title: Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1.
abstract: BACKGROUND
  Cross-reactivity between the major birch pollen allergen, Bet v 1, and the apple protein, Mal d 1, frequently causes food allergy.
  
  
  OBJECTIVE
  To investigate the effects of successful sublingual immunotherapy (SLIT) with birch pollen extract on apple allergy and the immune response to Bet v 1 and Mal d 1.
  
  
  METHODS
  Before and after 1 year of SLIT, Bet v 1-sensitized patients with oral allergy syndrome to apple underwent nasal challenges with birch pollen and double-blind placebo-controlled food challenges with apple. Bet v 1-specific and Mal d 1-specific serum antibody levels and proliferation in PBMCs and allergen-specific T-cell lines (TCLs) were determined. Bet v 1-specific TCLs were mapped for T-cell epitopes.
  
  
  RESULTS
  In 9 patients with improved nasal provocation scores to birch pollen, apple-induced oral allergy syndrome was not significantly reduced. Bet v 1-specific IgE and IgG(4) levels significantly increased. Bet v 1-specific T-cell responses to all epitopes and those cross-reactive with Mal d 1 significantly decreased. However, neither Mal d 1-specific IgE and IgG(4) levels nor Mal d 1-induced T-cell proliferation changed significantly. In contrast, Mal d 1-specific TCLs showed increased responses to Mal d 1 after 1 year of SLIT.
  
  
  CONCLUSIONS
  This longitudinal study indicates that pollen SLIT does not efficiently alter the immune response to pollen-related food allergens, which may explain why pollen-associated food allergy is frequently not ameliorated by pollen immunotherapy even if respiratory symptoms significantly improve.
  
  
  CONCLUSIONS
  SLIT with birch pollen may have no clinical effect on associated apple allergy.
authors.affiliation: Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Center for Physiology and Pathophysiology, Medical University of Vienna, Austria. barbara.bohle@meduniwien.ac.at
authors.forename: Tamar
authors.initials: T
authors.lastname: Kinaciyan
authors.forename: Beatrice
authors.initials: B
authors.lastname: Jahn-Schmid
authors.forename: Astrid
authors.initials: A
authors.lastname: Radakovics
authors.forename: Bettina
authors.initials: B
authors.lastname: Zwölfer
authors.forename: Claudia
authors.initials: C
authors.lastname: Schreiber
authors.forename: James N
authors.initials: JN
authors.lastname: Francis
authors.forename: Christof
authors.initials: C
authors.lastname: Ebner
authors.forename: Barbara
authors.initials: B
authors.lastname: Bohle
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000737:chemistry / Q000276:immunology*; D000595:Amino Acid Sequence; D052179:Antigens, Plant; D029662:Betula / Q000276:immunology; D002460:Cell Line; D003888:Desensitization, Immunologic; D004311:Double-Blind Method; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology / Q000276:immunology* / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D027845:Malus / Q000276:immunology; D008875:Middle Aged; D008969:Molecular Sequence Data; D009061:Mouth Mucosa / Q000276:immunology; D010940:Plant Proteins / Q000008:administration & dosage / Q000737:chemistry / Q000276:immunology*; D011058:Pollen / Q000737:chemistry / Q000276:immunology*; D040681:Structural Homology, Protein
chemical_list: D000485:Allergens; D052179:Antigens, Plant; C095551:MALD1 protein, Malus domestica; D010940:Plant Proteins; C061312:Bet v 1 allergen, Betula