Kinaciyan T, et al. – Researchers set up this study and compared 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. As determined by standardized challenges, sublingual treatment with a recombinant food allergen was safe and clinically effective. A promising approach was presented for the effective treatment of birch pollen–related apple allergy.

Methods

• They randomized sixty participants with birch pollen-related apple allergy 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.
• They regularly recorded adverse events.
• Before and after treatment, 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.

Results

• As per results, both formulations caused comparable, mainly local adverse events.
• This study did not observe any systemic reactions.
• 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), as compared to the placebo and the rBet v 1-treated group.
• It was reported that SLIT with rBet v 1 neither improved the clinical reactivity to rMal d 1 nor enhanced rMal d 1-specific IgG4/IgE ratios.
• No allergen-specific changes were exhibited by participants receiving placebo.