Allergy to lipid transfer proteins (LTP) in a pediatric population

Abstract

Non-specific lipid transfer proteins (LTP) are panallergens present in plant-foods, being the most relevant allergens of Rosacea family fruits in the Mediterranean area (1,2). These ubiquitous proteins are highly conserved and widely distributed in the plant kingdom, sharing a moderate-to-high homologous molecular structure, which put the patients allergic to LTP at risk of developing allergic reactions after the ingestion of an array of botanically unrelated foods, including fruits, tree nuts, seeds, vegetables and cereals (1,3-7).Despite the fact that milk and egg proteins are the main causes of food allergy in childhood, fruits and vegetables have been recognized as emergent allergens in pediatrics (8).Since LTP may cause severe systemic reactions it is essential to better understand this allergy in childhood.Even though multiple studies on LTP have been published in the last years, so far, not much is known about LTP allergy in children, especially regarding daily practice, since only a few case series focused on pediatric ages have been published (9-13). A recent study has shown that fresh fruits are the 5th cause of anaphylaxis in children, with tree nuts being the 2 nd , both potentially caused by LTP in this region (14).Our aim was to characterize a series of children with allergy to LTP, in order to better understand its characteristics. M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n MethodsWe performed a retrospective analysis of medical records from patients under 18 years-old with confirmed LTP allergy (2013)(2014)(2015)(2016)(2017)(2018)(2019).Diagnosis was established based on a convincing history of immediate allergic reactions to plant-foods (i.e. repeated symptoms to LTP containing foods on several occasions) supported by positive skin prick tests (SPT) (defined as the mean diameter of the wheal ≥ 3 mm than negative control ( 15)) to LTP extract (Roxall, Bilbao, Spain) and positive specific IgE (sIgE) to LTP allergens (Pru p 3, Cor a 8 and/or Jug r 3) determined by ImmunoCAP (ThermoFisher Scientific, Uppsala, Sweden; cut-off: ≥0.35 kUA/L) and/or ImmunoCAP TM ISAC microarray

Anaphylaxis across Europe: are pollen food syndrome and lipid transfer protein allergy so far apart?

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Phenotypes and Endotypes of Peach Allergy: What Is New?

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