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Anaphylaxis to plant-foods and pollen allergens in patients with lipid transfer protein syndrome

Asero, Riccardo; Pravettoni, Valerio

Current Opinion in Allergy and Clinical Immunology: August 2013 - Volume 13 - Issue 4 - p 379–385
doi: 10.1097/ACI.0b013e32835f5b07
ANAPHYLAXIS AND INSECT ALLERGY: Edited by Theodore Freeman and Ralf Heine

Purpose of review Nonspecific lipid transfer protein (LTP) is the main cause of primary food allergy in adults living in the Mediterranean area. The way allergic patients get sensitized to this protein is all but established, and the clinical expression of sensitization is extremely variable, ranging from long-lasting symptomless sensitization to severe anaphylaxis. Such variability is seemingly due to the presence/absence of a number of cofactors.

Recent findings The possibility that LTP sensitization occurs via the inhalation of LTP-containing pollen particles seems unlikely; in contrast, peach particles containing the protein seem able to sensitize both via the airways and the skin. Cosensitization to pollen allergens as well as to labile plant food allergens makes LTP allergy syndrome less severe. In some LTP sensitized subjects clinical food allergy occurs only in the presence of cofactors such as exercise, NSAIDs, or chronic urticaria.

Summary Lipid transfer protein allergy syndrome shows some peculiarities that are unique in the primary food allergy panorama: geographical distribution, frequent asymptomatic sensitization, frequent need for cofactors, and reduced severity when pollen allergy is present. Future studies will have to address these points as the results may have favorable effects on other, more severe, types of food allergy.

aAmbulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy

bClinical Allergy and Immunology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Correspondence to Dr Riccardo Asero, Ambulatorio di Allergologia, Clinica San Carlo, Via Ospedale 21, 20037 Paderno Dugnano, Milan, Italy. Tel: +39 02 99038470; fax: +39 02 99038223; e-mail: r.asero@libero.it

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