Botrytis Allergy Shots: When Winery and Greenhouse Workers Need More Than Medication
Botrytis cinerea is the gray mold of grapes, strawberries, and cut roses — and in some contexts the prized 'noble rot' of Sauternes wines. Its clinical allergy relevance is dominated by occupational exposure: vineyard workers, winery cellar staff, strawberry harvesters, and florists. No species-specific SCIT RCT exists; no WHO/IUIS Botrytis allergens are registered. Occupational exposure modification is the primary intervention.
About Curex’s SCIT program
Curex’s at-home allergy shots (SCIT) are coming soon and focus on the most common environmental allergens:
- • Pollens — tree, grass, weed & ragweed
- • Pet dander — cat & dog
- • Dust mites
- • Molds — Alternaria & mold mix
Botrytis cinereais covered here for general education and may not be part of Curex’s current treatment set. Join the waitlist and our care team will help confirm your options.
Botrytis cinerea Allergy Immunotherapy: How It Works
Allergy immunotherapy is the only long-term treatment that re-trains the immune system to stop overreacting to botrytis cinerea — rather than just masking symptoms with antihistamines or steroids. By gradually exposing the body to controlled doses of botrytis cinerea allergen, immunotherapy shifts the underlying allergic response and produces relief that often outlasts treatment by 7–10 years.
There are two evidence-based forms of botrytis cinerea immunotherapy used today, both built on the same desensitization principle but delivered very differently.
of sustained relief after a complete immunotherapy course — the only allergy treatment with proven long-term effect after stopping.
Allergy Shots (SCIT)
Weekly injections of botrytis cinerea extract in a clinic, escalating over 3–6 months until a maintenance dose is reached. Continued monthly for 3–5 years. Longest clinical track record for botrytis cinerea allergy.
- Strongest evidence base for severe and polysensitized patients
- Covered by most insurance plans
- Requires 50–100+ in-person clinic visits across the full course
- Or at home with no clinic visits— Curex’s Virtual Shot Room model delivers the same SCIT program with live video supervision by trained Curex clinical staff for the first injection from each new vial or concentration and restarts after gaps or reactions.
Allergy Drops / Tablets (SLIT)
Daily drops or dissolvable tablets containing botrytis cinerea extract, held under the tongue at home. Same desensitization principle, delivered without injections. WHO-recognized as an effective form of allergy immunotherapy since 2001.
- Taken at home — no weekly clinic trips, no needles
- Lower systemic reaction rate than allergy shots
- Curex offers prescription botrytis cinerea immunotherapy drops with allergist oversight
The rest of this page goes deep on allergen-specific immunotherapy with shots — protocol, efficacy data, side effects, and cost. If you’d rather skip the clinic and treat botrytis cinerea allergy with at-home drops, see how Curex sublingual immunotherapy compares below.
What is Botrytis cinerea?
The biology, taxonomy, and clinical fingerprint of Botrytis cinerea — the foundation of how SCIT targets it.
Botrytis cinerea gray mold on grape clusters — the same fungus that in controlled viticulture becomes noble rot, concentrating sugars for Sauternes and Tokaji dessert wines.
- Scientific name
- Botrytis cinerea (teleomorph: Botryotinia fuckeliana)
- Family
- SclerotiniaceaeHelotiales order, Leotiomycetes
- Type
- Occupational necrotrophic plant pathogen; gray mold of grapes, strawberries, and ornamentals
- Native to
- Worldwide; infects >200 plant species including grapevines, strawberries, tomatoes, lettuce, and cut flowers
- Allergen proteins
- No WHO/IUIS-registered Botrytis allergens as of 2024Cross-reactivity via pan-fungal serine protease and enolase at kingdom level (Crameri 2014)
- Particle size
- Gray-brown conidia 6-18 x 4-11 µm; abundantly airborne during pruning, harvest, and processing
- Avoidance difficulty
- Nearly impossible
How Botrytis cinerea Allergy Presents
Symptoms by body system — useful for distinguishing Botrytis cinerea sensitivity from overlapping allergies and infections.
Respiratory
- Occupational rhinitis during pruning and grape harvesting
- Asthma exacerbations in winery cellar workers during high-spore periods
- Winegrower's lung — HP from Botrytis-contaminated cellar air (de Vuyst 1989)
- Strawberry-harvester cough from concentrated conidia in enclosed field conditions
Ocular
- Occupational conjunctivitis in florists and vineyard workers
- Itchy red eyes during direct handling of infected plant material
- Tearing and irritation during high-conidial-load cellar work
Dermal
- Skin sensitization from direct contact with infected grapes or strawberries
- Contact dermatitis in susceptible florists handling moldy cut flowers
- Non-specific urticaria in heavily exposed workers
Systemic
- Fatigue from chronic occupational exposure in wine cellar environments
- Fever and malaise in winegrower's lung HP episodes
- Weight loss with untreated chronic HP if source exposure continues
- Reduced work capacity from persistent occupational rhinitis
When a vineyard worker or winery cellar hand comes in with asthma and a Botrytis positive, I ask about the cellar conditions before I consider immunotherapy. Harvest-season conidial counts in poorly ventilated cellars can exceed 10,000 CFU per cubic meter. Proper respiratory protection during harvest and improved cellar ventilation often provide more benefit than anything I can offer in a vial.
When & Where Botrytis cinerea Peaks
Allergen intensity by month and by state. Useful for timing SCIT start dates and travel planning.
12-Month Intensity
Peak occupational exposure: grape and strawberry harvest season, typically September-October in temperate viticultural regions· Occupational exposure peaks during harvest but can be year-round for winery cellar workers and commercial greenhouse operators
US Exposure Map
3 high-intensity statesExposure intensity by state (text version)
- ME:
- Low
- VT:
- Low
- NH:
- Low
- WA:
- High
- MT:
- Low
- ND:
- Low
- MN:
- Low
- WI:
- Low
- MI:
- Moderate
- NY:
- Moderate
- MA:
- Low
- OR:
- High
- ID:
- Low
- WY:
- Low
- SD:
- Low
- IA:
- Low
- IL:
- Low
- IN:
- Low
- OH:
- Moderate
- PA:
- Moderate
- NJ:
- Low
- CT:
- Low
- RI:
- Low
- CA:
- High
- NV:
- Low
- UT:
- Low
- CO:
- Low
- NE:
- Low
- MO:
- Low
- KY:
- Low
- WV:
- Low
- VA:
- Moderate
- MD:
- Low
- DE:
- Low
- AZ:
- Low
- NM:
- Low
- KS:
- Low
- AR:
- Low
- TN:
- Low
- NC:
- Low
- SC:
- Low
- OK:
- Low
- LA:
- Low
- MS:
- Low
- AL:
- Low
- GA:
- Low
- TX:
- Low
- FL:
- Moderate
- AK:
- Low
- HI:
- Low
What Botrytis cinerea Cross-Reacts With
Patients sensitized to one allergen often react to others sharing similar proteins. This map shows the documented molecular overlaps.
Botrytis cinerea belongs to Leotiomycetes, a distinct class from most other clinical molds (Dothideomycetes, Eurotiomycetes). Cross-reactivity within Leotiomycetes is less characterized than within Pleosporales; pan-fungal cross-reactivity via serine protease and enolase is expected at the kingdom level.
Parallel produce-pathogen agricultural mold; similar occupational exposure context though different taxonomic class
Is SCIT Right for Your Botrytis cinerea Allergy?
Answer five questions to determine whether your Botrytis sensitization — especially in an occupational winery, greenhouse, or garden context — warrants allergist evaluation.
How severe are your work-related respiratory symptoms (rhinitis, cough, asthma) during or after handling grapes, strawberries, or working in wine cellars?
The Botrytis cinerea SCIT Protocol
SCIT is not standardly indicated for Botrytis cinerea sensitization. For severe occupational asthma without other options, family-level mold mix SCIT may be considered. Standard mold build-up schedule applies; vials are kept separate from pollen mixes.
Weekly escalating doses of non-standardized mold extract mix including Botrytis, self-administered at home through Curex with a 30-minute self-observation period and a prescribed epinephrine auto-injector on hand; the first injection from each new vial or concentration is Virtual Shot Room–supervised by the care team. Pre-season build-up timing (spring to early summer before September-October harvest peak) is recommended for viticultural workers.
Maintenance injections continue on a schedule individualized by your allergist. Concurrent occupational health monitoring for PPE compliance and exposure measurement is recommended.
Discontinuation follows standard mold SCIT protocols, with assessment of ongoing occupational exposure as a factor in continuation decisions.
Extract Concentration Ladder
You progress through each vial during build-up. Concentration increases ~10x per step.
What the Research Shows for Botrytis cinerea SCIT
No published SCIT RCT exists for Botrytis cinerea. As a Leotiomycetes member, it lacks even the Pleosporales family-level connection to Alternaria RCT evidence that Stemphylium and Epicoccum can invoke.
- Alternaria SCIT (Pleosporales family-level reference — does not transfer cleanly to Botrytis Leotiomycetes)63%Kuna et al., J Allergy Clin Immunol 2011, N=111, DBPC-RCT
No published SCIT RCT targets Botrytis cinerea. Unlike Stemphylium and Epicoccum (Pleosporales), Botrytis belongs to Leotiomycetes — a distinct class — making Alternaria DBPC-RCT evidence even less directly applicable. For occupational workers with severe asthma where exposure modification is insufficient, mold mix SCIT is a clinical-judgment option with anecdotal rather than trial-level evidence.
Ready to skip the surprise bills?
At-home allergy shots (SCIT) are designed by board-certified allergists. See the listed SCIT plan rate in our pricing record and request a quote for eligibility, initiation and total care costs.
- MD-ledBoard-certified allergists
- QuoteTotal care estimate
- 50K+Patients treated
- HSA/FSAEligible
Botrytis cinerea SCIT Side Effects
Side effects of mold mix SCIT including Botrytis follow standard mold SCIT parameters. Mold proteases increase local reaction rates compared to pollen SCIT.
Local reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Injection site swelling and erythema Standard wheal-and-flare response | Rate 30-50% | Mild |
Large local reaction Higher with protease-rich mold extracts | Rate 10-20% | Moderate |
Injection site itching Managed with topical antihistamine | Rate 20-40% | Mild |
Delayed local swelling Self-resolving 4-12 hours post-injection | Rate 5-15% | Mild |
Systemic reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Rhinitis flare Within 30 minutes of injection | Rate 0.5-1% | Mild |
Urticaria Requires antihistamine; next-visit dose adjustment | Rate 0.1-0.5% | Moderate |
Asthma exacerbation Pre-injection peak flow check required | Rate 0.1-0.3% | Severe |
Anaphylaxis Epinephrine auto-injector prescribed and confirmed on hand before the first Botrytis dose; 30-minute self-observation after each at-home injection, with the first injection from each new vial or concentration Virtual Shot Room–supervised | Rate <0.01% | Severe |
All mold SCIT requires epinephrine available and a mandatory 30-minute observation period — with Curex, you self-observe at home with a prescribed epinephrine auto-injector, and the first injection from each new vial or concentration is Virtual Shot Room–supervised by the care team. Asthmatic patients require pre-injection peak flow measurement.
SCIT vs Alternatives for Botrytis cinerea
For Botrytis occupational sensitization, exposure modification is the most effective and evidence-supported first intervention. When that is insufficient, family-level mold mix SCIT is a clinical-judgment adjunct.
| Criterion | Occupational exposure controlBest | SCIT (mold mix) | SLIT drops | Medications |
|---|---|---|---|---|
| Effectiveness | High effectiveness for occupational Botrytis cases | Anecdotal; no Botrytis-specific RCT | No Botrytis SLIT data | Symptomatic control only |
| 5-yr cost | PPE/ventilation: variable | $3,500-$8,000 over 5 years | $500-$2,000/yr | $500-$2,000/yr ongoing |
| Duration | Ongoing workplace modification | 3-5 years | 3-5 years | Ongoing |
| Convenience | Employer cooperation required | Weekly then monthly clinic visits | Daily at-home use | Daily pills/sprays |
| Safety | No injection risks | Systemic reactions <1%; 30-min obs | Lower systemic reaction risk | Drug side effects long-term |
| Lasting effect | Effective while controls maintained | Uncertain for this organism | Evidence not established for Botrytis | No lasting effect |
Occupational exposure controlBest
SCIT (mold mix)
SLIT drops
Medications
For Botrytis occupational allergy, exposure control (N95 respirators, cellar ventilation, harvest timing) is the primary intervention with the most meaningful clinical yield. When that is insufficient and SCIT is being considered, Curex delivers immunotherapy as weekly at-home self-injections with pricing confirmed in a current program quote — though direct evidence for Botrytis-specific mold sensitization is limited, the at-home format suits agricultural workers with difficult access to weekly clinic visits, and it includes allergist oversight via telehealth, a prescribed epinephrine auto-injector confirmed on hand, and Virtual Shot Room–supervised dosing for the first injection from each new vial or concentration.
What Botrytis cinerea SCIT Actually Costs
Curex at-home blood panels confirm Botrytis sensitization for agricultural and winery workers without disrupting seasonal schedules. Workers' compensation coverage may apply for documented occupational Botrytis asthma; standard allergy benefits cover testing and pharmacotherapy when ordered by a board-certified allergist.
Cost range varies by deductible, co-insurance, and clinic.
Verify these codes with your insurer to confirm coverage.
See the listed Environmental Allergy Shots Plan rate, commercial terms dated 2026-10-12; consultations are included without copay. Confirm availability, eligibility, other included services, testing, any in-person care, insurance responsibility and billing cadence in your written quote before enrolling.
Join the waitlistStop guessing about your botrytis cinerea allergy. Get a plan.
Take Curex’s 3-minute allergy quiz. A board-certified allergist will review your symptoms and recommend the right immunotherapy path for you — shots or drops.
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Botrytis cinerea SCIT — Frequently Asked
Quick answers to the questions patients ask most before starting treatment.
For the vast majority of people, drinking wine made from Botrytis-infected grapes — including Sauternes, Tokaji, and German Trockenbeerenauslese — does not cause an IgE-mediated allergic reaction even if they are sensitized to Botrytis aeroallergens via skin or blood testing. The fermentation and wine-making process substantially degrades and transforms Botrytis conidial proteins, reducing their allergenicity. Wine intolerance symptoms (flushing, headache, rhinitis, asthma) are much more commonly caused by sulfite sensitivity, biogenic amines (histamine, tyramine), or alcohol intolerance than by Botrytis IgE reactivity. If you experience symptoms specifically after drinking Botrytis-style dessert wines but not other wines, discuss this with your allergist — but separate wine intolerance from Botrytis aeroallergen sensitization as distinct clinical entities.
Winegrower's lung is a form of hypersensitivity pneumonitis affecting winery cellar workers, vineyard pruners, and cave workers in wine-producing regions. The causative antigens are multiple — Botrytis cinerea, Cladosporium, and other cellar molds mixed in the characteristic wine-cellar air environment. Published case series from France and Belgium (de Vuyst 1989, Popp 1989) documented respiratory symptoms including cough, dyspnea, fever, and reduced pulmonary function in affected workers. Like all HP, progressive disease can lead to pulmonary fibrosis if antigen exposure continues. Early recognition is critical: improved cellar ventilation, N95 respirator use during harvest and racking, and antigen avoidance produce meaningful benefit. Systemic corticosteroids are used for active HP episodes.
Strawberry food allergy and Botrytis aeroallergen sensitization are separate clinical entities. Strawberry food allergy involves IgE to strawberry proteins — Fra a 1 (the PR-10 Bet v 1 homologue causing oral allergy syndrome in birch-sensitized patients), Fra a 3 (lipid transfer protein), or profilins. Botrytis sensitization involves IgE to fungal proteins in the gray mold that grows on strawberry fruit and leaves. The fact that Botrytis infects strawberry plants does not create a direct immunological link between the two allergies. If you have both symptoms after eating strawberries and respiratory symptoms during strawberry harvest work, your allergist will evaluate them separately with appropriate testing.
Home gardeners with extensive rose, strawberry, or grape plantings can develop Botrytis exposure levels that produce symptoms, particularly during pruning and harvest. Practical reduction strategies include: wearing an N95 respirator when handling moldy plant material, pruning in dry weather rather than after rain (wet conditions increase spore dispersal), removing and bagging infected plant debris rather than composting it, improving garden air circulation to reduce local humidity, washing hands and changing clothes after garden work, and taking a non-sedating antihistamine before expected exposure. Applying fungicide to plants can reduce Botrytis spore production. For home gardeners with significant symptoms despite these measures, an allergist evaluation may clarify whether the Botrytis exposure level warrants more aggressive management.
Botrytis cinerea is categorized as a minor mold allergen in clinical practice. It is on commercial allergy panels (ImmunoCAP m7) primarily due to its widespread occurrence as a plant pathogen and the occupational exposure it generates. It lacks the two hallmarks of major mold allergens: no WHO/IUIS-registered allergen proteins have been characterized, and no double-blind placebo-controlled randomized controlled trial has evaluated Botrytis SCIT. By contrast, Alternaria alternata — the definitive major mold allergen — has the most characterized allergen repertoire (Alt a 1 recognized by 80-100% of sensitized patients), an adjusted OR of 189.5 for respiratory arrest (O'Hollaren 1991), and two DBPC-RCTs (Kuna 2011, Tabar 2019). Botrytis sensitization warrants clinical attention primarily in occupational contexts, not as a standalone driver of standard allergy management.
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. Content reviewed by board-certified allergists at Curex.
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