n: Population; W : Women ; M: Men; RC: Rhinoconjunctivitus; A: Asthma ; AD : Atopic Dermatitis ; µ: Average;
28 patients were included (23 women and 5 men); average age 30.6 years (10 to 51 years). All had birch pollen- related allergic rhino conjunctivitis, 14 of them were asthmatic.PFAS duration averaged out at 6.8 years (1/2 - 20 years) and occurred 8.6 years on average after respiratory symptoms for 20 patients. For 8 patients, food allergy occurred the same year as rhinitis. 26 patients had a positive apple prick test. rBet v 1 IgE remained positive for all patients with an average rate of 37.99 kU /L (0,53kU/L to 100 kU/L); this rate is independent of the severity of the symptoms. rBet v 2 IgE remained positive for 11 patients with an average of 7,67 kU/L; apple IgE positive for 27 patients with an average of 4.15 kU/L ; 4 patients had rPru p 3 positive IgE (0.19 kU/L to 4.43 kU/L). The rate is low and it is not a contraindication for performing UR. All patients reached the cumulative dose. Tolerance was very good for 26 patients; Two did not tolerate the last dose; the first had an episode of isolated vomiting; the second had lower lip oedema. No severe anaphylactic reaction was observed.
During the post-hospitalization phase, all patients were able to consume half of a RGA a day for one month, and all of them consumed one raw apple a day during the 2d month. Adverse effects of PFAS were mainly concentrated during the first two weeks (W); 25.5% at W1, and 15.3% at W2 to finally fall to 0.02% at W3 and after. No serious allergic reaction was recorded. Eleven out of 12 patients who had the rush between May and July reconsidered other raw rosaceae at two months. 4 asthmatic patients followed the protocol during the birch pollination period without severe incident, no particular exacerbations were observed.
At one year, 2 patients were lost to follow-up. 5 had stopped the protocol, 2 for compliance difficulties, 2 for the persistence of an uncomfortable PFAS, and 1 for gastroparesis attacks. At least 21 patients or 75% consumed all rosaceae at 1 year.
We demonstrated in a cohort of 28 patients that resumption of RGA eating in patients with PFAS related to raw rosaceae associated with persistent and severe allergic rhinitis to birch with Bet v 1 biological profile is possible with an UR protocol to reach a cumulative dose of 255 g in 3 hours. This simple, fast and safe protocol, is easy to administer and allows acquiring tolerance that is quickly maintained by the regular consumption of apple. The tolerance is good. This protocol allows consumption of other raw rosacea at the end of the week 5 if it is achieved between mid-April and mid-July which could be the best period to carry out the UR. It is likewise feasible during the birch pollination phase without destabilizing underlying asthma. In all, the results of this study are encouraging. The effects are very positive particularly on quality of life. The disappearance of the PFAS was maintained over time if patients continued to consume raw rosaceae fruit regularly.
CONFLICTS OF INTEREST
Dr Bouvier report personal fees from Alk Abello, Chiesi, Stallergene Greer, Menarini and AstraZeneca unrelated to this work.
Dr Hacker report personal fees from Alk Abello, and Stallergene Greer unrelated to this work.
Dr Lefevre has no conflicts of interest.
ACKNOWLEDGEMENTS
We gratefully acknowledge the aid of Mrs Maya Perrou (Capio-Ramsay research coordinator) for her precious support throughout the conduct of this study, Professor Frederic Berard for his help during our first work on raw apple tolerance induction and our assistant Mrs Melissa Mcmahon. We also wish to thank the nursing teams in the 2 clinics, particularly Mrs Adeline Ballu allergology referent at the polyclinic of Beaujolais.
ETHICS COMMITTEE APPROVAL AND CONSENT TO PARTICIPATE
The Ethics Committee’s approval was obtained by the Lyon University Hospital. Consent to participate was collected by sending an information letter to each patient or their family and non-objection to collection of their personal data. The study complied with national ethical and regulatory requirements (including data protection).
Michel Bouvier ID1,2
Marion Hacker ID3
Sébastien Lefevre ID4
1 Allergology Center of Beaujolais, 69400 Limas, France
2 Polyclinic of Beaujolais, 69400 Arnas, France
3 Department of Allergology, Lyon-Sud Hospital, 69190 Pierre Bénite, France
4 Regional Institute for Allergic and Environmental diseases 57085 Metz, France
Address for Correspondence : Michel Bouvier, Allergology Center of Beaujolais, 63 Chemin de la Croix de Fer 69400 Limas France
Tel : +33608099155
Fax : +33478720840
Email :dr.michel.bouvier@orange.fr
Key Words: apple allergy; rosacea allergy; oral allergy syndrome; tolerance induction; ultra-rush