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The diagnosis and management of allergic reactions in patients sensitized to non‐specific lipid transfer proteins
Author(s) -
Skypala Isabel J.,
Bartra Joan,
Ebo Didier G.,
Antje Faber Margaretha,
FernándezRivas Montserrat,
Gomez Francisca,
Luengo Olga,
Till Stephen J.,
Asero Riccardo,
Barber Domingo,
Cecchi Lorenzo,
Diaz Perales Araceli,
HoffmannSommergruber Karin,
Anna Pastorello Elide,
Swoboda Ines,
Konstantinopoulos Anastasios. P.,
Ree Ronald,
Scala Enrico
Publication year - 2021
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.14797
Subject(s) - sensitization , allergen , medicine , allergy , immunology , plant lipid transfer proteins , immunotherapy , food allergens , immune system , biology , biochemistry , gene
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.