Sublingual Reactivity to rBET V1 and rPHL P1 in Patients with Oral Allergy Syndrome

Abstract

Oral Allergy Syndrome (OAS) in patients with pollen-induced rhinoconjunctivitis is caused by specific IgE recognizing cross-reacting epitopes of fruits and plants, which were clearly shown in vitro, but failed to be demonstrated in vivo by cross-challenges in the target organs. Considering the hypothesis of degradation of such epitopes in natural extracts, challenges with recombinant pollen allergens were done to evaluate the reactivity of the oral mucosa in OAS patients. Seventeen patients with OAS and rhinitis from birch (10) and grass pollen (7) and 10 non-atopic controls were studied by skin prick tests (SPT), allergen specific nasal challenges (ASNC) and allergen specific sublingual challenges (ASSC) with birch and timothy extracts and with rBet vl and rPhl pt at increasing concentrations from 1 to 1000 meg/mi. None of the healthy subjects in the control group had any positive test for birch and timothy extracts or for recombinant allergens. In the OAS group the following results were observed: SPTs with recombinant allergens were positive in all patients, mostly at 10 mcg/ml concentration; ASNC with rBet vl were positive in all patients, mostly at 100 mcg/ml; ASSC with natural pollen extracts were positive in only 2 of 17 patients, but in 15 of'17 with rBet vl and rPhl pt, mostly at 500 mcg/ml and 1000 meg/mi. ASSC with rBet vi and rPhl p l were positive with a mean concentration of 677 and 533 mcg/ml, respectively. The results of sublingual challenges with rBet vl and rPhl pt showed the in vivo cross-reactivity between pollens and foods in patients with OAS, but high concentrations ofthe recombinant allergens were needed to reproduce oral symptoms, thus explaining the failure of challenges performed with natural extracts, which have concentrations of major allergens lower than 50 meg/mi. This indicates that sublingual mucosa is much less reactive to allergens than other surfaces, such as skin and nasal mucosa, probably because of its anatomic and immunologic peculiarity.Oral allergy syndrome (OAS) is a condition characterized by oral swelling and itching after the contact of specific foods with the oral mucosa (1). In most cases this syndrome occurs in patients with pollen-induced rhinoconjunctivitis when eating fresh fruits or vegetables (2-4). The etiology ofOAS is generally attributed to cross-reactivity between some food allergens and some inhalant allergens. The contact with the inhaled allergen leads to sensitization of upper and lower airways, with a production of specific IgE cross-reactive to food allergens, which, in turn, are responsible for the oral

Immune mechanisms of allergen‐specific sublingual immunotherapy

“…Allergen‐challenge experiments performed in humans with recombinant allergens (e.g. rPhl p 1, rBet v 1) have confirmed that the sublingual mucosa is at least 10 times less reactive than the nasal mucosa or the skin (142). This is likely explained by the fact that only limited numbers of proinflammatory cells (such as mast cells) are present in the oral mucosa.…”

Strategies of mucosal immunotherapy for allergic diseases

“…However, it was evident that the sublingual mucosa could tolerate higher allergen levels than the mucosa in the nose or skin. 145 Clinically, use of the sublingual route is supported by numerous controlled trials showing its efficacy in asthma and rhinitis in adults and children. 143,146 Additionally, no severe adverse events occurred during the trial, and the most common adverse events were mild asthma attack and local rash.…”

Expression of Co-stimulatory Molecules on Langerhans Cells in Lesional Epidermis of Human Atopic Dermatitis

“…It has been suggested that the AD process of allergic inflammation is mediated by the T-helper type 2 (Th2) lymphocyte (2)(3)(4) Langerhans cells (LC) represent a subset of dendritic cells (DC) found in the stratified epithelia of skin and mucosae. LC expresses CD1a, but is distinguished from other DC by the presence of intracellular Birbeck granules.…”