Components and OAS: Diagnosis supported by molecular allergology increases the probability of appropriate SIT treatment
Paul, a 14-year-old boy with a history of severe rhino-conjunctivitis, visits his healthcare provider after two episodes of asthma during late spring and summer. Paul also experiences oral allergy syndrome when eating various fruits and vegetables (tomatoes, melon, mandarin, kiwi, and peaches). His parents want Paul to undergo specific immunotherapy (SIT).
Paul's healthcare provider conducts a full clinical history and physical examination and decides to test using grass pollen components.
Paul has a history of rhino-conjunctivitis, episodes of asthma, and oral allergy syndrome (OAS) when eating some fruits and vegetables.
Patient History
Family History
- Atopic mother
Paul's Personal History
- He was diagnosed as allergic to egg and milk after presenting with eczema at 12 months old.
- At 8 years old, he exhibited recurrent mild to moderate seasonal rhino-conjunctivitis.
- He was previously tested and subsequently diagnosed with a pollen allergy.
Test |
Type |
Paul's Results |
Egg |
Whole Allergen |
0 |
Milk |
Whole Allergen |
0 |
Grass Mix |
Whole Allergen |
+3 |
Birch |
Whole Allergen |
+2 |
Paul’s previous healthcare provider recommended that he use oral antihistamines and nasal steroids during pollen season.
Paul’s ImmunoCAP™ Test Results
These results together with this patient's case history and symptoms, help confirm the diagnosis.
| Allergen | Type |
Paul's Results |
Timothy |
Whole Allergen |
11.1 |
Birch |
Whole Allergen |
8.3 |
Tomato |
Whole Allergen |
4.2 |
Melon |
Whole Allergen |
7.1 |
Peach |
Whole Allergen |
3.9 |
Kiwi |
Whole Allergen |
6.5 |
| Allergen | Type |
Paul's Results |
Phl p 1 |
Allergen Component |
10.4 |
Phl p 5b |
Allergen Component |
3.9 |
Phl p 6 |
Allergen Component |
1.1 |
Phl p 12 (profilin) |
Allergen Component |
8.7 |
Bet v 2 (profilin) |
Allergen Component |
6.3 |
Differential Diagnosis
The significant IgE levels to the grass-specific components Phl p 1 and 5b indicate a “true” grass pollen sensitization. Paul’s IgE response to profilin also supports the noted OAS to various fruits and vegetables.1
REFINED DIAGNOSIS
- Timothy grass pollen allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
Paul's healthcare provider advises him to:
- Undergo Timothy grass SIT treatment.
- Avoid tomatoes, melon, mandarin, kiwi, or peaches if unpleasant.
FOLLOW UP
- After two years of SIT, Paul’s pollen symptoms improved significantly. Also, an improvement in the food allergy was noted, probably due to the allergen load reduction.
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.
