Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Vienna, Austria.
Department of Pathophysiology and Allergy Research and Christian Doppler Laboratory for Immunomodulation, Medical University of Vienna, Vienna, Austria.
J Allergy Clin Immunol. 2018 Mar;141(3):1002-1008. doi: 10.1016/j.jaci.2017.07.036. Epub 2017 Sep 1.
Birch pollen-related apple allergy is among the most prevalent food allergies in adolescent/adult subjects and mainly results from sensitization to the major birch pollen allergen Bet v 1 and subsequent cross-reaction with the apple protein Mal d 1. However, specific immunotherapy with birch pollen has inconsistent effects on apple allergy.
We sought to compare the safety and efficacy of sublingual immunotherapy (SLIT) with 2 formulations containing either rMal d 1 or rBet v 1 on birch pollen-related apple allergy.
Sixty participants with birch pollen-related apple allergy were randomized to daily sublingual application of placebo (n = 20) or 25 μg of rMal d 1 (n = 20) or rBet v 1 (n = 20) for 16 weeks. Adverse events were regularly recorded. Sublingual challenges with standardized doses of rMal d 1, skin prick tests with recombinant allergens, and measurements of allergen-specific IgE and IgG antibodies were performed before and after treatment.
Both formulations caused comparable, mainly local adverse events. No systemic reactions occurred. Compared with the placebo and rBet v 1-treated groups, SLIT with rMal d 1 reduced rMal d 1-induced oral symptoms (P = .001 and P = .038) accompanied by longitudinally reduced rMal d 1-specific cutaneous reactions (P = .022) and enhanced IgG/IgE ratios (P = .012). SLIT with rBet v 1 neither improved the clinical reactivity to rMal d 1 nor enhanced rMal d 1-specific IgG/IgE ratios. Participants receiving placebo showed no allergen-specific changes.
Sublingual treatment with a recombinant food allergen was safe and clinically effective, as determined by using standardized challenges. We present a promising approach for the effective treatment of birch pollen-related apple allergy.
桦树花粉相关的苹果过敏是青少年/成年人群中最常见的食物过敏之一，主要是由于对主要桦树花粉过敏原 Bet v 1 致敏以及随后与苹果蛋白 Mal d 1 的交叉反应引起的。然而，桦树花粉的特异性免疫治疗对苹果过敏的效果不一致。
我们旨在比较含有 rMal d 1 或 rBet v 1 的两种舌下免疫疗法（SLIT）治疗桦树花粉相关苹果过敏的安全性和疗效。
60 名桦树花粉相关苹果过敏患者被随机分为每日舌下应用安慰剂（n=20）、25μg rMal d 1（n=20）或 rBet v 1（n=20）组，共 16 周。定期记录不良反应。在治疗前后进行标准化 rMal d 1 剂量的舌下挑战、重组过敏原的皮肤点刺试验以及过敏原特异性 IgE 和 IgG 抗体的测量。
两种配方均引起类似的主要局部不良反应。没有发生全身性反应。与安慰剂和 rBet v 1 治疗组相比，rMal d 1 的 SLIT 降低了 rMal d 1 诱导的口腔症状（P=.001 和 P=.038），同时伴有 rMal d 1 特异性皮肤反应的纵向减少（P=.022）和 IgG/IgE 比值的增加（P=.012）。rBet v 1 的 SLIT 既不能改善对 rMal d 1 的临床反应，也不能增强 rMal d 1 特异性 IgG/IgE 比值。接受安慰剂的患者没有表现出过敏原特异性变化。
使用标准化挑战，确定了含有重组食物过敏原的舌下治疗是安全且具有临床疗效的。我们提出了一种有前途的方法，用于有效治疗桦树花粉相关的苹果过敏。
