Intestinal allergic inflammation in birch pollen allergic patients in relation to pollen season, IgE sensitization profile and gastrointestinal symptoms.

Georgios Rentzos,Esbjörn Telemo,Vanja Lundberg,Teet Pullerits,Per‐Ove Stotzer

doi:10.1186/2045-7022-4-19

Georgios Rentzos, Esbjörn Telemo + Show 3 more

Open Access

https://doi.org/10.1186/2045-7022-4-19

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Abstract

BackgroundBirch pollen allergic patients frequently experience gastrointestinal upset accompanied by a local allergic inflammation in the small intestine especially during the pollen season. However, it is not known if the GI pathology is connected to the subjective symptoms of the patient. The objective of this study was to evaluate the immune pathology of the duodenal mucosa and the serum IgE antibody profiles in birch pollen allergic patients in relation to their gastrointestinal symptoms, during and outside the birch pollen season.MethodsThirty-two patients with birch pollen allergy and sixteen healthy controls were enrolled in the study. Twenty allergic patients had gastrointestinal symptoms and twelve did not. All participants underwent an allergy investigation and gastroscopy with duodenal biopsy. The duodenal biopsies were retrieved during the pollen season (May-June) and off-season (November-March). The biopsies were immunostained for mast cells (IgE and tryptase), eosinophils, T cells (CD3), and dendritic cells (CD11c). Pollen-specific IgE antibodies were determined by ImmunoCAP and component microarray (ISAC).ResultsPatients in both pollen allergic groups showed similar degree of intestinal allergic inflammation during the pollen season regardless of gastrointestinal symptoms. The eosinophils, mast cells and dendritic cells were increased in the mucosa. Patients with gastrointestinal symptoms had significantly elevated IgE antibodies to birch (rBet v 1), hazelnut (rCor a 1), and apple (rMal d1) during the pollen season.ConclusionsPatients allergic to birch pollen have clear signs of an ongoing allergic inflammation in their intestinal mucosa, which is aggravated during the pollen season. The magnitude of the allergic intestinal inflammation is not associated with subjective gastrointestinal symptoms of the individual patient.

Highlights

Birch pollen allergic patients frequently experience gastrointestinal upset accompanied by a local allergic inflammation in the small intestine especially during the pollen season
There were no significant differences in the frequency and severity of symptoms that could be related to the severity of the pollen seasons
The objective of this study was to elucidate whether subjective gastrointestinal symptoms in birch pollen allergic patients are related to the degree of allergic inflammation in their intestinal mucosa, and to monitor if the intestinal allergic inflammation varies with the pollen season

Summary

Introduction

Birch pollen allergic patients frequently experience gastrointestinal upset accompanied by a local allergic inflammation in the small intestine especially during the pollen season. It is not known if the GI pathology is connected to the subjective symptoms of the patient. Some patients experience gastrointestinal symptoms only during the pollen season while others have continuous symptoms that aggravate during the pollen season. Some of the latter patients are diagnosed with irritable bowel syndrome (IBS). Whether the pollen exposure by itself or rather the ingestion of birch-pollen related food has an impact on the gastrointestinal inflammation is not known

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