Peach and Birch Pollen: Testing with allergen components enables risk assessment and helps to explain symptoms due to cross-reactivity
Patricia, a 16-year old girl with a history of seasonal rhino-conjunctivitis during early spring goes to see her healthcare provider because her symptoms have been getting worse the last two to three years. She also has been experiencing oral itching when eating peaches and wants advice regarding her potential peach allergy.
Her healthcare provider conducts a full clinical history and physical examination and decides to test using peach and birch allergen components.
A girl with a history of seasonal rhino-conjunctivitis and oral itching when eating peaches goes to see her healthcare provider.
Patient History
Family History
- None
Patricia's Personal History
- Patricia has had recurrent, mild to moderate seasonal rhino-conjunctivitis during early spring since she was 9 years old.
Test |
Type |
Patricia's Results |
Birch Pollen |
Whole Allergen |
+5 |
Patricia's test results were negative to ash, grass, and mugwort.
Her previous healthcare provider recommended that Patricia use oral antihistamines during birch pollen season and local steroids were prescribed to use during birch pollen season.
Test |
Type |
Patricia's Results |
Birch Pollen |
Whole Allergen |
+6 |
Peach |
Whole Allergen |
+3 |
Patricia’s ImmunoCAP™ Test Results
These results together with this patient's case history and symptoms, help confirm the diagnosis.
| Allergen | Type |
Patricia's Results |
Birch Pollen |
Whole Allergen |
33.3 |
Peach |
Whole Allergen |
10.4 |
Bet v 1 (PR-10) |
Allergen Component |
35.2 |
Bet v 2 |
Allergen Component |
<0.1 |
Bet v 4 |
Allergen Component |
<0.1 |
Bet v 6 |
Allergen Component |
<0.1 |
Pru p 1 (PR-10) |
Allergen Component |
16.3 |
Pru p 3 |
Allergen Component |
<0.1 |
Differential Diagnosis
Skin-prick testing and blood testing with whole allergens indicate that Patricia is sensitized to both birch and peach. Sensitization to Pru p 1 will likely result in oral symptoms.1 However, the allergen component results are positive only for the PR-10 protein of birch (Bet v 1) and peach (Pru p 1), indicating that Patricia's symptoms from eating peach are a consequence of her birch pollen allergy. She may in the future experience symptoms also to other PR-10 containing plant foods, such as apples, pears, hazelnuts, carrots, or celery.
REFINED DIAGNOSIS
- Birch pollen allergy and birch-pollen-related food allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
Patricia’s healthcare provider:
- Prescribed antihistamines and local steroids to use during birch pollen season.
- Advised by her healthcare provider to avoid eating peach if unpleasant.
FOLLOW UP
- Patricia is seen by her healthcare provider one year later. She has had no further issues and 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.
- Fernandez-Rivas M. Peach allergy: different clinical profiles across Europe. Clinical and Translational Allergy. https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-1-S1-S58. Published August 12, 2011. Accessed January 5, 2018.
