The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins.

Domingo Barber, Enrico Scala, Ronald van Ree, Anastasios P Konstantinopoulos, Ines Swoboda, Elide Anna Pastorello, Karin Hoffmann-Sommergruber, Araceli Diaz Perales, Lorenzo Cecchi, Isabel J Skypala, Riccardo Asero, Stephen J Till, Olga Luengo, Francisca Gomez, Montserrat Fernández-Rivas, Margaretha Antje Faber, Didier G Ebo, Joan Bartra

Journal: Allergy 2021;76(8):2433-2446

PMID: 33655502

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Abstract

Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.

Address: Royal Brompton & Harefield NHS Foundation Trust, London, UK.; Department of Allergy and Clinical Immunology, Imperial College, London, UK.; Hospital Clinic, Barcelona, Spain.; IDIBAPS, Universitat de Barcelona, ARADyAL, Barcelona, Spain.; Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Sciences, Infla-Med Centre of Excellence, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.; Jan Palfijn Ziekenhuis Ghent, Ghent, Belgium.; Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology, Infla-Med Centre of Excellence, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.; Department of Allergy, Hospital Clínico San Carlos, Universidad Complutense de Madrid, IdISSC, ARADyAL, Madrid, Spain.; Allergy Unit, IBIMA-Hospital Regional Universitario de Malaga, Malaga, Spain.; Spanish Network for Allergy - RETICS de Asma, Reaccionesadversas y Alérgicas (ARADyAL, Madrid, Spain.; Allergy Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, ARADyAL, Barcelona, Spain.; Peter Gorer Department of Immunobiology, King's College London, London, UK.; Department of Allergy, Guy's & St Thomas' NHS Foundation Trust, London, UK.; Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy.; IMMA, School of Medicine, Universidad San Pablo CEU, Universities, Madrid, Spain.; RETIC ARADYAL RD16/0006/0015, Instituto de Salud Carlos III, Madrid, Spain.; SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy.; Centro de Biotecnología y Genómica de Plantas, Universidad Politecnica, Madrid, Spain.; Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria.; Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milan, Italy.; Biotechnology Section, Campus Vienna Biocenter, FH Campus Wien, University of Applied Sciences, Vienna, Austria.; Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece.; Department of Experimental Immunology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.; Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.; Experimental Allergy Unit, Istituto Dermopatico dell'Immacolata - IRCCS, FLMM, Rome, Italy.

DOI: 10.1111/all.14797