Pollen allergy: Choosing the right pollen for SIT therapy
Adam, 23 years old, and Ben, 28 years old, have both suffered from recurrent, severe rhino-conjunctivitis for the last six years in early spring (February to May). Both patients are considered for specific immunotherapy (SIT) treatment.
But before making a decision, identification of the primary IgE sensitization at the molecular level is necessary.
Adam and Ben's healthcare provider conducts a full clinical history and physical examination and decides to test using grass and birch pollen components.
Two men suffer from recurrent, severe rhino-conjunctivitis. What will testing using grass and birch pollen components reveal?
Patient History
Family History
- Atopic mother
Adam and Ben's Personal History
| Skin Prick Test | |||
|---|---|---|---|
Test |
Type |
Adam’s Results |
Ben’s Results |
Birch |
Whole Allergen |
+3 |
+3 |
Timothy grass |
Whole Allergen |
+3 |
+3 |
| ImmunoCAPTM Test Results (kUA/I) | |||
|---|---|---|---|
Test |
Type |
Adam’s Results |
Ben’s Results |
Birch |
Whole Allergen |
15 |
8.5 |
Timothy grass |
Whole Allergen |
6.3 |
11.3 |
Both Adam’s and Ben's previous healthcare providers diagnosed them with grass and birch allergy and recommended that they use oral antihistamines and nasal steroids during pollen season.
Adam and Ben’s ImmunoCAP™ Test Results
These results together with this patient's case history and symptoms, help confirm the diagnosis.
Test |
Type |
Adam's Results |
Ben's Results |
Bet v 1 |
Allergen Component |
10.1 |
0.1 |
Bet v 2 (profilin) |
Allergen Component |
<0.1 |
6.3 |
Bet v 4 (polcalcin) |
Allergen Component |
5.2 |
0.1 |
Bet v 6 |
Allergen Component |
<0.1 |
<0.1 |
Phl p 1 |
Allergen Component |
<0.1 |
7.3 |
Phl p 5 |
Allergen Component |
<0.1 |
<0.1 |
Phl p 7 (procalcin) |
Allergen Component |
5.8 |
0.1 |
Phl p 12 |
Allergen Component |
<0.1 |
5.7 |
Differential Diagnosis
Adam
Adam’s specific IgE response to the individual birch pollen component, Bet v 1, indicates that birch pollen SIT is appropriate. The specific IgE response to the cross-reacting polcalcins (Bet v 4 and Phl p 7) explains the positive grass extract result.1
REFINED DIAGNOSIS
- Birch pollen allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Adam's healthcare provider advises him to have birch pollen SIT.
FOLLOW UP
- Adam has an appointment with his healthcare provider after two years of SIT—Adam’s pollen symptoms improved significantly. He is doing well.
Ben
The absence of specific IgE antibodies to Bet v 1 indicates that the pollen sensitization is not originating from birch pollen. Ben’s specific IgE response to Phl p 1 indicates that grass pollen SIT is appropriate. The specific IgE response to the cross-reacting profilin (Bet v 2 and Phl p 12) explains the positive birch extract result.1
REFINED DIAGNOSIS
- Timothy grass pollen allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Ben's healthcare provider advises him to have grass pollen SIT treatment.
FOLLOW UP
- Ben has an appointment with his healthcare provider after two years of SIT—Ben’s pollen symptoms improved significantly. He is doing well.
The people, places, and events depicted in these case studies and photographs do not represent actual patients, nor are they affiliated in any way with Thermo Fisher Scientific.
- Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;27 Suppl 23:1-250.
