Booster Injection with Birch Pollen Extract Activates B‐Cellular Memory Responses in Patients Having Completed Allergen Immunotherapy

Allergen immunotherapy (AIT) of patients with IgE-mediated allergy results in the synthesis of blocking IgG antibodies mediating allergen tolerance. However, as antibody concentrations wane after stopping AIT, tolerance may be lost. The impact of a single booster allergen application on B-cellular memory in AIT-treated birch pollen (BP)-allergic patients was investigated. Twenty-five patients with BP allergy who finished AIT 3-12 years ago received one allergen injection approximately 4 months prior to the next BP season. We determined peripheral Bet v 1-specific IgG-secreting cells (ASC) by ELISPOT analysis and BP-specific IgG, IgG4, and IgE serum antibodies by ImmunoCAP, and the allergen-blocking capacity of IgG/IgG4 antibodies by ELIFAB assay. Clinical responses were assessed by visual analog scales. Immunological findings were compared with the primary B cell response of 12 BP-allergic patients receiving conventional AIT. Bet v 1-specific ASC significantly increased 2-4 weeks after BP-injection, accompanied by enhanced levels of both BP-specific IgG/IgG4 antibodies and allergen-blocking serum activity. Compared with conventional up-dosing, a single booster vaccination led to a markedly stronger B cell response after 4 weeks. Allergen booster injection activates B-cellular memory associated with blocking IgG/IgG4 antibodies, pointing to reinforcement of allergen tolerance after completion of AIT.