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