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Vol. 46. Issue 6.
Pages 565-570 (November - December 2018)
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Vol. 46. Issue 6.
Pages 565-570 (November - December 2018)
DOI: 10.1016/j.aller.2018.04.002
Anaphylaxis caused by lipid transfer proteins: an unpredictable clinical syndrome
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Inês Motaa, Ângela Gaspara,
Corresponding author
angela.gaspar@sapo.pt

Corresponding author.
, Filipe Benito-Garciaa, Magna Correiaa, Cristina Arêdea, Susana Piedadea, Graça Sampaioa, Graça Piresa, Cristina Santa-Martaa, Luís-Miguel Borregoa,b, Mário Morais-Almeidaa
a Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
b CEDOC, NOVA Medical School, Immunology, Lisbon, Portugal
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Tables (2)
Table 1. Food groups implicated in LTP-allergy symptoms and associations in same patient.
Table 2. Clinical characterization of seven patients with food-dependent exercise-induced anaphylaxis.
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Abstract
Introduction

Lipid transfer proteins (LTPs) are panallergens found in many plant foods. They are a common cause of food-induced anaphylaxis (FIA) in adults living in the Mediterranean area. LTPs have also been proposed as a main cause of food-dependent exercise-induced anaphylaxis (FDEIA).

Objectives

Describe clinical characteristics and allergen sensitization profiles in patients with FIA related to LTP.

Materials and Methods

Forty-three patients were included, aged 3–52 years with a clinical history of FIA and proven sensitization to LTP. Patients were tested with a multiple plant food and pollen panel and specific IgE to LTP allergens. LTP sensitization was assessed by in vivo (Pru p 3, LTP extract) and/or by in vitro tests (specific IgE, ImmunoCAP/ISAC®).

Results

Median age of first anaphylactic episode was 24 years (range 2–51), 44% had asthma, 74% were atopic and 42% had pollinosis (olive, mugwort, plane tree, wall pellitory and cypress). Co-sensitization to profilins was found in 22%. Overall in our center, LTP-induced anaphylaxis represents 17% of all causes of FIA. Foods implicated in anaphylactic reactions were: fresh fruits 51%, tree nuts 42%, vegetables (including peanut) 40% and seeds 14%. Seven patients had FDEIA.

Conclusions

LTPs are important allergens of FIA in Portugal. Clinical reactivity to several taxonomically unrelated plant foods may raise suspicion toward LTP sensitization. The association of LTP-induced anaphylaxis with pollinosis is relevant in our country. The unpredictable clinical expression depends on the effect of cofactors such as exercise. The management of avoidance plans can be challenging due to LTP being a widely cross-reacting allergen in plant foods.

Keywords:
Anaphylaxis
Food allergy
Food-dependent exercise-induced anaphylaxis
Lipid transfer proteins
Panallergens

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