면역치료로 치유된 구강 알레르기 증후군 1예

Abstract

Oral allergy syndrome (OAS), defined as an immediate swelling and itching sensation of mouth and throat after ingestion of fresh fruit, is commonly found in the patients with pollinosis. The high incidence of OAS is due to cross- reactivity between pollen and fruit allergens. Many recent studies show that immunotherapy (IT) with extracts of pollen can relieve symptoms of OAS. A 33 year-old female visited our clinic with the complaint of oral mucosal swelling and itching sensation after ingestion of fresh fruit (apple, pear, kiwi, banana, melon and fresh chest nut) for 13 years, with simultaneous allergic rhinitis worsening in spring and fall. In the skin prick test, she had strongly positive reaction to alder (mean wheal size 23.5 mm), oak (10.5 mm), walnut (12 mm), Japanese cedar (17 mm), bermuda (14 mm), sagebrush (8.5 mm), and Dermatophagoides farinae (17 mm). For pollens, specific IgE to alder (58.6 kU/L), oak (35.2 kU/L), walnut (9.51 kU/L), Japanese cedar (3.99 kU/L), bermuda (6.96 kU/L) and sagebrush (9.88 kU/L) have been proved by CAP-FEIA(Fluorescent Enzyme Immunoassay) (Pharmacia, Uppsala, Sweden). For fruit allergens, specific IgE to apple (13.0 kU/L), peanut (4.1 kU/L), carrot (5.9 kU/L), and pear (1.7 kU/L) have been detected but not to peach and banana. The IT with extracts of alder, oak, walnut, Japanese cedar, bermuda, sagebrush and D. farinae was started. Her allergic symptoms to pollens in spring and autumn were improved after IT. Furthermore the allergic symptoms to fruits began to disappear after initiation of IT. After 9 months of IT, she can enjoy all the fruits that provoking OAS without allergic symptoms.