BPA patients with prFA to apples could both improve prFA and simultaneously may reduce birch pollen‐induced rhinoconjunctivitis.…”

Inverse relation between structural flexibility and IgE reactivity of Cor a 1 hazelnut allergens

“…We verified the immunologic activity of our recombinantly produced Cor a 1.04 proteins using blood sera from twenty-two Austrian patients (Tyrol) included in a pilot study 34 . The patients show birch-pollen related hazelnut allergy (specific IgE to Cor a 1 > 0.35 kU/mL and Bet v 1 > 0.35 KU/mL), positive skin-prick test to hazelnut extract and oral allergy symptoms to hazelnuts (see demographic data in Table 2 ).…”

Relationship between Phenolic Compounds, Antioxidant Properties, and the Allergenic Protein Mal d 1 in Different Selenium-Biofortified Apple Cultivars (Malus domestica)

“…Another mechanism concerns the influence of phenolic compounds on mast cells and the prevention of histamine secretion [ 27 , 35 , 42 , 66 ]. Thus, polyphenols are able to influence the binding between IgE antibodies and the FCεRI receptor on the mast cell surfaces [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ], resulting in a lower amount of released histamine and, thus, in a lower allergic recruitment [ 35 ].…”

“…The identification of hypoallergenic apple cultivars is important for dietary recommendations, especially for patients suffering from severe symptoms of apple allergy [ 18 , 19 ]. For this reason, various aspects of apple allergy have been highlighted in numerous scientific studies since the early 1990s [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The assessment of the allergenic potential of an apple cultivar is a complex issue, as the allergen content of apples is influenced by various factors: the content of allergenic proteins depends primarily on the genotype [ 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] but is also influenced by the level of maturation, postharvest conditions, as well as cultivation conditions and practices, such as the use of selected fertilizers [ 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 36 , 37 ].…”