Immunity, Inflammation and Disease (Jun 2021)

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

  • Bettina Nothegger,
  • Norbert Reider,
  • Claudia E. Covaciu,
  • Valentina Cova,
  • Linda Ahammer,
  • Reiner Eidelpes,
  • Jana Unterhauser,
  • Stefan Platzgummer,
  • Elisabeth Raffeiner,
  • Martin Tollinger,
  • Thomas Letschka,
  • Klaus Eisendle

DOI
https://doi.org/10.1002/iid3.410
Journal volume & issue
Vol. 9, no. 2
pp. 503 – 511

Abstract

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Abstract Background Seventy percent of patients suffering from birch pollen allergy (BPA) develop a pollen‐related food allergy (prFA), especially to apples, due to a clinically relevant cross‐reactivity between the major allergen in birch Bet v 1 and Mal d 1 in apples. Therefore allergen‐specific immunotherapy with fresh apples (AITA) could be a promising natural treatment of both BPA and prFA. Objective To assess the clinical efficacy of immunotherapy by daily apple consumption for patients with BPA and prFA. Methods A daily defined increasing amount of selected cultivars (Red Moon®, Pink Lady®, Topaz, Golden Delicious) was continuously consumed by 16 patients (12 female; median age; 50; range, 23–68 years), leading to increased intake of allergen over a period of at least 8 months. Specific IgE and IgG4 to Bet v 1 and Mal d 1, conjunctival and oral provocation tests, skin reactivity, and the average daily rhinoconjunctivitis combined symptom and medication score (CSMS) were measured during the peak birch pollen season. Results After 8 months of therapy, patients showed increased tolerance to apples (p < .001) and a decreased skin reactivity to apples. Oral allergy syndrome to other birch prFA than apple also decreased (p < .05). Moreover, daily rhinoconjunctivitis CSMS declined by 34% (p < .001), as did conjunctival reactivity to birch pollen extract by 27% (p < .01), while specific IgG4 to Mal d 1 and Bet v 1 increased (p < .01).

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