Cofactors, age at onset, allergic comorbidities and gender are different in patients sensitized to omega-5 gliadin and Pru p 3

Abstract

Aim of this study is to clarify the impact of cofactors on allergic reactions in patients sensitized to LTP and ω-5-gliadin. We retrospectively examined the charts of our outpatients from January 2015 to July 2019 and identified 157 patients seen for urticaria/angioedema or anaphylaxis after a meal, in presence or absence of cofactors and sensitized to LTPs (Pru p 3 and/or Tri a 14) and/or ω-5-gliadin (Tri a 19). we compared LTPs-positive patients and those sensitized to Tri a 19 in order to assess the difference in cofactors involved and in frequency of clinical presentation. Our data show that exercise is the most frequent cofactor in FDEIAn and the involvement of exercise, alcohol and multiple cofactors was more frequently found in males than in females. We found that exercise, pollen counts peaks and multiple cofactors were more often related to anaphylaxis than mild reactions. Finally, we performed a comparison between patients LTPs+ and Tri a 19+ that showed in the latter group a lower frequency of allergic comorbidities, a higher median age at the onset of symptoms and frequency of alcohol exposure. Our data show that the search for possible cofactors involved in food allergy is essential not only for diagnostic purposes, but also for risk assessment strategies.

Factors and co-factors influencing clinical manifestations in nsLTPs allergy: between the good and the bad

“…Some of these observations confirm the results reported in an Italian study that assessed the effect also of other co-factors in patients sensitized to Pru p 3 and Tri a 14, confirming a later onset of the co-factors related reactions in adulthood rather than childhood. Also in this case, in fact, exercise was the most common co-factor reported (31.9%), followed by humid-heat in 31.2%, pollen peak in 17.8%, NSAIDs in 15.9%, alcohol in 9.6%, and PPI (pump proton inhibitors) in 4.5% ( 50 ).…”

“…Furthermore, it is worth recalling that NSAIDs intake to control menstrual pain, as well as during acute infections, is a frequent practice, determining the risky concomitance of multiple co-factors ( 50 ).…”

The Role of Co-Factors in Mast Cell Activation

“…10 Complement activation by immune complexes can result in release of complement 3a, complement 4a, and complement 5a anaphylatoxins that can cause histamine release via an IgE independent mechanism. 11 It was shown that degranulation of mast cells via anaphylatoxins is restricted to certain subpopulations of mast cells because mucosal mast cells do not express anaphylatoxin receptors. 12 Reciprocal interactions between sensory nerves and mast cells happen via vasoactive intestinal peptides and neuropeptides (substance P), leading to stimulation and degranulation of mast cells potentiation of pruritus and inflammatory response.…”

The Role of Co-Factors in Mast Cell Activation

“…10 Complement activation by immune complexes can result in release of complement 3a, complement 4a, and complement 5a anaphylatoxins that can cause histamine release via an IgE independent mechanism. 11 It was shown that degranulation of mast cells via anaphylatoxins is restricted to certain subpopulations of mast cells because mucosal mast cells do not express anaphylatoxin receptors. 12 Reciprocal interactions between sensory nerves and mast cells happen via vasoactive intestinal peptides and neuropeptides (substance P), leading to stimulation and degranulation of mast cells potentiation of pruritus and inflammatory response.…”