Anaphylaxis caused by lipid transfer proteins

an unpredictable clinical syndrome

Inês Mota, Ângela Gaspar, Filipe Benito-Garcia, Magna Correia, Cristina Arêde, Susana Piedade, Graça Sampaio, Graça Pires, Cristina Santa-Marta, Luís-Miguel Borrego, Mário Morais-Almeida

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)565-570
Number of pages6
JournalAllergologia et Immunopathologia
Volume46
Issue number6
Early online date5 Jul 2018
DOIs
Publication statusPublished - Nov 2018

Fingerprint

Anaphylaxis
Food
Edible Plants
Allergens
Seasonal Allergic Rhinitis
Exercise
Immunoglobulin E
lipid transfer protein
Parietaria
Cupressus
Profilins
Artemisia
Nuts
Portugal
Olea
Pollen
Vegetables
Fruit
Seeds
Asthma

Keywords

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

Cite this

Mota, I., Gaspar, Â., Benito-Garcia, F., Correia, M., Arêde, C., Piedade, S., ... Morais-Almeida, M. (2018). Anaphylaxis caused by lipid transfer proteins: an unpredictable clinical syndrome. Allergologia et Immunopathologia, 46(6), 565-570. https://doi.org/10.1016/j.aller.2018.04.002
Mota, Inês ; Gaspar, Ângela ; Benito-Garcia, Filipe ; Correia, Magna ; Arêde, Cristina ; Piedade, Susana ; Sampaio, Graça ; Pires, Graça ; Santa-Marta, Cristina ; Borrego, Luís-Miguel ; Morais-Almeida, Mário. / Anaphylaxis caused by lipid transfer proteins : an unpredictable clinical syndrome. In: Allergologia et Immunopathologia. 2018 ; Vol. 46, No. 6. pp. 565-570.
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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{\circledR}).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.",
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Mota, I, Gaspar, Â, Benito-Garcia, F, Correia, M, Arêde, C, Piedade, S, Sampaio, G, Pires, G, Santa-Marta, C, Borrego, L-M & Morais-Almeida, M 2018, 'Anaphylaxis caused by lipid transfer proteins: an unpredictable clinical syndrome', Allergologia et Immunopathologia, vol. 46, no. 6, pp. 565-570. https://doi.org/10.1016/j.aller.2018.04.002

Anaphylaxis caused by lipid transfer proteins : an unpredictable clinical syndrome. / Mota, Inês; Gaspar, Ângela; Benito-Garcia, Filipe; Correia, Magna; Arêde, Cristina; Piedade, Susana; Sampaio, Graça; Pires, Graça; Santa-Marta, Cristina; Borrego, Luís-Miguel; Morais-Almeida, Mário.

In: Allergologia et Immunopathologia, Vol. 46, No. 6, 11.2018, p. 565-570.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anaphylaxis caused by lipid transfer proteins

T2 - an unpredictable clinical syndrome

AU - Mota, Inês

AU - Gaspar, Ângela

AU - Benito-Garcia, Filipe

AU - Correia, Magna

AU - Arêde, Cristina

AU - Piedade, Susana

AU - Sampaio, Graça

AU - Pires, Graça

AU - Santa-Marta, Cristina

AU - Borrego, Luís-Miguel

AU - Morais-Almeida, Mário

N1 - Copyright © 2018 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

PY - 2018/11

Y1 - 2018/11

N2 - 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.

AB - 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.

KW - Anaphylaxis

KW - Food allergy

KW - Food-dependent exercise-induced anaphylaxis

KW - Lipid transfer proteins

KW - Panallergens

U2 - 10.1016/j.aller.2018.04.002

DO - 10.1016/j.aller.2018.04.002

M3 - Article

VL - 46

SP - 565

EP - 570

JO - Allergologia et Immunopathologia

JF - Allergologia et Immunopathologia

SN - 0301-0546

IS - 6

ER -