Efficacy and safety of 4 months of sublingual immunotherapy with recombinant Mal d 1 and Bet v 1 in patients with birch pollen-related apple allergy

Publication date: Available online 1 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Tamar Kinaciyan, Birgit Nagl, Sandra Faustmann, Florian Frommlet, Stephan Kopp, Martin Wolkersdorfer, Stefan Wöhrl, Katharina Bastl, Hans Huber, Uwe Berger, Barbara Bohle
BackgroundBirch pollen-related apple allergy is among the most prevalent food allergies in adolescent/adult individuals and mainly results from sensitization to the major birch pollen allergen Bet v 1 and subsequent cross-reaction with the apple protein Mal d 1. However, specific immunotherapy with birch pollen has inconsistent effects on apple allergy.ObjectiveTo compare the safety and efficacy of sublingual immunotherapy (SLIT) with two formulations containing either recombinant (r) Mal d 1 or Bet v 1 on birch pollen-related apple allergy.MethodsSixty participants with birch pollen-related apple allergy were randomized to daily sublingual application of placebo (n=20), 25 μg of rMal d 1 (n=20) or rBet v 1 (n=20) for 16 weeks. Adverse events were regularly recorded. Sublingual challenges with standardized doses of rMal d 1, skin prick testing with recombinant allergens and measurements of allergen-specific IgE and IgG4 antibodies were performed before and after treatment.ResultsBoth formulations caused comparable, mainly local adverse events. No systemic reactions occurred. Compared to the placebo and the rBet v 1-treated group SLIT with rMal d 1 reduced rMal d 1-induced oral symptoms (P=0.001 and P=0.038), accompanied by longitudinally reduced rMal d 1-specific cutaneous reactions (P=0.022) and enhanced IgG4/IgE ratios (P=0.012). SLIT with rBet v 1 neither improved the clinical reactivity to rMal d 1 nor enhanced rMal d 1-specific IgG4/IgE ratios. Participants receiving placebo showed no allergen-specific changes.ConclusionSublingual treatment with a recombinant food allergen was safe and clinically effective as determined by standardized challenges. We present a promising approach for the effective treatment of birch pollen-related apple allergy.

Teaser

SLIT with recombinant Mal d 1 is a promising approach for the effective treatment of birch pollen-related apple allergy.


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