Abstract: Background: birch pollen sensitization and associated pollen-food syndrome among Chinese allergic patients have not been investigated. Methods: Sera from 203 allergic patients from the northern part of China and collected during February to July 2014 were investigated. specific immunoglobulin E (IgE) against birch pollen extract Bet v and major birch pollen allergen Bet v 1 were measured using the ADVIA Centaur. The presence of major apple allergen Mal d 1 and soy bean allergen Gly m 4 specific IgE was measured by ImmunoCAP 100. Results: Among the 203 sera, 34 sera (16.7%) had specific IgE to Bet v and of these, 28 sera (82.4%) contained Bet v 1-specific IgE. Among the 28 sera with Bet v 1-specific IgE, 27 sera (96.4%) contained Mal d 1-specific IgE and 22 sera (78.6%) contained Gly m 4-specific IgE. Of the 34 Bet v-positive sera, 6 sera (17.6%) contained no specific IgE for Bet v 1, Mal d 1, or Gly m 4. Almost all Bet v-positive sera were donated during the birch pollen season. Conclusions: The prevalence of birch allergy among patients visiting health care during pollen season can be as high as 16.7% in Tangshan City. The majority of Chinese birch allergic patients are IgE-sensitized to the major birch pollen allergen Bet v 1 as well as to the major apple allergen Mal d 1 and soy bean allergen Gly m 4. A relatively high number of patients (17.6%) are IgE-sensitized to birch pollen allergen(s) other than Bet v 1. The high prevalence of specific IgE to Mal d 1 and Gly m 4 among Bet v 1-sensitized patients indicates that pollen-food allergy syndrome could be of clinical relevance in China.

桦树花粉、大豆和苹果过敏原之间高免疫球蛋白E相关性表明中国北方地区桦树花粉过敏患者很可能同时患有花粉-食物综合征

[1]Caillaud, D., Martin, S., Segala, C., et al., 2014. Effects of airborne birch pollen levels on clinical symptoms of seasonal allergic rhinoconjunctivitis. Int. Arch. Allergy Immunol., 163(1):43-50.

[2]Ebisawa, M., Brostedt, P., Sjolander, S., et al., 2013. Gly m 2S albumin is a major allergen with a high diagnostic value in soybean-allergic children. J. Allergy Clin. Immunol., 132(4):976-978.

[3]Eriksson, N.E., Holmen, A., Moller, C., et al., 1998. Sensitization according to skin pick testings in atopic patients with asthma or rhinitis at 24 allergy clinics in Northern Europe and Asia. Allergol. Int., 47(3):187-196.

[4]Fukutomi, Y., Sjolander, S., Nakazawa, T., et al., 2012. Clinical relevance of IgE to recombinant Gly m 4 in the diagnosis of adult soybean allergy. J. Allergy Clin. Immunol., 129(3):860-863.

[5]Gajhede, M., Osmark, P., Poulsen, F.M., et al., 1996. X-ray and NMR structure of Bet v 1, the origin of birch pollen allergy. Nat. Struct. Biol., 3(12):1040-1045.

[6]Hauser, M., Roulias, A., Ferreira, F., et al., 2010. Panallergens and their impact on the allergic patient. Allergy Asthma Clin. Immunol., 6(1):1.

[7]Hofmann, A., Burks, W.A., 2008. Pollen food syndrome: update on the allergens. Curr. Allergy Asthma Rep., 8(5):413-417.

[8]Holm, J., Baerentzen, G., Gajhede, M., et al., 2001. Molecular basis of allergic cross-reactivity between group 1 major allergens from birch and apple. J. Chromatogr. B Biomed. Sci. Appl., 756(1-2):307-313.

[9]Holm, J., Ferreras, M., Ipsen, H., et al., 2011. Epitope grafting, re-creating a conformational Bet v 1 antibody epitope on the surface of the homologous apple allergen Mal d 1. J. Biol. Chem., 286(20):17569-17578.

[10]Holzhauser, T., Wackermann, O., Ballmer-Weber, B.K., et al., 2009. Soybean (Glycine max) allergy in Europe: Gly m 5 (β-conglycinin) and Gly m 6 (glycinin) are potential diagnostic markers for severe allergic reactions to soy. J. Allergy Clin. Immunol., 123(2):452-458.

[11]Hong, H., Fan, Y., Yang, Q., et al., 2011. A cohort investigation of the allergen and pathogenesis in the patients with allergic rhinitis from three hospital of Guangzhou Province. J. Clin. Otorhinolaryngol. Head Neck Surg., 25(23):1064-1067 (in Chinese).

[12]Ipsen, H., Løwenstein, H., 1983. Isolation and immunochemical characterization of the major allergen of birch pollen (Betula verrucosa). J. Allergy Clin. Immunol., 72(2):150-159.

[13]Ito, K., Sjolander, S., Sato, S., et al., 2011. IgE to Gly m 5 and Gly m 6 is associated with severe allergic reactions to soybean in Japanese children. J. Allergy Clin. Immunol., 128(3):673-675.

[14]Kampe, M., Janson, C., Stalenheim, G., et al., 2010. Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regards to the inflammatory response. Clin. Respir. J., 4(1):37-44.

[15]Katelaris, C.H., 2010. Food allergy and oral allergy or pollen-food syndrome. Curr. Opin. Allergy Clin. Immunol., 10(3):246-251.

[16]Kleine-Tebbe, J., Wangorsch, A., Vogel, L., et al., 2002. Severe oral allergy syndrome and anaphylactic reactions caused by a Bet v 1-related PR-10 protein in soybean, SAM22. J. Allergy Clin. Immunol., 110(5):797-804.

[17]Kosma, P., Sjolander, S., Landgren, E., et al., 2011. Severe reactions after the intake of soy drink in birch pollen-allergic children sensitized to Gly m 4. Acta Paediatr., 100(2):305-306.

[18]Lahti, A., Bjorksten, F., Hannuksela, M., 1980. Allergy to birch pollen and apple, and cross-reactivity of the allergens studied with the RAST. Allergy, 35(4):297-300.

[19]Li, J., Sun, B., Huang, Y., et al., 2009. A multicenter study assessing the prevalence of sensitizations in patients with asthma and/or rhinitis in China. Allergy, 64(7):1083-1092.

[20]Ma, S., Sicherer, S.C., Nowark-Wegrzyn, A., 2003. A survey on the management of pollen-food allergy syndrome in allergy practices. J. Allergy Clin. Immunol., 112(4):784-788.

[21]Mittag, D., Vieths, S., Vogel, L., et al., 2004. Soybean allergy in patients allergic to birch pollen: clinical investigation and molecular characterization of allergens. J. Allergy Clin. Immunol., 113(1):148-154.

[22]Movérare, R., Westritschnig, K., Svensson, M., et al., 2002. Different IgE reactivity profiles in birch pollen sensitive patients from six European populations revealed by recombinant allergens: an imprint of local sensitization. Int. Arch. Allergy Immunol., 128(4):325-335.

[23]Petersen, A.B., Gudmann, P., Milvang-Gronager, P., et al., 2004. Performance evaluation of a specific IgE assay developed for the ADVIA centaur immunoassay system. Clin. Biochem., 37(10):882-892.

[24]Rashid, R.S., Smith, K.A., Nambiar, K.Z., et al., 2011. Pollen-food syndrome is related to Bet v 1/PR10 protein sensitization, but not all patients have spring sensitization. Allergy, 66(10):1391-1392.

[25]Schöning, B., Ziegler, W.H., Vieths, S., et al., 1996. Apple allergy: the cDNA sequence of the major allergen of apple, determined by performing PCR with a primer based on the N-terminal amino acid sequence, is highly homologous to the sequence of the major birch pollen allergen. J. Sci. Food Agric., 71(4):475-482.

[26]Tolkki, L., Alanko, K., Petman, L., et al., 2013. Clinical characterization and IgE profiling of birch (Betula verrucosa)—allergic individuals suffering from allergic reactions to raw fruits and vegetables. J. Allergy Clin. Immunol. Pract., 1(6):623-631.

[27]Wang, Z.H., Lin, W.S., Wang, L., et al., 2012. Distribution of allergens in patients with allergic rhinitis in Hebei villagers and Tianjin citizens. J. Clin. Otorhinolaryngol. Head Neck Surg., 47(10):809-812 (in Chinese).

[28]Zheng, Y., Li, J., Lai, X., et al., 2011. Allergen micro-array detection of specific IgE reactivity in Chinese allergic patients. China Med. J., 124(24):4350-4354.