title: Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens.
abstract: BACKGROUND
  Multiple plant-food sensitizations with a complex pattern of clinical manifestations are a common feature of lipid transfer protein (LTP)-allergic patients. Component-resolved diagnosis permits the diagnosis of the allergen sensitization profile.
  
  
  OBJECTIVE
  We sought to clinically characterize and describe the plant-food and pollen molecular sensitization profile in patients with LTP syndrome.
  
  
  METHODS
  Forty-five subjects were recruited, after being diagnosed with multiple plant-food allergies sensitized to LTP, but not to any other plant-food allergen, according to the molecular allergen panel tested (Pru p 3 (LTP), Pru p 1 (Bet v 1-like), Pru p 4 (profilin) and those included in a commercial microarray of 103 allergenic components). IgE-mediated food-allergy symptoms and pollinosis were collected. Patients were skin prick tested with a plant-food and pollens panel, and specific IgE to Tri a 14 was evaluated.
  
  
  RESULTS
  A heterogeneous group of plant-foods was involved in local and systemic symptoms: oral allergy syndrome (75.6%), urticaria (66.7%), gastrointestinal disorders (55.6%) and anaphylaxis (75.6%), 32.4% of which were cofactor dependent (Non-Steroidal Anti-inflammatory Drugs, exercise). All tested subjects were positive to peach and Pru p 3, Tri a 14 and to some of the LTPs included in the microarray. Pollinosis was diagnosed in 75.6% of subjects, with a broad spectrum of pollen and pollen-allergen sensitization. Plane tree and mugwort were the statistically significant pollens associated with Pru p 3.
  
  
  CONCLUSIONS
  Several plant-foods, taxonomically unrelated, independent of peach involvement, are implicated in LTP syndrome. Local symptoms should be evaluated as a risk marker for anaphylaxis because they are frequently associated with cofactor-dependent anaphylaxis. The association of these symptoms with pollinosis, especially plane tree pollinosis, could be part of this syndrome in our area.
authors.affiliation: Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pascal
authors.forename: R
authors.initials: R
authors.lastname: Muñoz-Cano
authors.forename: Z
authors.initials: Z
authors.lastname: Reina
authors.forename: A
authors.initials: A
authors.lastname: Palacín
authors.forename: R
authors.initials: R
authors.lastname: Vilella
authors.forename: C
authors.initials: C
authors.lastname: Picado
authors.forename: M
authors.initials: M
authors.lastname: Juan
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-López
authors.forename: M
authors.initials: M
authors.lastname: Rueda
authors.forename: G
authors.initials: G
authors.lastname: Salcedo
authors.forename: A
authors.initials: A
authors.lastname: Valero
authors.forename: J
authors.initials: J
authors.lastname: Yagüe
authors.forename: J
authors.initials: J
authors.lastname: Bartra
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology*; D052179:Antigens, Plant / Q000276:immunology*; D001249:Asthma / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D002352:Carrier Proteins / Q000276:immunology*; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D010940:Plant Proteins / Q000276:immunology*; D010944:Plants / Q000145:classification / Q000276:immunology*; D011058:Pollen / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D012882:Skin Tests; D013577:Syndrome; D055815:Young Adult
chemical_list: D000485:Allergens; D052179:Antigens, Plant; D002352:Carrier Proteins; D010940:Plant Proteins; C511920:lipid transfer proteins, plant; D007073:Immunoglobulin E