Lipid Transfer Protein Syndrome Research Articles

A case of a 6-year-old boy diagnosed with lipid transfer protein syndrome using the ImmunoCAP and ImmunoCAP Immuno Solid-phase Allergen Chip

A case of a 6-year-old boy diagnosed with lipid transfer protein syndrome using the ImmunoCAP and ImmunoCAP Immuno Solid-phase Allergen Chip

Evolution of laboratory parameters in patients with lipid transfer protein syndrome after 3 years of immunotherapy.

Lipid transfer protein (LTP) syndrome is an increasingly prevailing disease, especially in the young population, with severely affected quality of life. Since 2013, a specific treatment, called sublingual immunotherapy (SLIT), with peach extract (SLIT-peach®) has been used, but with no long-term effectiveness studies. The main objective of the present study was to assess the long-term effectiveness of SLIT-peach® and to relate the clinical evolution of patients. This was an ambispective study conducted for 3 years. A total of 25 patients with LTP syndrome were selected and treated with SLIT-peach®. They underwent a provocation test in the first year with reintroduced foods that had produced symptoms in the past. Analytical determination of specific immunoglobulin E (IgE) and immunoglobulin G4 (IgG4) to peach (Pru p 3) was performed at the beginning of treatment, at the first year of initiation, and at the end of treatment. These data were compared with the control group comprising 14 patients with LTP syndrome without treatment. A statistically significant decrease in specific IgE to Pru p 3 at the end of the treatment and an increase in specific IgG4 to Pru p 3 1 year after treatment initiation were observed in the active group in relation to tolerance to foods with LTPs. These results indicate that food tolerance begins after the first year and is maintained after the end of 3 years of treatment. In conclusion, treatment with SLIT-peach® for 3 years is effective for patients with LTP syndrome, preventing the evolution of the disease, allowing patients to restart a diet with plant foods, and improving their quality of life.

Lipid transfer protein syndrome: How to save a life through careful education

IntroductionLipid transfer proteins (nsLTPs) are ubiquitous allergens. Patients affected by nsLTP syndrome experience symptoms to various plant-derived foods, ranging from local manifestations to anaphylaxis, the critical treatment of which is represented by self-administration of adrenaline. The principle aim of this study is to assess how dietary recommendations influence the occurrence of new and severe cases and if poly-sensitization to different nsLTPs may play a role. We also investigated about the appropriate use of adrenaline auto-injector during the episodes of anaphylaxis. Moreover, we examinated how other features (ie, co-sensitization to profilin and PR-10 and the presence of risk co-factors) affect these events. Materials and methodsWe evaluated 78 patients allergic to nsLTPs, investigating adherence to diet and ability to use the adrenaline auto-injector. Number of sensitization to nsLTPs, co-sensitization to other panallergens, and presence of risk factors for new reactions were also assessed. Diagnosis was based on clinical history and positivity to in vivo and in vitro tests. During the follow-up, compliance, diet modifications, and new reactions were noted, and re-training for the use of epinephrine auto-injector was performed. At the last visit we evaluated the patients’ ability to use the self-injector. ResultsThe whole of fruits belonging to the Rosaceae family emerged as the most frequent culprit foods (28%), followed by walnut (17%), peanut (17%), and hazelnut (10%). At the baseline visit 23% of the patients described the presence of a risk factor during the allergic reaction (mainly nonsteroidal anti-inflammatory drugs [NSAIDs] and exercise). Forty-five percent of the patients reported anaphylactic reactions; no association between the type of food and the severity of the reactions was found. The presence of sensitization to 4 or more nsLTPs was associated to more severe reactions (p < .05; OR 1.67). During the follow-up 38% of the patients experienced at least 1 new allergic reaction: in 79% of them the culprit food was previously tolerated, and in 69% the reaction was an anaphylaxis. Only 47% of the patients showed a proper use of adrenaline auto-injector during the final evaluation, but a significant correlation between periodic education and reduction of the probability of mistakes in the use was reported (p < .05; OR 0.34). Furthermore, an association between co-sensitization to PR-10 (in particular Bet v1) and profilin and less severe symptoms was found, but without a significant odds ratio. ConclusionA careful education aimed to the prevention of new reactions, through dietary restrictions and avoidance of risk co-factors, and to the management of anaphylaxis, through the training for the correct use of adrenaline auto-injector, should be a routine practice in nsLTP syndrome.

WHEN SHOULD CANNABIS CROSS YOUR MIND? A CASE REPORT OF ANAPHYLACTIC SHOCK INDUCED BY MARIJUANA-TOMATO CROSS REACTIVITY

TOPIC: Allergy and Airway TYPE: Medical Student/Resident Case Reports INTRODUCTION: With the increased prevalence of recreational and medical marijuana use throughout the United States, patients with severe food allergies are particularly vulnerable to severe and devastating allergic reactions from its use. Nonspecific lipid transfer proteins, which can be found on the Cannabis sativa leaf, are also found on a variety of fruits and legumes, providing a mechanism for cross-reactivity in those susceptible to certain food allergies. CASE PRESENTATION: We present a case of a 35-year-old female with a past medical history of OSA on CPAP, hypertension, and anxiety with complaints of shortness of breath and wheezing. The night prior, she attested to having a glass of wine and smoking half of a marijuana joint. Shortly after she smoked, she began to complain of an itchy throat and an itching sensation throughout her body. She perceived the symptoms as only mild and went to bed with her CPAP machine, hoping that her symptoms would resolve spontaneously. Hours later, she suddenly woke up with severe dyspnea and respiratory distress, prompting her to call EMS. Initial vitals were BP 120/62, HR 75, RR 28, and SpO2 98% on non-rebreather mask. Her chemistry profile was unremarkable with normal renal and liver indices. EKG showed normal sinus rhythm with a ventricular rate of 86 bpm. Her listed allergies included angioedema to Lisinopril, urticaria to aromatic oils, and hives to tomatoes. Family history was non-contributory. Chest X-ray showed no acute pulmonary findings. On physical exam, she was in severe respiratory distress and barely able to complete any sentences. There were no adventitious sounds on auscultation of her lung fields, although severe upper airway stridor was appreciated. Diffuse urticaria was also noted over her extremities. She required urgent endotracheal intubation and mechanical ventilation for severe respiratory distress and upper airway edema, attributed to severe anaphylaxis. At the time, the precipitating agent that caused her to clinically deteriorate was unclear. Two doses of epinephrine IM, benadryl 50 mg IV, and Solumedrol 125 mg IV were administered. Within 24 hours, the patient's airway edema markedly improved and she passed a leak test prior to extubation. She was successfully discharged home the following day on a steroid taper and H2 inhibitor. DISCUSSION: Review of literature demonstrates a well established cross reactivity between the cannabis sativa leaf and multiple plant-food allergens, including tomatoes, peaches, and apples (1). Patients who are sensitized to non-specific lipid transfer proteins, found on the surface of these and other fruits, may develop a cross-reaction when marijuana is ingested, leading to a wide range of allergic reactions (2). CONCLUSIONS: A thorough history, physical, and review of potential cross-reactions between a patient's known allergies & recently ingested foods or substances is imperative to an accurate diagnosis. REFERENCE #1: Decuyper, I. I., Van Gasse, A. L., Cop, N., Sabato, V., Faber, M. A., Mertens, C., ... & Ebo, D. G. (2017). Cannabis sativa allergy: looking through the fog. Allergy, 72(2), 201-206. REFERENCE #2: Azofra, J., Berroa, F., Gastaminza, G., Saiz, N., Gamboa, P. M., Vela, C., ... & Goikoetxea, M. J. (2016). Lipid transfer protein syndrome in a non-Mediterranean area. International archives of allergy and immunology, 169(3), 181-188. DISCLOSURES: No relevant relationships by Maie Abdullah, source=Web Response no disclosure on file for Bhavinkumr Dalal; No relevant relationships by Kareem Ebeid, source=Web Response

Case series of seven cases of urticaria, angioedema, and anaphylaxis (LTP syndrome) due to foods (nuts, lentils, and citrus foods) related to tree pollen (Prosopis juliflora and Holoptelea integrifolia) sensitization

Lipid transfer protein syndrome (LTPS) results from a primary sensitization to LTP belonging to the PR-14 family of pathogenesis-related PR-proteins which are plant food allergens, stable against heat and digestive enzymes, and can induce systemic reactions of urticaria, angioedema, and anaphylaxis. Here, we report a case series of seven patients with nsLTP syndrome. Our six cases of LTPS were significantly sensitized to Prosopis juliflora and Holoptelea integrifolia and one case was sensitized to H. integrifolia only. In our seven cases, we hypothesized that symptoms of hypersensitivity reaction to foods were due to cross-reactivity by IgE reactive protein of ns-LTP as a major allergenic protein in foods.

A novel case discussion of pediatric lipid transfer protein syndrome

Lipid transfer proteins (LTPs) are allergens widely found in plants and plant-derived foods.1,2 Lipid transfer protein syndrome occurs in individuals sensitized to LTPs. Lipid transfer protein syndrome is a significant cause of food-induced anaphylaxis as well as food-dependent exercise-induced anaphylaxis.3 Lipid transfer proteins represent dominant proteins that cause allergic reactions to fruits, nuts, and vegetables in adults and children from the Mediterranean basin; yet, whereas LTP syndrome is common in Mediterranean countries, it is rare in birch endemic areas (ie, northern Europe).

Pru p 3 Sublingual Immunotherapy in Patients with Lipid Transfer Protein Syndrome: Is It Worth?

Background: Lipid transfer proteins (LTPs) syndrome is an important cause of multiple plant food allergy in the Mediterranean area. The effectiveness of sublingual immunotherapy (SLIT) with the LTP Pru p 3 extract has been little investigated in the real-world setting. This study aimed to investigate the outcome of Pru p 3 SLIT in real-life patients with LTP syndrome with/without concurrent reactions to peanut and/or nuts. Methods: This was a prospective real-life study including all patients diagnosed with LTP allergy and treated with Pru p 3 SLIT between 2011 and 2018 in a tertiary hospital in Spain. Patients underwent open oral food challenge (OFC) tests for unpeeled peach and nuts/peanuts 1 year after the treatment started to assess food tolerance. A control group of patients diagnosed with LTP allergy who refused treatment with immunotherapy were included. Severity of symptoms and diet avoidance was recorded in both groups. Results: Twenty-nine patients with a median age of 24.7 years (range 5.5–43.1) were included: 100% were allergic to fruit; 72%, to peanut and/or nuts; 19 had a history of severe systemic reactions. Seven patients discontinued therapy; 3 (10%), due to adverse events. One year after SLIT start, 16 (73%) patients had negative OFC to peach; 95%, after 2 years; 69% had negative OFC to nuts/peanuts. The control group included 13 patients: 53.8% experienced reactions with new foods; severity of symptoms increased significantly (p < 0.001), and diet restrictions were maintained in this group. Conclusions: SLIT with Pru p 3 shows a good safety profile, and avoid dietary restrictions in patients with LTP syndrome treated in the real-life setting.

Nowy wymiar zespołu białek przenoszących lipidy – zwrócenie uwagi na seks, narkotyki i alkohol

Nowy wymiar zespołu białek przenoszących lipidy – zwrócenie uwagi na seks, narkotyki i alkohol

A case report of recurrent anaphylaxis in a 36-year-old female: Lipid transfer protein syndrome

A case report of recurrent anaphylaxis in a 36-year-old female: Lipid transfer protein syndrome

Pollen-food allergy syndrome and lipid transfer protein syndrome: Clinical relevance

Pollen-food allergy syndrome and lipid transfer protein syndrome: Clinical relevance

Clinical Relevance of Cross-Reactivity in Food Allergy

The diagnosis and management of food allergy is complicated by an abundance of homologous, cross-reactive proteins in edible foods and aeroallergens. This results in patients having allergic sensitization (positive tests) to many biologically related foods. However, many are sensitized to foods without exhibiting clinical reactivity. Although molecular diagnostics have improved our ability to identify clinically relevant cross-reactivity, the optimal approach to patients requires an understanding of the epidemiology of clinically relevant cross-reactivity, as well as the food-specific (degree of homology, protein stability, abundance) and patient-specific factors (immune response, augmentation factors) that determine clinical relevance. Examples of food families with high rates of cross-reactivity include mammalian milks, eggs, fish, and shellfish. Low rates are noted for grains (wheat, barley, rye), and rates of cross-reactivity are variable for most other foods. This review discusses clinically relevant cross-reactivity related to the aforementioned food groups as well as seeds, legumes (including peanut, soy, chickpea, lentil, and others), tree nuts, meats, fruits and vegetables (including the lipid transfer protein syndrome), and latex. The complicating factor of addressing co-allergy, for example, the risks of allergy to both peanut and tree nuts among atopic patients, is also discussed. Considerations for an approach to individual patient care are highlighted.

Acute urticaria with angioedema in the setting of coronavirus disease 2019

This is the case of a 30-year-old female physician with no relevant past medical history except for pine seeds allergy, following a strict nut-free diet since she was diagnosed. Lipid transfer protein syndrome was ruled out at diagnosis. She did not have a family history of hereditary angioedema, and she was not on any medication. In March 2020, she presented with symptoms of odynophagia and dry cough, with rapid onset of fever. The day after the symptoms appeared, a PCR of upper-airway secretions (by nasopharyngeal swab) was performed, revealing severe acute respiratory syndrome coronavirus 2 infection.

Wheat-dependent exercise-induced anaphylaxis with Tri-a-14-sensitization as part of a lipid transfer protein syndrome

Wheat-dependent exercise-induced anaphylaxis with Tri-a-14-sensitization as part of a lipid transfer protein syndrome

Wheat-dependent exercise-induced anaphylaxis with Tri-a-14-sensitization as part of a lipid transfer protein syndrome

Wheat-dependent exercise-induced anaphylaxis with Tri-a-14-sensitization as part of a lipid transfer protein syndrome

How to cope with food allergy symptoms?

Food allergy symptoms may involve a wide variety of organs (skin, gastrointestinal tract, and eyes) and systems (respiratory, circulatory, and neurological). They are often associated. Their severity ranges from mild to potentially life-threatening reactions and the presentation from acute to chronic. Food allergies have been the focus of multiple studies, position papers, and guidelines in recent years. They have defined an approach in classifying symptoms as mild to anaphylactic, distinguishing objective from subjective symptoms, and describing their heterogeneity, specific phenotypes or syndromes (e.g., lipid transfer protein syndrome or pollen food syndrome). Cofactors can also influence food allergy reactions. Symptoms of non-IgE-gastrointestinal food allergies, illustrated by eosinophilic esophagitis and food-protein-induced enterocolitis syndrome, are also now better understood and defined. Improvement in the knowledge of food allergy symptoms is crucial for correct diagnosis and a personalized treatment approach. Through a better description and understanding of symptoms, the diversity of food allergies is now better known. The next step is to harmonize symptom assessment not only for clinicians but also for patients, researchers, and public health stakeholders, to describe food allergy phenotypes and their underlying mechanisms and endotypes, to develop targeted management.

Clinical Profile of Lipid Transfer Protein Syndrome in a Mediterranean Area.

Clinical Profile of Lipid Transfer Protein Syndrome in a Mediterranean Area.

Lettuce Allergy Is a Lipid Transfer Syndrome-Related Food Allergy With a High Risk of Severe Reactions.

Lipid transfer protein (LTP) sensitization is the most common cause of food allergy in the Mediterranean area, with peach allergy acting as the primary sensitizer in most cases. Lettuce has been described as a common offending food in patients with LTP syndrome. The aim of the study was to investigate the frequency and clinical expression of LTP syndrome in a sample of lettuceallergic patients. We determined specific IgE to Pru p 3 and lettuce in a sample of 30 patients with a diagnosis of lettuce allergy. Symptoms elicited by other LTP-containing plant-derived foods and the presence of cofactors were assessed. The clinical symptoms of lettuce allergy were frequently severe, with 18 of the 30 patients experiencing anaphylaxis. All the patients had allergic reactions to other plant foods. Cofactors were involved in the clinical reactions of 13 of the 30 patients. Sensitization to pollens was found in 90% of patients. Lettuce allergy is found not as an isolated condition but in the context of LTP syndrome and it is characterized by severe reactions and frequent cofactor association.

Lipid Transfer Protein Syndrome in a Non-Mediterranean Area

Background: Plant food allergies associated with lipid transfer protein (LTP) have been widely described in the Mediterranean Basin. Objective: The aim of this work was to describe the clinical profile and pollen sensitization of plant food- allergic patients sensitized to LTP in a non-Mediterranean area. Methods: Patients with clear IgE-mediated symptoms associated with plant foods and a positive skin prick test (SPT) to Pru p 3 were included in a prospective study in the north of Spain. Reported symptoms were analyzed together with a battery of food and pollen SPTs and specific IgE components by ISAC microarray. Cross-inhibition studies were performed by ImmunoCAP with plane tree, mugwort and rPru p 3. Results: Among the 72 patients included, the most frequent food allergy reported was to peaches (69%) followed by nuts (walnuts 55%, peanuts 54% and hazelnuts 43%). Most patients suffered from symptoms with multiple plant foods (a median of 6 foods per patient). Regarding the patients' pollen sensitization, 36% were sensitized to mugwort pollen (72% showing sIgE to Art v 3), 33% to grass pollen and 24% to plane tree pollen (94% with sIgE to Pla a 3). Inhibition studies showed that specific IgEs against mugwort and plane tree pollen are inhibited by Pru p 3 in a strong manner, whereas Pru p 3 was less inhibited by pollen extracts. Conclusions: LTP syndrome occurs in a non-Mediterranean area and is related to multiple sensitizations to foods and pollens such as plane tree and mugwort. In these pollen sensitizations, Pru p 3 seems to be the primary sensitizer.

Fruit and vegetable allergy.

Fruit and vegetable allergies are the most prevalent food allergies in adolescents and adults. The identification of the allergens involved and the elucidation of their intrinsic properties and cross-reactivity patterns has helped in the understanding of the mechanisms of sensitisation and how the allergen profiles determine the different phenotypes. The most frequent yet contrasting fruit and vegetable allergies are pollen-food syndrome (PFS) and lipid transfer protein (LTP) syndrome. In PFS, fruit and vegetable allergies result from a primary sensitisation to labile pollen allergens, such as Bet v 1 or profilin, and the resulting phenotype is mainly mild, consisting of local oropharyngeal reactions. In contrast, LTP syndrome results from a primary sensitisation to LTPs, which are stable plant food allergens, inducing frequent systemic reactions and even anaphylaxis. Although much less prevalent, severe fruit allergies may be associated with latex (latex-fruit syndrome). Molecular diagnosis is essential in guiding the management and risk assessment of these patients. Current management strategies comprise avoidance and rescue medication, including adrenaline, for severe LTP allergies. Specific immunotherapy with pollen is not indicated to treat pollen-food syndrome, but sublingual immunotherapy with LTPs seems to be a promising therapy for LTP syndrome.

A safe foodstuff for wheat allergic patients

Background Lipid Transfer Protein (LTP) allergy constitutes the first cause of food allergy to vegetables in Southern Europe. LTPs are highly stable proteins, resistant to both gastric digestion and high temperatures. Allergic reactions to multiples vegetables, not phylogenetically related, are produced based on the cross-reactivity among these proteins, a phenomenon that has been named LTP syndrome. Tri a 14, the wheat LTP, is involved in baker s asthma and anaphylactic reaction. In the present work, we studied Weetabix ® foodstuff tolerance in four patients with wheat allergy, characterized by oral food challenge (OFC) and skin tests, trying to identify the source of this tolerance in wheat-based foodstuff.