Special section: Food allergyBirch pollen-related food allergy: Clinical aspects and the role of allergen-specific IgE and IgG4 antibodies

BackgroundPatients with birch pollen allergy often develop allergic reactions to plant foods.ObjectiveTo evaluate the prevalence, main symptoms, and triggers of birch pollen-related food allergy and the role of food-specific IgG4 antibodies in food tolerance.MethodsFood-induced symptoms were evaluated in 225 individuals with birch pollen allergy by using a standardized questionnaire. IgE and IgG4 levels specific for the major birch pollen allergen Bet v 1 and birch profilin Bet v 2 and the Bet v 1 homologs in apple (Mal d 1) and hazelnut (Cor a 1) were quantified by ImmunoCAP. Mock-treated and IgG-depleted sera from patients tolerating hazelnuts in food challenges were compared for their inhibitory activity for binding of Cor a 1-IgE complexes to B cells.ResultsIn total, 73% of the study population experienced food allergy, which was perennial in 86% of the affected individuals. The oral allergy syndrome was the main clinical manifestation. However, more than 58% of the patients also experienced food-induced rhinoconjunctivitis. Apples and hazelnuts were identified as the most frequent triggers. Food allergy correlated with IgE reactivity to Bet v 1 but not to Bet v 2. Mal d 1-specific and Cor a 1-specific IgG4/IgE ratios were significantly higher in food-tolerant individuals than individuals with food allergy. Sera from IgG4-positive food-tolerant patients possessed IgG-dependent IgE-inhibitory activity.ConclusionBirch pollen-related food allergy is highly prevalent and often perennial. High food allergen-specific IgG4/IgE ratios seem associated with food tolerance, potentially because specific IgG4 blocks IgE binding to food allergens. Thus, the presence of food allergen-specific IgG4 antibodies is no diagnostic marker for birch pollen-related food allergy.