Oral Challenges with Four Apple Cultivars Result in Significant Differences in Oral Allergy Symptoms

Nybom, Hilde; Cervin-Hoberg, Charlotte; Andersson, Morgan

doi:10.1159/000345954

Cited by 13 publications

(11 citation statements)

References 19 publications

(36 reference statements)

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“…A break of at least 2 days was induced between each challenge. OPT has been modified after Nybom et al 25 and Kopac et al, 7 so increasing amounts of allergenic apple pieces were given to patients to consume (Fig. 1).…”

Section: Oral Provocationsmentioning

confidence: 99%

Allergen‐specific immunotherapy with apples: selected cultivars could be a promising tool for birch pollen allergy

Nothegger

Reider

Covaciu

et al. 2020

Acad Dermatol Venereol

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Background Most birch pollen-allergic patients develop allergic cross-reactions to the major allergen found in apples Mal d1, known as pollen-related food allergy (prFA). This is due to a strong clinically relevant homology between the major allergen in birch Bet v 1 and Mal d 1. Daily apple consumption induces oral tolerance in prFA, but its effect on the inhalational allergy has not been investigated. Objectives As continuous apple consumption might also mitigate the inhalational allergy, this study aimed to uncover apple cultivars suitable for treatment of birch pollen rhinoconjunctivitis and apple allergy in a controlled and established dosage. Methods Patients (n = 52) with birch pollen allergy and prFA to apples were subjected to a prick-to-prick test (SPT) with 23 cultivars (red-fleshed, old traditional and new commercial). By SPT, the apple parts flesh, peel equatorial and peel apical near the stalk were compared for their reactivity. One apple cultivar of each allergenicity class (low, middle and high) was subsequently tested in an oral provocation test (OPT). Results According to the SPTs, we provide a ranking of all 23 cultivars. Red-fleshed apples displayed the lowest reactivity, followed by old and new cultivars. Four cultivars showed disagreement from their allergenicity class: Santana and Pink Ladyâ, new cultivars that provoked only low to moderate. In contrast, White Rosemary and Goldparm€ ane, two old cultivars, induced strong reactions. Skin reactivity increased from flesh to peel to stalk, and SPT results could predict the severity of prFA of each allergenicity class. Conclusions Herein, we propose a treatment protocol for allergen immunotherapy to birch pollen and prFA with daily apple consumption. Red-fleshed, old and the new cultivars Santana and Pink Ladyâ provoke less allergic reactions and are suitable for initial induction. After a controlled and well-tolerated increase of intake, also moderate and finally high allergenic apple cultivars should be integrated into treatment of birch pollen allergenic patients.

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Section: Oral Provocationsmentioning

confidence: 99%

Allergen‐specific immunotherapy with apples: selected cultivars could be a promising tool for birch pollen allergy

Nothegger

Reider

Covaciu

et al. 2020

Acad Dermatol Venereol

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“… 2 3 4 5 6 7 8 According to recent reports, up to 90% of patients allergic to birch pollen Bet v 1 or its homologues show immunoglobulin E (IgE)-mediated reactions to plant fruits including apples. 9 10 11 An increasing number of reports have demonstrated Bet v 1-specific T lymphocyte reactions with related food homologues. 2 3 12 13 Jahn-Schmid and colleagues 3 showed that T lymphocytes specific for the Bet v 1 142-156 epitope were triggered to produce cytokines and proliferate in response to homologous pathogenesis-related (PR)-10-like allergens such as Api g 1, Cor a 1, Dau c 1, Gly m 4, Pru av 1, and Mal d 1.…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Delayed-Type Hypersensitivity Reactions to Apples Among Patients Allergic to Birch Pollen

Wagner

Zielińska‐Bliźniewska

Wagner

2018

Allergy Asthma Immunol Res

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The major apple allergen Mal d 1 cross-reacts with the homologous birch pollen allergen Bet v 1 and causes immunoglobulin E (IgE)-mediated immediate-type allergic reactions. In some patients, delayed-type hypersensitivity to apples may develop within 72 hours without evidence of specific IgE or a positive skin prick test (SPT). The aim of the study was to evaluate the concomitance of delayed-type hypersensitivity reactions and immediate IgE-mediated reactions against high- and low-allergenic apple cultivars in patients with birch pollen allergy. Data were obtained from 45 adults with clinical symptoms of birch pollen allergy. Patients were exposed to apple pulp via atopy patch tests (APTs) and SPTs. Levels of IgE specific to Bet v 1 and Mal d 1 were measured with a radioallergosorbent test. Patients allergic to birch pollen showed the highest rate of positive SPT responses to Golden Delicious apples and the lowest rate to low-allergenic cultivar Grey French Reinette. Among these patients, 9% developed delayed hypersensitivity reactions to either Golden Delicious or Grey French Reinette apples; these reactions manifested clinically as erythema with papules (class ++). Fifty percent of APT-positive patients were concomitantly SPT-negative. Here, we show for the first time the clinical relevance of T cell-driven allergic reactions to apples. APTs may reveal type IV sensitization in patients who are negative for the corresponding type I sensitization tests. Thus, utilization of the APT procedure with fresh apple appears to be a valuable tool for the diagnosis of apple allergy and may improve the accuracy of food allergy diagnoses.

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“…Although Santana, Topaz, Pink Lady, and Elise were all classified as low allergenic [ 28 , 30 ], VAS scores of Santana were significantly lower than those of Topaz and VAS scores of Elise were significantly lower than those of Santana and Pink Lady [ 29 , 30 ]. Neither SPT nor Mal d 1 content seem to predict allergenicity of different apple cultivars as determined by food challenge [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Dietary Interventions in Pollen-Related Food Allergy

et al. 2018

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In practice, it remains unclear what the best dietary approach is in subjects with pollen-related food allergy (PRFA). Our objective was to evaluate the effect of (1) dietary avoidance advice, (2) oral immunotherapy (OIT), (3) (heat) processing, and (4) consumption of hypoallergenic cultivars on frequency, severity, and eliciting dose of pollen-related food allergic reactions. A systematic search was conducted in PubMed, Embase, and Cochrane. All studies performing an in vivo investigation of one of the four interventions in adults with PRFA were included. Each study was assessed for quality and validity. Available data on frequency, severity, and eliciting dose of allergic reactions were extracted. Ten studies matched the eligibility criteria. No studies were retrieved on dietary avoidance advice. Two studies (N = 92) on apple OIT reported that tolerance was induced in 63% and 81% of subjects. Four studies (total N = 116) focused on heat processing. Heating was found to completely eradicate symptoms in 15–71% of hazelnut allergic and 46% of celery allergic individuals. Four studies (N = 60) comparing low to high allergenic apple cultivars revealed that Santana (and possibly Elise) apples seemed to cause milder reactions than Golden Delicious. In the awareness that overall level of evidence was low, we conclude that OIT, heat processing, and hypoallergenic cultivars may diminish or completely prevent allergic reactions in some but not all subjects with PRFA.

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Oral Challenges with Four Apple Cultivars Result in Significant Differences in Oral Allergy Symptoms

Cited by 13 publications

References 19 publications

Allergen‐specific immunotherapy with apples: selected cultivars could be a promising tool for birch pollen allergy

Allergen‐specific immunotherapy with apples: selected cultivars could be a promising tool for birch pollen allergy

The Incidence of Delayed-Type Hypersensitivity Reactions to Apples Among Patients Allergic to Birch Pollen

Dietary Interventions in Pollen-Related Food Allergy

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