Fennel, cucumber, and melon allergy successfully treated with pollen-specific injection immunotherapy

Background: In subjects with both pollinosis and vegetable food allergy, most allergenic epitopes of fruits and vegetables are present in pollen. A recent study showed a marked reduction or a total disappearance of apple-induced oral allergy syndrome in patients receiving injection immunotherapy with birch pollen extracts. Objective: To assess whether vegetable food allergy following other kinds of primary pollinosis may be successfully treated with pollen-specific immunotherapy. Methods: A 34-year-old woman with long-standing pollinosis and typical oral allergy syndrome (OAS) with the ingestion of both fennel and cucumber and whose OAS was associated with immediate laryngeal edema after the ingestion of melon, was treated with two commercial depot aluminum hydroxide-adsorbed extracts of (1) grass pollen and (2) mugwort pollen 50% + ragweed pollen 50%. Results: After 36 months of injection specific immunotherapy, the patient was able to tolerate both fresh fennel and cucumber without consequence on open oral challenge tests. After 43 months of immunotherapy, the patient tolerated fresh melon as well on open oral challenge. She has re-introduced these vegetables in her normal diet. Skin tests showed no reactivity to fresh fennel and there was a reduction of the wheal induced by fresh cucumber. Conclusion: Vegetable food allergy following primary sensitization to pollens, other than birch, may also be effectively reduced by pollen-specific injection immunotherapy.