Birch pollen–related food allergy: Clinical aspects and the role of allergen-specific IgE and IgG4 antibodies Marija Geroldinger-Simic, MD, Thomas Zelniker,

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The Editors' Choice Journal of Allergy and Clinical Immunology

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Birch pollen–related food allergy: Clinical aspects and the role of allergen-specific IgE and IgG4 antibodies Marija Geroldinger-Simic, MD, Thomas Zelniker, MD, Werner Aberer, MD, Christof Ebner, MD, Cornelia Egger, MD, Antonia Greiderer, Nicole Prem, MD, Jonas Lidholm, PhD, Barbara K. Ballmer-Weber, MD, Stefan Vieths, PhD, Barbara Bohle, PhD Journal of Allergy and Clinical Immunology Volume 127, Issue 3, Pages 616-622.e1 (March 2011) DOI: 10.1016/j.jaci.2010.10.027 Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 IgE levels of patients with birch pollen allergy with and without food allergy. A, Levels of total IgE and IgE specific for birch pollen, Bet v 1, and Bet v 2 were compared in food-tolerant (open circles) and food-reactive (filled circles) patients. B, Percentage of Bet v 1–sensitized and Bet v 2–sensitized patients in tolerant (white bars) and food-reactive (gray bars) individuals. Horizontal lines indicate median values. Wilcoxon signed-ranks test, ∗P < .05, ∗∗∗P < .001. Journal of Allergy and Clinical Immunology 2011 127, 616-622.e1DOI: (10.1016/j.jaci.2010.10.027) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Specific IgE and IgG4 levels in patients with and without food allergy. Patients with IgE >0.35 kUA/L to Mal d 1 or Cor a 1 were grouped into food-tolerant (white) or food-reactive (gray). Food allergen–specific IgG4 and IgG4/IgE ratios were determined. For IgG4/IgE ratios, box plots are shown. Wilcoxon signed-ranks test, ∗P < .05. Journal of Allergy and Clinical Immunology 2011 127, 616-622.e1DOI: (10.1016/j.jaci.2010.10.027) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 IgG4 in food-tolerant patients shows IgE inhibitory activity. Sera from Cor a 1–sensitized, hazelnut-tolerant patients (1-6) and patients who underwent birch pollen SIT (7-10; Table III) were included. A, Cor a 1–specific IgG4 in mock-treated (white bars) and IgG-depleted (gray bars) sera assessed by ELISA. B, Serum inhibitory activity tested in FAB inhibition assays. Sera obtained from SIT-treated patients before therapy served as controls. Horizontal lines indicate median values. Journal of Allergy and Clinical Immunology 2011 127, 616-622.e1DOI: (10.1016/j.jaci.2010.10.027) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Standardized questionnaire to evaluate the cause and symptoms of birch pollen–related food allergy. Journal of Allergy and Clinical Immunology 2011 127, 616-622.e1DOI: (10.1016/j.jaci.2010.10.027) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions