Birch-Apple Syndrome Treated with Birch Pollen Immunotherapy

Abstract

Background: The most common pollen-fruit cross-reaction is the birch-apple syndrome. Allergen immunotherapy (IT) is clearly effective for birch allergy, but its efficacy on apple allergy is controversial. We performed a randomized study on patients with birch-apple syndrome to evaluate the outcome of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Methods: Forty patients underwent IT with a birch extract (Staloral; Stallergenes, Antony, France), 20 by SCIT and 20 by SLIT. After 1 year of treatment, 15 patients (8 for SCIT and 7 for SLIT) accepted to undergo an oral apple challenge. Measurements of specific IgE to Bet v 1 and Mal d 1 and related allergens Api g 1 and Dau c 1 were obtained in 10 patients, at baseline and after IT. Results: Two of 8 SCIT-treated patients (25%) and 1 of 7 SLIT-treated patients (14.2%) developed complete tolerance to apple. In the remaining patients, an increase in the provocative dose was found in 3 of the SCIT-treated (37.5%) and 2 of the SLIT-treated patients (28.6%). Changes in the levels of specific IgE to Mal d 1 were unrelated to clinical results. Conclusions: These findings suggest that different doses of birch extract may be needed in different patients to improve the associated apple allergy and that a finer diagnostic work-up in selecting patients with birch-apple syndrome who are candidates to respond to birch pollen IT also concerning apple allergy is required.

Oral exposure to Mal d 1 affects the immune response in patients with birch pollen allergy

“…20 SLIT with birch pollen did not effectively alter T-cell and antibody responses to Mal d 1. 24,32 In view of our finding that orally administered GMP-rMal d 1 targeted different T cells than GMP-rBet v 1, SLIT with GMP-rMal d 1 might be a promising approach to cure birch pollen-related apple allergy.…”

Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report

“…In the remaining patients, an increase in the provocative dose was found in 3 of the SCIT-treated (37.5%) and 2 of the SLIT-treated patients (28.6%). They concluded that different doses of birch extract may be needed in different patients to improve the associated apple allergy and that a finer diagnostic work-up in selecting patients with birch-apple syndrome who are candidates to respond to birch pollen IT also concerning apple allergy is required [36]. …”

Japanese Cedar Pollen-Based Subcutaneous Immunotherapy Decreases Tomato Fruit-Specific Basophil Activation

“…However, there are no standard treatments for food allergies, including PFAS, other than avoiding the implicated foods. Pollen allergen-specific subcutaneous immunotherapy (SCIT) is reportedly beneficial for associated food allergies, primarily for patients with a birch pollen-induced allergy to apples [4,5,6,7]. Some studies have shown the beneficial effects of SCIT on PFAS occurring in response to foods other than those containing Bet v 1-related protein [8,9].…”