Clinical and serological characteristics of patients allergic to LTP

Main Article Content

Juan Carlos Miralles-Lopez
Antonio Carbonell-Martínez
Soledad Zamarro-Parra
Cristina Navarro-Garrido
Ana Isabel Escudero-Pastor
Muna Boulaich
Sol Sanromán-Sirvent
Yulia Petryk-Petryk
Maria Dolores Ladrón-de-Guevara
Virginia Pérez-Fernández

Keywords

Food allergy, LTP allergy, Clinical features, Skin prick test, Specific IgE

Abstract

Background: Allergy to lipid transfer proteins (LPT) is common in Mediterranean Europe, and it causes severe reactions in patients and affects multiple foods, impairing the quality of life.


Objective: This study aimed to describe the clinical and sensitization profile of patients with LTP syndrome and to determine a clinical pattern of severity. Molecular diagnosis is shown in a broad population through microarrays.


Material and Methods: This study was performed at the LTP Allergy Consultation of the Reina Sofia Hospital in Murcia, Spain. We analyzed the patients’ characteristics, reactions, cofactors, food implicated, quality of life, skin prick test to food and aeroallergens, and serologic parameters, such as total immunoglobulin E, peach LTP (Pru p 3 IgE) and immunoglobulin G4, and microarray Immuno Solid-phase Allergen Chip (ISAC). We related the severity of the reactions with other variables.


Results: We presented a series of 236 patients diagnosed with LTP allergy, 54.66% suffering from anaphylaxis, 36.02% from urticaria angioedema, and 9.32% from oral allergy syndrome. The most frequently implicated food was peach, producing symptoms in 70% of patients, followed by walnut in 55%, peanut in 45%, hazelnut in 44%, and apple in 38% patients. Regarding the food that provoked anaphylaxis, walnut was the most frequent instigator, along with peach, peanut, hazelnut, almond, sunflower seed, and apple. According to the severity of LPT reaction, we did not discover significant differences in gender, age, food group involved, and serologic parameters. We found differences in the presence of cofactors, with 48.84% of cofactors in patients with anaphylaxis, compared to 27.1% in patients without anaphylaxis and in family allergy background (P < 0.0001).


Conclusion: In our series of patients, 54% presented anaphylaxis, and the foods that most frequently produced symptoms were peaches, apples, and nuts. Cofactors and family allergy backgrounds were associated with the severity of LPT reaction.

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References

1. Bogas G, Muñoz-Cano R, Mayorga C, Casas, Bartra J, Pérez N, et al. Phenotyping peach-allergic patients sensitised to lipid transfer protein and analysing severity biomarkers. Allergy 2020; 75(12):3228–3236. 10.1111/all.14447

2. Skypala IJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann-Sommergruber K et al. Non-specificlipid-transferproteins: Allergen structure and function, cross-reactivity, sensitisation, and epidemiology. Clinical and Translational Allergy 2021; 11(3):e12010. 10.1002/clt2.12010

3. Asero R, Pravettoni V, Scala E, Villalta D. Lipid transfer protein allergy: A review of current controversies. Clin Exp Allergy. 2022 Feb;52(2):222–230. 10.1111/cea.14049

4. Pali-Schöll I, Untersmayr E, Klems M, Jensen-Jarolim E. The Effect of Digestion and Digestibility on Allergenicity of Food. Nutrients. 2018; 10(9):1129. 10.3390/nu10091129

5. Asero R, Piantanida M, Pinter E, Pravettoni V. The clinical relevance of lipid transfer protein. Clin Exp Allergy. 2018;48(1): 6–12. 10.1111/cea.13053

6. Flokstra-de Blok BMJ, van der Meulen GN, Dunn Galvin A, Vlieg-Boerstra J, Oude Elberink JNG, Duiverman EJ, et al. Development and validation of the Food Allergy Quality of Life Questionnaire–Adult Form. Allergy 2009;64:1209–1217. 10.1111/j.1398-9995.2009.01968.x

7. Antolin-Amerigo D, Cerecedo Carballo I, Muriel A, Fernández-Rivas M, Diéguez Pastor M, Flokstra-de Blok B et al. Validation of the Spanish Version of the Food Allergy Quality of Life Questionnaire–Adult Form (S-FAQLQ-AF). J Investig Allergol Clin Immunol 2015; 25:270–275.

8. Indolfi C, Dinardo, Klain A, Contieri M, Umano GR, Decimo F, et al. Sensitization to nsLTP: A Retrospective Study in An Italian Pediatric Population over the Last Decade. J Immunol Res 2023: 4053799. 10.1155/2023/4053799

9. Asero R, Pravettoni V, Villalta D, Cecchi L, Scala E. IgE-Mediated Reactivity to Non-Specific Lipid Transfer Protein (nsLTP): Clinical Implications and Management. Consensus Document of the Association of Italian Territorial and Hospital Allergists and Immunologists (AAIITO). Eur Ann Allergy Clin Immunol 2023. 10.23822/EurAnnACI.1764-1489.316

10. Turner PJ, Arasi S, Ballmer-Weber B, Baseggio Conrado A, Deschildre A, Gerdts J, et al. Risk factors for severe reactions in food allergy: Rapid evidence review with meta-analysis. Allergy 2022;77:2634–2652. 10.1111/all.15318

11. Cardona V, Luengo O, Garriga T, Labrador-Horrillo M, Sala-Cunill A, Izquierdo A, et al. Co-factor-enhanced food allergy. Allergy. 2012;67:1316–1318. 10.1111/j.1398-9995.2012.02877.x

12. Pascal M, Muñoz-Cano R, Mila J, et al. Nonsteroidal anti--inflammatory drugs enhance IgE-mediated activation of human basophils in patients with food anaphylaxis dependent on and independent of nonsteroidal anti-inflammatory drugs. Clin Exp Allergy 2016;46:1111–1119. 10.1111/cea.12735

13. Flokstra-De Blok BMJ, van der Velde JL, Vlieg-Boerstra BJ, Oude Elberink JN, DunnGalvin A, Hourihane JO, et al. Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires. Allergy. 2010; 65(8): 1031–1038. 10.1111/j.1398-9995.2009.02304.x

14. Morou Z, Vassilopoulou E, Galanis P, Tatsioni A, Papadopoulos NG, Dimoliatis IDK. Investigation of quality of life determinants in children with food allergies. Int Arch Allergy Immunol 2021;182:1058–1065. 10.1159/000516875

15. Mota I, Gaspar Â, Benito-Garcia F, Correia M, Arêde C, Piedade S et al. Anaphylaxis caused by lipid transfer proteins: an unpredictable clinical syndrome. Allergol Immunopathol (Madr). 2018 Nov-Dec;46(6):565–570. 10.1016/j.aller.2018.04.002

16. Basagaña M, Elduque C, Teniente-Serra A, Casas I, Roger A. Clinical profile of lipid transfer protein syndrome in a Mediterranean area. J Investig Allergol Clin Immunol. 2018;28(1):58–60. 10.18176/jiaci.0209

17. González Pérez A, Carbonell Martínez A, Escudero Pastor AI, Navarro Garrido C, Miralles López JC. Pru p 3 oral immunotherapy efficacy, induced immunological changes and quality of life improvement in patients with LTP syndrome. Clin Transl Allergy. 2020 Jun 8;10:20. 10.1186/s13601-020-00325-y

18. Pastorello EA, Farioli L, Pravettoni V, Scibilia J; Mascheri A, Borgonovo L, et al. Pru p 3-sensitised Italian peach-allergic patients are less likely to develop severe symptoms when also presenting IgE antibodies to Pru p 1 and Pru p 4. Int Arch Allergy Immunol 2011;156:362–72. 10.1159/000324440

19. Scala E, Abeni D, Guerra EC, Locanto M, Pirrotta L, Meneguzzi G, et al. Cosensitization to profilin is associated with less severe reactions to foods in nsLTPs and storage proteins reactors and with less severe respiratory allergy. Allergy. 2018;73:1921–1923. 10.1111/all.13501

20. Tordesillas L, Sirvent S, Díaz-Perales A, Villalba M, Cuesta-Herranz J, Rodríguez R, et al. Plant lipid transfer protein allergens: no cross-reactivity between those from foods and olive and Parietaria pollen. Int Arch Allergy Immunol. 2011;156(3):291–296. 10.1159/000323503

21. Balsells-Vives S, San Bartolomé C, Casas-Saucedo R, Ruano-Zaragoza M, Rius J, Torradeflot M et al. (Low Levels Matter: Clinical Relevance of Low Pru p 3 sIgE in Patients With Peach Allergy. Front Allergy 2022:3:868267. 10.3389/falgy.2022.868267

22. Thorpe M, Movérare R, Fischer C, Lidholm MD, Rudengren M, Borres MP. History and utility of specific ige cutoff levels: What is the relevance for allergy diagnosis? J Allergy Clin Immunol Pract 2023; 11: 3021–3029. 10.1016/j.jaip.2023.05.022