[Relationship between pollen allergy and oral allergy syndrome]

Effect of pollen-specific sublingual immunotherapy on oral allergy syndrome: an observational study

Background

Oral allergy syndrome (OAS) triggered by fruit and vegetables often occurs in patients with pollen-induced rhinoconjunctivitis because of cross-reactive epitopes in pollen and associated foods. This open observational study examined the effect of pollen-specific sublingual immunotherapy ([SLIT] B. U. Pangramin or SLITone involving birch/alder/hazel, grasses/rye, and/or mugwort) on OAS triggered by several foods in patients treated in standard practice. Very few studies have examined SLIT use in this situation.

Methods

Patients (n = 102) had pollen-induced rhinoconjunctivitis and OAS and were followed for up to 12 months. Baseline OAS (triggers, symptoms, and symptom severity) was assessed by questionnaire and patient history. Change in OAS was assessed using oral challenge test with 1 or 2 dominant food triggers (and compared with the sum score calculated from the OAS questionnaire at baseline) and clinician ratings of change. Pollen-induced rhinoconjunctivitis symptoms and medication use were also measured.

Results

In the oral challenge test, 77.0% of patients were considered responders (decrease in sum score of ≥ 50%; no difference in patients receiving B. U. Pangramin or SLITone). At baseline, investigators rated OAS severity as at least moderate in 94.9% of patients compared with 36.9% after 12 months of treatment. After 12 months, OAS was rated as much or very much improved in 72.9% of patients. Sublingual immunotherapy significantly reduced rhinoconjunctivitis symptoms and medication use. Only 10% of patients experienced adverse drug reactions.

Conclusion

This study supplements the sparse literature on this topic and suggests that pollen-specific SLIT can reduce OAS triggered by pollen-associated foods in patients with pollen-induced rhinoconjunctivitis.

[Relationship between IgE antibodies to recombinant allergens rBet v 1 and rBet v 2 and food causing oral allergy syndrome in cases of birch-pollen allergy]

BACKGROUND

Persons allergic to birch pollen often report oral and pharyngeal hypersensitivity to fruit and vegetables, such as apples and peaches due to immunological cross-reactivity, or oral allergy syndrome (OAS) sometimes accompanied by systemic reaction. Such cross-reactive antigen reactions involve Bet v 1, the main birch-pollen allergen, and Bet v 2, birch-pollen profilin. We evaluated the food/antigen relationship.

METHODS

Subjects interviewed numbered 60-40 women and 20 men aged 12 to 70 (mean age: 35 years)-suffering OAS episodes and having IgE birch-pollen antibodies. Using CAP scoring we examined IgE antibodies to recombinant Bet v 1 (rBet v 1), recombinant Bet v 2 (rBet v 2), and recombinant Pru p 3 (rPru p 3) a peach lipid transfer protein (LTP). A CAP score of 0.35 or more was considered positive. We evaluated the relationship between recombinant allergens and 9 fruit often involving OAS--apple, peach, cherry, kiwi, pear, melon, plum, strawberry, and watermelon-based on subjects' reports.

RESULTS

Of the 60, all (100%) were rBet v 1-positive, 9 (15%) rBet v 2-positive, and none (0%) rPru p 3-positive. Rose-family fruit-apples, peaches, cherries, pears, plums, and strawberries-often caused OAS regardless of positive or negative rBet v 2 CAP and were associated with rBet v 1. In contrast, more of those who were rBet v 2 CAP-positive had OAS to non-rose-family fruit-melon and watermelon-than those rBet v 2-negative. In rose-family and non-rose-family classification of the 9 fruit, cluster analysis and kappa statistics showed non-rose-family melon, watermelon, and kiwi to be associated with rBet v 2, as were grass and mugwort pollen allergies.

CONCLUSION

Bet v 1 is associated with OAS due to rose-family fruit and Bet v 2 with OAS due to non-rose-family fruit.