Pollen Allergy: Identifying the primary sensitization to increase the probability of successful SIT outcome
Maria, 27 years old, and Richard, 29 years old, both visit their healthcare provider for additional insight into their pollen allergies and are requesting specific immunotherapy (SIT).
Maria and Richard's healthcare provider conducts a full clinical history and physical examination and decides to test using grass pollen component, as testing with allergen components can aid in making appropriate management plans.
Can tests using grass and pollen components help lead to appropriate management plans for Maria and Richard?
Patient History
Family History
- None
Maria and Richard's Personal History
- Recurrent seasonal rhino-conjunctivitis for the last 10 years.
- Asthma symptoms during summer the last 2 years.
Test |
Type |
Maria's Results |
Richard's Results |
Grass mix |
Whole Allergen |
+4 |
+4 |
Birch |
Whole Allergen |
+3 |
+3 |
Maria's previous physician recommended that she take antihistamines for her allergies.
Test |
Type |
Maria's Results |
Richard's Results |
Timothy grass |
Whole Allergen |
49 |
22 |
Birch |
Whole Allergen |
6.9 |
8.1 |
Maria and Richard’s ImmunoCAP™ Test Results
These results together with this patient's case history and symptoms, help confirm the diagnosis.
Test |
Type |
Maria's Results |
Richard's Results |
Phl p 1 |
Allergen Component |
22 |
<0.1 |
Phl p 2 |
Allergen Component |
3.8 |
<0.1 |
Phl p 4 |
Allergen Component |
1.8 |
<0.1 |
Phl p 5b |
Allergen Component |
11 |
<0.1 |
Phl p 6 |
Allergen Component |
7 |
<0.1 |
Phl p 11 |
Allergen Component |
2.7 |
<0.1 |
Phl p 7 |
Allergen Component |
<0.1 |
9.7 |
Phl p 12 |
Allergen Component |
7.3 |
2.1 |
Bet v 1 |
Allergen Component |
<0.1 |
<0.1 |
Bet v 2 |
Allergen Component |
6.3 |
7.6 |
Bet v 4 |
Allergen Component |
<0.1 |
3.2 |
Differential Diagnosis
Maria
Maria’s significant levels of IgE to Phl p 1 and Phl p 5b indicate primary grass pollen sensitization. SIT treatment for Timothy grass is suggested since the component specific IgE antibody pattern indicates Timothy as the primary sensitizer. The profilin (Phl p 12 and Bet v 2) response explains the positive birch extract result since profilin also is found in plant food, tree, and weed pollen.1
REFINED DIAGNOSIS
- Timothy pollen allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Maria's healthcare provider advises her to have Timothy SIT treatment.
FOLLOW UP
- After two years of SIT Maria’s pollen symptoms improved significantly.
Richard
Richard does not show sensitization to the grass-specific components. Together with the significant IgE response to the cross-reacting components Phl p 7 (polcalcin) and Phl p 12 (profilin), this indicates that the pollen sensitization is not originating from grass pollen.1,2 The polcalcin (Phl p 7 and Bet v 4) and profilin (Phl p 12 and Bet v 2) responses explain the positive birch extract result.1,2
REFINED DIAGNOSIS
- No primary grass pollen allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Richard is advised by his healthcare provider to undergo further testing to understand what pollen can explain his sensitization pattern.
- Further investigation identifies mugwort as a primary sensitization source for Richard.
FOLLOW UP
- Richard has an appointment with his healthcare provider one year later—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.
- Popescu F-D. Cross-reactivity between aeroallergens and food allergens. World Journal of Methodology. 2015;5(2):31-50. doi:10.5662/wjm.v5.i2.31.
- 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.
