Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript presents a very logically designed and carried out study, providing sufficient justification and accounting for the feasibility of such investigations. The clinical problem addressed in the research is highly relevant and frequently encountered in daily allergy practice. Therefore, addressing it remains feasible and reasonable. The study goals are clearly explained and adequately addressed and discussed further.

Below, please find my comments on this manuscript.

1. The authors focus on the sensitization to profilins in patients presenting with both respiratory allergy and pollen-food allergy syndrome (PFAS) and examined patients sensitized to brich pollen, grass pollen, or both. The groups are well defined; however, this rigorous approach likely explains the relatively small number of subjects included, particularly in the birch pollen allergy group. The exploration of sensitization to allergen components of both birch and grasses is complete, well described and adequately discussed. I would, however, emphasize even more that the lack of sensitization to profilins and polcalcins in a 10-subject group of birch pollen allergic subjects should be interpreted with caution, if not considered a case-series finding and not reflecting any trend in a Belgian population.
2. The finding on the significantly higher prevalence of sensitization to rBet v 1 in grass pollen allergic subjects with PFAS is interesting and – as the authors acknowledge – supports the important role of co-sensitization (symptomatic or not) in the development of food-induced symptoms in patients with airborne allergy. In addition, the clinical correlates provide further support for that statement. However, what draws attention is the low prevalence of more severe food-induced symptoms and the lack of anaphylaxis cases. This aligns with the low and insignificant prevalence of sensitization to nsLTP, albumins and globulins. I was wondering whether this is purely accidental, or was the history of anaphylaxis a reason for not including the patient in the study? The authors state that recruitment was consecutive; therefore, these results might reflect a small number of recruited subjects. Please consider providing additional comments on this issue.
3. Lines 49-50: It is unclear why the authors state that „Profilin sensitization is not yet associated with more severe symptoms of respiratory and pollen-related food allergy in grass pollen allergic patients.” I suggest removing „yet” since it implies that profilin sensitization may be associated with severe symptoms of pollen-related food allergy in the future… Please explain or else remove it.
4. Regarding statistics: Have the effect sizes been accounted for? Due to small and variable number of subjects between the groups, this may be justified and feasible. In addition, the adjusted comparisons may be considered due to wide age and asthma frequency distributions between the groups (older age and more prevalent asthma in PFAS).

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Although largely confirmatory this study provides a very good comparison of birch and grass pollen allergy co-existing in a well-defined region. The respiratory and oral allergy and correlations with IgE binding to the grass and birch components would be of interest to many allergy researchers and the broader results to allergists.

The timing of the symptoms plays an important part in the differentiation between birch, grass and mixed allergy and the association responses with pattern of IgE to component is impressive. The methods should give more information on how precisely the seasons (months of symptoms) was ascertained.

The correlation of IgE binding titres  to the profilins Phl p12 and Bet v 2 and comparisons of the correlations in mixed and grass allergic group would be of interest. Was it all just cross-reactivity with antibodies to Phl p 12 ? Does the detection of the response to 2 profilins just pick up subjects with the highest titre?

I am sorry but I cannot understand what Table 3b is meant to show.

The abbreviation CCD for cross reactive carbohydrate determinant needs to be given.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript investigates the clinical relevance of Bet v 1 and profilin sensitisation in Belgian patients with birch, grass, or mixed pollen allergy. The study addresses a clinically relevant question and provides useful regional data, but several methodological and interpretative issues require attention. The areas requiring the authors' attention are mentioned below:
Specific Comments
1. The introduction provides sufficient background but would benefit from tightening and clearer linkage to the study's objectives.
2. Methods require more transparency, such as explaining why these specific allergens were the authors' choice and justifying why the 2010-2011 time period was chosen (why not current).
3. Mention the catalogue no. of the Im-116 Imuno CAP™M assay.
4. Authors are suggested to discuss the interpretation of the outcomes of the study rather than factual reporting. Encourage narrative flow of results.
5. The sample size for BPA (n=10) is very small, limiting statistical power, Explain.
6. It is suggested adding an explicit section mentioning the limitations of the study.
7. The manuscript needs to keep the text font consistent, requires language improvement in terms of grammar, and use professional help for the same, Additionally, remove the typos carefully.

Author Response

Please, see the attachment.

Author Response File: Author Response.pdf