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
Abstract
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 IgG 4 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 IgG 4 to Mal d 1 and Bet v 1 increased ( p < .01).