Immunological cross-reactivity between lipid transfer proteins from botanically unrelated plant-derived foods: a clinical study.
BACKGROUND
Lipid transfer proteins (LTP) are highly conserved and widely distributed throughout the plant kingdom. Recent studies demonstrated immunological cross-reactivity between LTP from many botanically unrelated fruits and vegetables and concluded that LTP are pan-allergens. This study aimed to evaluate the clinical relevance of such cross-reactivity in a group of subjects monosensitized to LTP.


METHODS
Twenty LTP-hypersensitive patients were selected from a population of about 600 subjects with history of Rosaceae allergy by means of: 1) negative skin prick test (SPT) with a commercial birch pollen extract; 2) positive SPT with a commercial plum extract, rich in LTP but virtually lacking both Bet v 1-like proteins and profilin; 3) in-vitro IgE reactivity to the 9-10 kDa fraction of peach peel or immunoblot with peach peel showing a single band at 10 kDa; and 4) total inhibition of reactivity to whole peach extract (containing Bet v 1-related allergen, profilin, and LTP) by purified peach LTP on enzyme-linked immunoassay (ELISA). Allergy to foods other than Rosaceae was ascertained by careful interview and analysis of medical recordings. SPT with a large series of plant-derived foods were carried out as well. The cross reactivity between LTPs from botanically unrelated plant-derived foods was assessed by ELISA inhibition tests using walnut and peanut extracts as substrate, and peach LTP as inhibitor.


RESULTS
All patients reported allergic reactions after the ingestion of at least one from a large number of vegetable foods other than Rosaceae, and in several cases clinical reactions were very severe (anaphylaxis, asthma, urticaria/angioedema). Nuts and peanuts were the most frequently reported causes of allergic reactions (80% and 40% of patients, respectively). All patients showed positive SPT to several non-Rosaceae food extracts. SPT with nuts, peanut, legumes, celery, rice, and corn were positive in the majority of patients. In ELISA inhibition studies, absorption of sera with peach LTP caused complete inhibition of IgE reactivity to walnut and peanut in all cases.


CONCLUSIONS
LTP is a clinically relevant pan-allergen. Most Rosaceae-allergic, LTP-hypersensitive patients experience adverse reactions after ingestion of botanically unrelated plant-derived foods as well. In view of the high prevalence and severity of the allergic reactions induced, hazelnut, walnut, and peanut should be regarded as potentially hazardous for these patients.
Asero
R
R
Ambulatorio di Allergologia, Ospedale Caduti Bollatesi, Bolllate (MI), Italy.
Mistrello
G
G
Roncarolo
D
D
Amato
S
S
Caldironi
G
G
Barocci
F
F
van Ree
R
R
D000485:Allergens / Q000009:adverse effects / Q000276:immunology*; D052179:Antigens, Plant; D019661:Apiaceae / Q000009:adverse effects / Q000276:immunology; D002352:Carrier Proteins / Q000009:adverse effects / Q000276:immunology*; D003429:Cross Reactions / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005512:Food Hypersensitivity / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D009754:Nuts / Q000009:adverse effects / Q000276:immunology; D010940:Plant Proteins; D010944:Plants / Q000009:adverse effects / Q000276:immunology*; D015995:Prevalence; D012882:Skin Tests
D000485:Allergens; D052179:Antigens, Plant; D002352:Carrier Proteins; D010940:Plant Proteins; C511920:lipid transfer proteins, plant; D007073:Immunoglobulin E