Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant‐foods and pollens

Abstract

Summary Background Multiple plant‐food sensitizations with a complex pattern of clinical manifestations are a common feature of lipid transfer protein ( LTP )‐allergic patients. Component‐resolved diagnosis permits the diagnosis of the allergen sensitization profile. Objective We sought to clinically characterize and describe the plant‐food and pollen molecular sensitization profile in patients with LTP syndrome. Methods Forty‐five subjects were recruited, after being diagnosed with multiple plant‐food allergies sensitized to LTP , but not to any other plant‐food allergen, according to the molecular allergen panel tested (Pru p 3 ( LTP ), Pru p 1 (Bet v 1‐like), Pru p 4 (profilin) and those included in a commercial microarray of 103 allergenic components). IgE‐mediated food‐allergy symptoms and pollinosis were collected. Patients were skin prick tested with a plant‐food and pollens panel, and specific IgE to Tri a 14 was evaluated. Results A heterogeneous group of plant‐foods was involved in local and systemic symptoms: oral allergy syndrome (75.6%), urticaria (66.7%), gastrointestinal disorders (55.6%) and anaphylaxis (75.6%), 32.4% of which were cofactor dependent ( Non‐Steroidal Anti‐inflammatory Drugs , exercise). All tested subjects were positive to peach and Pru p 3, Tri a 14 and to some of the LTP s included in the microarray. Pollinosis was diagnosed in 75.6% of subjects, with a broad spectrum of pollen and pollen‐allergen sensitization. Plane tree and mugwort were the statistically significant pollens associated with Pru p 3. Conclusions and Clinical Relevance Several plant‐foods, taxonomically unrelated, independent of peach involvement, are implicated in LTP syndrome. Local symptoms should be evaluated as a risk marker for anaphylaxis because they are frequently associated with cofactor‐dependent anaphylaxis. The association of these symptoms with pollinosis, especially plane tree pollinosis, could be part of this syndrome in our area.