High prevalence of sensitization to non-specific lipid transfer protein in adult patients with primary eosinophilic gastrointestinal disorders in Italy: a single center series

Rossi, Carlo Maria; Lenti, Marco Vincenzo; Achilli, Giovanna; Merli, Stefania; Anderloni, Andrea; Sabatino, Antonio Di

doi:10.1186/s12948-022-00174-z

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…The role of thermo- and acid-labile protein, such as PR-10 and profilin, as food allergens, is unlikely to be relevant in the pathogenesis of colon inflammation since they are totally degraded in upper segments of the gastrointestinal tract, while their positivity may simply reflect the co-occurrence of respiratory allergy. On the contrary, LTP, is a “true” food allergen, due to its stability to temperature, acidic environment, and proteases (such as pepsin), and main gastrointestinal route of sensitization, and may directly play a role, at least in a subset of patients in EC in the Mediterranean area, where it is geographically diffuse, as we have shown for other EGID [ 32 , 33 ]. Finally, we showed in a part of our cohort where complete data were available, that patients sensitized to food allergens had a higher number of disease relapse.…”

Section: Discussionmentioning

confidence: 92%

Clinical and atopic features of patients with primary eosinophilic colitis: an Italian multicentre study

Rossi,

Lenti,

Merli

et al. 2024

Intern Emerg Med

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Eosinophilic colitis (EC) is the rarest among primary eosinophilic gastrointestinal disorders (EGID). EC is underdiagnosed due to its blurred and proteiform clinical manifestations. To explore the clinical and atopic characteristic of EC adult patients, the diagnostic delay, and relapse-associated factors, by comparison with patients with eosinophilic esophagitis (EoE) and irritable bowel syndrome (IBS). EC patients followed-up at four clinics were included, and clinical, histopathological, and laboratory data were retrieved. As control groups, age-matched patients with EoE and IBS were recruited. Allergy tests included skin prick test and serum specific IgE. Diagnostic delay was assessed. Overall, data from 73 patients were retrieved, including 40 with EC (median age 39 years IQR 22.5–59, F:M 2.1:1), 12 with EoE (F:M ratio: 1:5), and 21 with IBS (F:M ratio: 1:0.9). The most common features in EC patients were female sex (67.5%), atopy (77.5%), abdominal pain/distention (70%), diarrhoea (77.5%), and faecal calprotectin elevation (22.5%). Blood eosinophils were elevated in EoE, but not in EC (p < 0.001), while ECP did not differ across the three groups (p = 0.4). The frequency of allergen sensitization reached 25% of patients. Several frequent pan-allergens for this region were present. The overall diagnostic delay was 10 months (IQR 4–15). Factors contributing to a greater diagnostic delay were atopy, weight loss, and a previous misdiagnosis. EC is mostly a diagnosis of exclusion, burdened by a substantial diagnostic delay. In female patients the presence of allergen sensitization, abdominal symptoms and faecal calprotectin elevation should raise the suspicion of EC.

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Section: Discussionmentioning

confidence: 92%

Clinical and atopic features of patients with primary eosinophilic colitis: an Italian multicentre study

Rossi,

Lenti,

Merli

et al. 2024

Intern Emerg Med

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“…In an Italian study sensitization/allergy to the peach lipid transfer protein (LTP), Pru p 3 , was a frequent finding, being present in almost 50% of patients with EoE, and was also detected in patients with other primary eosinophilic disorders of the gastrointestinal tract. Most patients in this series were already avoiding peaches and other nsLTP-containing foods for IgE-mediated manifestations ranging from contact urticaria to anaphylaxis [24]. The sensitization/allergy to LTP, a cross-reactive and thermal-resistant and acidic-resistant allergen present in the peel or seeds of many fruits and vegetables, significantly complicates the management and quality of life of patients with EoE because it may hence impose significant further dietary restrictions in EoE patients undergoing diet therapy.…”

Section: Nonpharmacological Approachmentioning

confidence: 99%

Diagnosis, management and therapeutic options for eosinophilic esophagitis

Caminati,

Senna,

Maule

et al. 2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Eosinophilic esophagitis is a chronic and commonly evolving condition leading to relevant and potentially irreversible burden in terms of tissue damage and related functional impairment, thus significantly impacting on quality of life. The aim of the present review is to summarize the recent advances in terms of diagnostic work-up and pharmacological and nonpharmacological management of the disease, under the broader perspective of type 2 inflammation. Recent findings Two major novelties have prompted an innovative approach to EoE. In terms of diagnosis, it has been proposed to dissect the disease heterogeneity in three endotypes, independent from tissue eosinophil number: EoEe1, characterized by normal appearing oesophagus; EoEe2, associated with type 2 inflammation and steroid-refractoriness; EoEe3, whose features include adult onset, a more fibro-stenotic aspect and loss of epithelial gene expression. Concerning treatment, two recently licensed drugs for EoE, oro-dispersible budesonide and dupilumab represent the first treatment options specifically developed for EoE and addressing EoE-related peculiar pathobiological features. Summary In the era of precision medicine, managing EoE according to a phenotype-driven approach might be helpful in defining the best treatment options in the different disease forms or stages. In addition, exploring the coexistence or the previous occurrence of other type 2 conditions may suggest the opportunity to specifically target type 2 inflammation through biologic therapy. The complex EoE pathobiology combining inflammatory and functional features, both at organ and systemic level, requires a multidimensional approach relying on the strict integration of gastroenterologists and allergist-immunologists.

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“…1 Nevertheless, it can elicit mild to moderate adverse reactions, particularly during the induction or the build-up phase, and its application in patients experiencing severe reactions is still under study. 2 This phenomenon could be attributed to the allergens utilized in immunotherapy, such as Pru p 3, which present IgE epitopes with complete allergenic potential. Besides immunotherapy and to solve these drawbacks, prebiotic approaches can also promote a tolerogenic environment.…”

Section: Butyrate Dietary Supplementation Promotes Tolerant Responses...mentioning

confidence: 99%

“…This may be attributed to the potential adverse effects of immunotherapy when using the complete allergen that, in some cases, could accentuate sensitization to allergens due to its allergenic properties. 2 Furthermore, the tolerogenic effects produced by butyrate may be non-specific, unlike SLIT with Pru p 3, and it would be necessary to assess whether the tolerogenic effect is maintained over time. Although further studies are needed, these findings provide insight into the butyrate dietary supplementation as a potential treatment for LTP allergy.…”

Section: Butyrate Dietary Supplementation Promotes Tolerant Responses...mentioning

confidence: 99%

Butyrate dietary supplementation promotes tolerant responses in a Pru p 3‐anaphylactic mouse model

Cruz‐Amaya,

Martín‐Astorga,

Lebrón‐Martín

et al. 2024

Allergy

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High prevalence of sensitization to non-specific lipid transfer protein in adult patients with primary eosinophilic gastrointestinal disorders in Italy: a single center series

Cited by 5 publications

References 10 publications

Clinical and atopic features of patients with primary eosinophilic colitis: an Italian multicentre study

Clinical and atopic features of patients with primary eosinophilic colitis: an Italian multicentre study

Diagnosis, management and therapeutic options for eosinophilic esophagitis

Butyrate dietary supplementation promotes tolerant responses in a Pru p 3‐anaphylactic mouse model

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