LTP allergy/sensitization in a pediatric population

Main Article Content

A. Aruanno
S. Urbani
F. Frati
E. Nucera

Keywords

LTP, Allergy, Children population

Abstract

Plant lipid transfer proteins (LTPs) are widespread plant food allergens, highly resistant to food processing and to the gastrointestinal environment, which have been described as the most common food allergens in the Mediterranean area. LTP allergy is widely described in adults, but it represents an emerging allergen also in the pediatric population. Little is known about the real prevalence and the clinical features of this allergy in children and it still often remains underdiagnosed in these patients.


An early identification and a deeper knowledge of this allergy in childhood can avoid severe systemic reactions and improve the child’s quality of life. Pediatricians should always consider the possibility of LTP involvement in cases of plant-derived food allergy.

Abstract 124 | PDF Downloads 108

References

1. Asero R, Antonicelli L, Arena A, Bommarito L, Caruso B, Crivellaro M, et al. EpidemAAITO: features of food allergy in Italian adults attending allergy clinics: a multicentre study. Clin Exp Allergy. 2009;39:547-55.

2. Asero R, Antonicelli L, Arena A, Bommarito L, Caruso B, Colombo G, et al. Causes of food-induced anaphylaxis in Italian adults: a multicentre study. Int Arch Allergy Immunol. 2009;150:271-7.

3. Tordesillas L, Sirvent S, Díaz-Perales A, Villalba M, CuestaHerranz 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;156:291-6.

4. Brenna O, Pompei C, Ortolani C, Pravettoni V, Farioli L, Pastorello EA. Technological processes to decrease the allergenicity of peach juice and nectar. J Agric Food Chem. 2000;48:493-7.

5. Lindorff-Larsen K, Winther JR. Surprisingly high stability of barley lipid transfer protein, LTP1, towards denaturant, heat and proteases. FEBS Lett. 2001;488:145-8.

6. Garcia-Casado G, Crespo JF, Rodriguez J, Salcedo G. Isolation and characterization of barley lipid transfer protein and protein Z as beer allergens. J Allergy Clin Immunol. 2001;108:647-9.

7. Salcedo G, Sánchez-Monge R, Barber D, Díaz-Perales A. Plant non-specific lipid transfer proteins: an interface between plant defence and human allergy. Biochim Biophys Acta. 2007;1771:781-91.

8. Carnés J, Fernández-Caldas E, Gallego MT, Ferrer A, CuestaHerranz J. Pru p 3 (LTP) content in peach extracts. Allergy. 2002;57:1071-5.

9. Ahrazem O, Jimeno L, López-Torrejón C, Herrero M, Espada JL, Sánchez-Monge R, et al. Assessing allergen levels in peach and nectarine cultivars. Ann Allergy Asthma Immunol. 2007;99:42-7.

10. Borges JP, Jauneau A, Brulé C, Culerrier R, Barre A, Didier A, et al. The lipid transfer proteins (LTP) essentially concentrate in the skin of Rosaceae fruits as cell surface exposed allergens. Plant Physiol Biochem. 2006;44:535-42.

11. van Loon L, van Strien E. The families of pathogenesis-related proteins, their activities, and comparative analysis of PR-1 type proteins. Physiol Mol Plant Pathol. 1999;55:85-97.

12. Gonzalez Mancebo E, Fernandez-Rivas M. Outcome and safety of double-blind, placebo-controlled food challenges in 111 patients sensitized to lipid transfer proteins. J Allergy Clin Immunol. 2008;121:1507-8.

13. Zuidmeer L, van Ree R. Lipid transfer protein allergy: primary food allergy or pollen/food syndrome in some cases. Curr Opin Allergy Clin Immunol. 2007;7:269-73.

14. Díaz-Perales A, Lombardero M, Sánchez-Monge R, García-Selles FJ, Pernas M, et al. Lipid-transfer proteins as potential plant panallergens: crossreactivity among proteins of Artemisia pollen, Castanea nut and Rosaceae fruits, with different IgE-binding capacities. Clin Exp Allergy. 2000;30: 1403-10.

15. Lauer I, Miguel-Moncin MS, Abel T, Foetisch K, Hartz C, et al. Identification of a plane pollen lipid transfer protein (Pla a 3) and its immunological relation to the peach lipid-transfer protein, Pru p 3. Clin Exp Allergy. 2007;37: 261-9.

16. Beyer K, Morrow E, Li XM, Bardina L, Bannon GA, Burks AW, et al. Effects of cooking methods on peanut allergenicity. J Allergy Clin Immunol. 2001;107:1077-81.

17. Gao ZS, Yang ZW, Wu SD, et al. Peach allergy in China: a dominant role for mugwort pollen lipid transfer protein as a primary sensitizer. J Allergy Clin Immunol. 2013;131:224-6.

18. Palacín A, Rivas LA, Gómez-Casado C, Aguirre J, Tordesillas L, Bartra J, et al. The involvement of thaumatin-like proteins in plant food cross-reactivity: a multicenter study using a specific protein microarray. PLoS ONE. 2012;7:e44088.

19. Scala E, Till SJ, Asero R, Abeni D, Guerra EC, Pirrotta L, et al. Lipid transfer protein sensitization: reactivity profiles and clinical risk assessment in an Italian cohort. Allergy. 2015;70:933-43.

20. Scala E, Cecchi L, Abeni D, Guerra EC, Pirrotta L, Locanto M, et al. Pla a 2 and Pla a 3-reactivity identify plane tree-allergic patients with respiratory symptoms or food allergy. Allergy. 2017;72:671-4.

21. Wangorsch A, Larsson H, Messmer M, García-Moral A, Lauer I, Wolfheimer S, et al. Molecular cloning of plane pollen allergen Pla a 3 and its utility as diagnostic marker for peach associated plane pollen allergy. Clin Exp Allergy. 2016;46: 764-74.

22. 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.

23. Pascal M, Munoz-Cano ˜ R, Reina Z, Palacín A, Vilella R, Picado C, et al. Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens. Clin Exp Allergy. 2012;42:1529-39.

24. Lambert GP, Boylan M, Laventure JP, Bull A, Lanspa S. Effect of aspirin and ibuprofen on GI permeability during exercise. Int J Sports Med. 2007;28:722-6.

25. Romano A, Scala E, Rumi G, Gaeta F, Caruso C, Alonzi C, et al. Lipid transfer proteins: the most frequent sensitizer in Italian subjects with food-dependent exercise-induced anaphylaxis. Clin Exp Allergy. 2012;42:1643-53.

26. Pastorello EA, Farioli L, Stafylaraki C, Scibilia J, Mirone C, Pravettoni V, et al. Wheat-dependent exercise-induced anaphylaxis caused by a lipid transfer protein and not by -5 gliadin. Ann Allergy Asthma Immunol. 2014;112.

27. Cabrera-Freitag P, Infante S, Bartolomé B, Álvarez-Perea A, Fuentes-Aparicio V, Zapatero Remón L. Anaphylaxis related to passive second-hand exposure to Cannabis sativa cigarette smoke in adolescents. J Invest Allergol Clin Immunol. 2019;29:298-300.

28. Decuyper II, Rihs HP, Van Gasse AL, Elst J, De Puysseleyr L, Faber MA, et al. Cannabis allergy: what the clinician needs to know in 2019. Expert Rev Clin Immunol. 2019;15:599-606.

29. Asero R. Lipid transfer protein cross-reactivity assessed in vivo and in vitro in the office: pros and cons. J Invest Allergol Clin Immunol. 2011;21:129-36.

30. Asero R, Piantanida M, Pravettoni V. Allergy to LTP: to eat or not to eat sensitizing foods? A follow-up study. Eur Ann Allergy Clin Immunol. 2018;50:156-62.

31. Fernández-Rivas M, Garrido Fernández S, Nadal JA, Díaz de Durana MD, García BE, González-Mancebo E, et al. Randomized double blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy. 2009;64:876-83.

32. Pereira C, Bartolomé B, Asturias JA, Ibarrola I, Tavares B, Loureiro G, et al. Specific sublingual immunotherapy with peach LTP (Pru p 3). One year treatment: a case report. Cases J. 2009.

33. Garrido-Fernández S, García BE, Sanz ML, Echechipía S, Lizaso MT, Tabar AI. Are basophil activation and sulphidoleukotriene determination useful tests for monitoring patients with peach allergy receiving sublingual immunotherapy with a Pru p 3-enriched peach extract? J Invest Allergol Clin Immunol. 2014;24:106-13.

34. Gomez F, Bogas G, Gonzalez M, Campo P, Salas M, Diaz-Perales A, et al. The clinical and immunological effects of Pru p 3 sublingual immunotherapy on peach and peanut allergy in patients with systemic reactions. Clin Exp Allergy. 2017;47:339-50.

35. Rona RJ1, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120:638-46.

36. Pascal M, Vazquez-Ortiz M, Folque MM, Jimenez-Feijoo R, Lozano J, Dominguez O, et al. Asymptomatic LTP sensitisation is common in plant-food allergic children from the Northeast of Spain. Allergol Immunopathol. 2016;44:351-8.

37. González-Mancebo E, González-de-Olano D, Trujillo MJ, Santos S, Gandolfo-Cano M, Meléndez A. Prevalence of sensitization to lipid transfer proteins and profilins in a population of 430 patients in the South of Madrid. J Invest Allergol Clin Immunol. 2011;21:278-82.

38. Boyano-Martínez T, Pedrosa M, Belver T, Quirce S, García-Ara C. Peach allergy in Spanish children: tolerance to the pulp and molecular sensitization profile. Pediatr Allergy Immunol. 2013;24:168-72.

39. Fernández-Rivas M, González-Mancebo E, Rodríguez-Pérez R, Benito C, Sánchez-Monge R, Salcedo G, et al. Clinically relevant peach allergy is related to peach lipid transfer protein, Pru p 3, in the Spanish population. J Allergy Clin Immunol. 2003;112:789-95.

40. Ciprandi G, De Amici M, Di Martino ML, Barocci F, Comite P. The impact of age on Pru p 3 IgE production in Italy. Asia Pac Allergy. 2017;7:42-7.

41. Tosca MA, Silvestri M, Olcese R, Sacco O, Pistorio A, Rossi GA, et al. Allergen-specific IgE to food molecular components and age: from early childhood to adulthood. Allergol Immunopathol (Madr). 2017;45:87-92.

42. Pastorello A, Farioli L, Stafylaraki C, Mascheri A, Scibilia J, Pravettoni V, et al. Anti-rPru p 3 IgE levels are inversely related to the age at onset of peach-induced severe symptoms reported by peach-allergic adults. Int Arch Allergy Immunol. 2013;162:45-9.

43. Novembre E, Mori F, Contestabile S, Rossi ME, Pucci N. Correlation of anti-Pru p 3 IgE levels with severity of peach allergy reactions in children. Ann Allergy Asthma Immunol. 2012;108:271-4.

44. Rossi RE, Monasterolo G, Canonica GW, Passalacqua G. Systemic reactions to peach are associated with high levels of specific IgE to Pru p 3. Allergy. 2009;64:1795-6.

45. Pastorello E, 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.

46. Geroldinger-Simic M, Zelniker T, Aberer W, Ebner C, Egger C, Greiderer A, et al. Birch pollen-related food allergy: clinical aspects and the role of allergen-specific IgE and IgG4 antibodies. J Allergy Clin Immunol. 2011;127:616-22.

47. Asero R, Mistrello G, Roncarolo D, Amato S. Relationship between peach lipid transfer protein specific IgE levels and hypersensitiivty to non-Rosaceae vegetable foods in patients allergic to lipid transfer protein. Ann Allergy Asthma Immunol. 2004;92:268-72.

48. Asero R, Pravettoni V. Anaphylaxis to plant-foods and pollen allergens in patients with lipid transfer protein syndrome. Curr Opin Allergy Clin Immunol. 2013;13:379-85.

49. 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;46:565-70.

50. Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol. 2008;121:1331-6.

51. Cuesta-Herranz J, Lázaro M, de las Heras M, Lluch M, Figueredo E, Umpierrez A, et al. Peach allergy pattern: experience in 70 patients. Allergy. 1998;53:78-82.