Efficacy of Oral Tolerance Induction to raw apple using an
Ultra-Rush protocol in 28 patients allergic to rosaceae fruits: RAAP
Study
To the Editor,
The diagnosis of pollen-food allergy syndrome (PFAS) or oral allergy
syndrome (OAS) relies on clinical history together with demonstration of
allergen-specific IgE. PFAS is mainly observed in central and northern
Europe. These symptoms follow the consumption of raw
fruits1 and last 30 minutes, then stop ; but they tend
to worsen over time, leading patients to avoid eating raw rosaceae fruit
and many other raw fruits. This clinical presentation evolves
concurrently with birch pollen allergy2. Over 70% of
patients with birch allergy suffer from PFAS to rosaceae, particularly
to raw apple3 . Therapeutic management is
limited 4 , based on avoidance of trigger
foods5.
The results of betulaceae pollen immunotherapy remain
limited6 . Raw Golden apple (RGA)
desensitization has already been described by NUCERA et al. in
20107 in 2 patients. Likewise, RGA tolerance induction
was described in 2012 by KOPAC et al8 and in 2014 by
BOUVIER et al9 according to slow protocols where the
maintenance dose was reached over several months.
We realized a retrospective observational impact study to present an
accelerated protocol or ultra-rush (UR) for resumption of RGA intake
performed in two private hospitals of the Lyon region (France), the
Charcot clinic and the Beaujolais clinic, on 28 patients hospitalized
between June 2016 until October 2017. The study was appropriately
registered (ClinicalTrials.gov Identifier: NCT04116580).
Eligible patients were 10 years of age and older with allergic rhinitis
related to PFAS for raw rosacea with avoidance of this family of fruits
for at least 6 months. Subjects were excluded from the study in case of
severe allergic reaction to rosacea or uncontrolled asthma with FEV1
< 70%. The medical procedure consisted of 4 phases. During
the first consultation, each patient’s medical history was collected.
Prick tests with airborne allergen and raw golden apple (RGA) were
performed according to the prick-prick technic 10;
specific IgE for apple, rBet v 1, rBet v 2\sout, rPru p 3 were
prescribed. In total the inclusion of patients was based on their
clinical history.
For the UR, patients were not on antihistamines. At time 0 (T0), prick
test were performed with RGA9. At T0 +20 minutes,
patients took 1 g of unpeeled RGA , then by doubling regularly the doses
from 2g to 128g, to reach a 255 g cumulative dose within in 3 hours.
Then,
half of an unpeeled RGA was consumed daily at home for one month, and
one whole RGA daily the following month. For the patients who underwent
the UR procedure between mid-April and mid-July, intake of other raw
rosaceae was permitted at the end of week 5 post UR. A two-month
evaluation consultation was conducted. Afterwards, patients had to
maintain their tolerance by consuming half a raw apple of any type three
times a week. A telephone interview was performed at 1 year of the UR to
evidence tolerance and compliance.
FIGURE 1 Shematic overview of the Ultra-Rush protocol
TABLE 1 Population profile - Allergologic and Biological results