title: Birch-apple syndrome treated with birch pollen immunotherapy.
abstract: BACKGROUND
  The most common pollen-fruit cross-reaction is the birch-apple syndrome. Allergen immunotherapy (IT) is clearly effective for birch allergy, but its efficacy on apple allergy is controversial. We performed a randomized study on patients with birch-apple syndrome to evaluate the outcome of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT).
  
  
  METHODS
  Forty patients underwent IT with a birch extract (Staloral; Stallergenes, Antony, France), 20 by SCIT and 20 by SLIT. After 1 year of treatment, 15 patients (8 for SCIT and 7 for SLIT) accepted to undergo an oral apple challenge. Measurements of specific IgE to Bet v 1 and Mal d 1 and related allergens Api g 1 and Dau c 1 were obtained in 10 patients, at baseline and after IT.
  
  
  RESULTS
  Two of 8 SCIT-treated patients (25%) and 1 of 7 SLIT-treated patients (14.2%) developed complete tolerance to apple. In the remaining patients, an increase in the provocative dose was found in 3 of the SCIT-treated (37.5%) and 2 of the SLIT-treated patients (28.6%). Changes in the levels of specific IgE to Mal d 1 were unrelated to clinical results.
  
  
  CONCLUSIONS
  These findings suggest that different doses of birch extract may be needed in different patients to improve the associated apple allergy and that a finer diagnostic work-up in selecting patients with birch-apple syndrome who are candidates to respond to birch pollen IT also concerning apple allergy is required.
authors.affiliation: Allergy Unit, Sant'Anna Hospital, Como, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Mauro
authors.forename: Marina
authors.initials: M
authors.lastname: Russello
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Incorvaia
authors.forename: Gianbattista
authors.initials: G
authors.lastname: Gazzola
authors.forename: Franco
authors.initials: F
authors.lastname: Frati
authors.forename: Philippe
authors.initials: P
authors.lastname: Moingeon
authors.forename: Gianni
authors.initials: G
authors.lastname: Passalacqua
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D029662:Betula / Q000009:adverse effects* / Q000276:immunology; D003888:Desensitization, Immunologic; D005260:Female; D005512:Food Hypersensitivity / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D007279:Injections, Subcutaneous; D008297:Male; D027845:Malus / Q000009:adverse effects*; D008875:Middle Aged; D011058:Pollen / Q000276:immunology*; D013577:Syndrome; D055815:Young Adult
chemical_list: D000485:Allergens; D007074:Immunoglobulin G; D007073:Immunoglobulin E