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ALEX AIR Case No. 1

Thomas, 54 years from Austria

Clinical history

Rhino-conjunctivitis and asthma exacerbations, triggered with and without exercise, began at age 5. Skin prick tests (1976) showed sensitisation to cat dander and various grass and tree pollens. Treatment included inhaled corticosteroids, antihistamines, and AIT for birch and grass pollen (started 1977). Respiratory symptoms - especially asthmatic episodes - improved markedly after completing AIT.

Family history

Both father and grandfather experienced allergic symptoms with rhino-conjunctivitis.

Present situation

Experiences allergy-like symptoms in the car or in households with cats and dogs, and near horses. Recent skin prick testing revealed sensitisations to pollen from trees, grasses and weeds. Further sensitisations were found for cat-, dog- and horse dander, as well as house dust mites.

Thomas' ALEX AIR test results

Allergen source Allergen

Timothy grass pollen

Phl p 1

Timothy grass pollen

Phl p 2

Timothy grass pollen

Phl p 5

Timothy grass pollen

Phl p 7

Allergen source Biochemical designation

Timothy grass pollen

β-Expansin

Timothy grass pollen

Expansin

Timothy grass pollen

Grass group 5/6

Timothy grass pollen

Polcalcin

Allergen source IgE Level [kUA/L]

Timothy grass pollen

7.91

Timothy grass pollen

8.20

Timothy grass pollen

27.31

Timothy grass pollen

7.89

Allergen source Allergen

Ash pollen

Fra e 1

Olive pollen

Ole 1

Birch pollen

Bet v 1

Allergen source Biochemical designation

Ash pollen

Ole e 1-family

Olive pollen

Ole e 1-family

Birch pollen

PR-10

Allergen source IgE Level [kUA/L]

Ash pollen

13.82

Olive pollen

12.69

Birch pollen

24.91

Allergen source Allergen

House dust mite

Der p 1

House dust mite

Der p 2

House dust mite

Der p 23

Allergen source Biochemical designation

House dust mite

Cysteine protease

House dust mite

NPC2-family

House dust mite

Chitinase class III

Allergen source IgE Level [kUA/L]

House dust mite

15.09

House dust mite

5.08

House dust mite

2.37

Allergen source Allergen

Cat dander

Fel d 1

Dog dander

Can f 1

Horse Dander

Equ c 1

Allergen source Biochemical designation

Cat dander

Uteroglobin

Dog dander

Lipocalin

Horse Dander

Lipocalin

Allergen source IgE Level [kUA/L]

Cat dander

12.52

Dog dander

0.66

Horse Dander

0.54

Analysis

Grass & tree pollen

  • High IgE-levels against the major allergens from tree and grass pollen
  • Genuine grass pollen sensitisation (Phl p 1, 2 and 5)
  • IgE-reactivity to Phl p 7 demonstrates that cross-reactivity to other grass-, weed- or tree pollen
  • The sensitisation to Bet v 1 likely causes cross-reactions to other PR-10 allergens like Ara h 8 (peanut), Gly m 4 (Soy) and other.
  • Fra e 1 and Ole e 1 are highly cross-reactive - also to other members of the Oleaceae family (e.g. lilac or privet)

House dust mites

  • House dust mite allergens Der p 1, 2 and 23 demonstrate a sensitisation to the major allergens from this source.
  • As the symptoms were described accordingly - an AIT could be helpful.

Furry animals

  • Furry animal allergens Fel d 1 (cat), Can f 1 (dog) and Equ c 1 (horse) are able to cause respiratory symptoms as described by the patient.
  • Before an AIT is considered contact to pets should be avoided.

Summary

  • Thomas’ skin test results were confirmed: responsible allergens detected on molecular level
  • Suitable candidate for AIT against various grass and tree pollen (genuine sensitisations). Positive SPT results for weed pollen caused by the sensitisation against Polcalcin (Phl p 7), a highly cross-reactive allergen
  • Further possible AIT for house dust mite (if encasings do not show the desired effect) and against furry animals (first therapeutic step: avoidance), as in all sources the major allergen is positive