Mueller Bettina, Reider Norbert, Demir Hilal, Bohle Barbara, Marquer Laurent, Yildirim Aylin, Deluca Jenny, Cova Valentina, Ahammer Linda, Eidelpes Reiner, Unterhauser Jana, Tollinger Martin, Letschka Thomas, Eisendle Klaus
Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
J Allergy Clin Immunol Pract. 2025 Jul 7. doi: 10.1016/j.jaip.2025.06.030.
Birch pollen food allergy syndrome to apples is prevalent, but no approved or standardized treatment exists so far.
To investigate the effect of oral therapy with fresh apples on birch pollen food allergy syndrome to apples using a feasible treatment protocol with different widely available apple cultivars.
In this uncontrolled phase II/III study, 42 apple cultivars were tested for their allergen content in vivo by skin prick tests and oral provocations. Afterward, 36 patients consumed apples of increasing dose and allergenicity over a period of 12 months. Side effects were documented weekly in a clinical diary. Efficacy was tested before and after therapy by oral provocation and a skin prick test with the Golden Delicious apple. Total IgE, specific IgE, and IgG for Mal d 1 and inhibition of basophil activation were analyzed before and after treatment. Other cross-reactive foods were determined by a questionnaire before and after therapy.
Oral immunotherapy with apples resulted in a consistent and durable tolerance of apples and a significant augmented tolerance to other Bet v 1 cross-reactive foods. After therapy, specific IgG antibodies to Mal d 1 increased significantly; simultaneously specific IgE to Mal d 1 and skin prick test reactivity to apples decreased significantly. Moreover, sera of treated patients displayed blocking activity to Mal d 1.
Oral allergy-specific immunotherapy with fresh apples is a promising treatment for birch pollen food allergy syndrome to apples and other Bet v 1 cross-reactive foods.
苹果引发的桦树花粉食物过敏综合征很常见，但目前尚无获批的或标准化的治疗方法。
采用可行的治疗方案，使用不同的常见苹果品种，研究口服新鲜苹果对苹果引发的桦树花粉食物过敏综合征的疗效。
在这项非对照的II/III期研究中，通过皮肤点刺试验和口服激发试验对42个苹果品种的过敏原含量进行了体内测试。之后，36名患者在12个月的时间里食用了剂量和过敏原性逐渐增加的苹果。每周在临床日记中记录副作用。治疗前后通过口服激发试验和使用金冠苹果进行皮肤点刺试验来测试疗效。分析治疗前后的总IgE、特异性IgE以及针对Mal d 1的IgG和嗜碱性粒细胞活化抑制情况。通过问卷在治疗前后确定其他交叉反应性食物。
苹果口服免疫疗法使患者对苹果产生了持续且持久的耐受性，并显著增强了对其他Bet v 1交叉反应性食物的耐受性。治疗后，针对Mal d 1的特异性IgG抗体显著增加；同时，针对Mal d 1的特异性IgE和对苹果的皮肤点刺试验反应性显著降低。此外，治疗患者的血清对Mal d 1表现出阻断活性。
新鲜苹果口服特异性免疫疗法是治疗苹果引发的桦树花粉食物过敏综合征以及其他Bet v 1交叉反应性食物过敏的一种有前景的治疗方法。
