title: Lipid transfer proteins: the most frequent sensitizer in Italian subjects with food-dependent exercise-induced anaphylaxis.
abstract: BACKGROUND
  Specific food-dependent exercise-induced anaphylaxis (S-FDEIAn) is a distinct form of food allergy in which symptoms are elicited by exercise performed after ingesting food to which the patient has become sensitised. Non-specific FDEIAn (NS-FDEIAn) is a syndrome provoked by exercise performed after ingesting any food.
  
  
  OBJECTIVE
  We sought to identify the culprit allergenic molecules in patients with FDEIAn, combining 'classic' allergy testing with an allergenic molecule-based microarray approach for IgE detection.
  
  
  METHODS
  All subjects were evaluated who reported at least one episode of anaphylaxis in association with physical exercise performed within 4 h after a meal. We performed skin prick tests (SPT) with commercial food extracts, prick plus prick tests (P + P) with fresh foods (P + P), and serum specific IgE assays by means of both the ImmunoCAP (CAP) and the ISAC 89 microarray system (ISAC).
  
  
  RESULTS
  Among our 82 FDEIAn patients, the most frequent suspected foods were tomato, cereals, and peanut. SPT, P + P, and CAP displayed different degrees of sensitivity. Each test disclosed some positivities not discovered by others. Seventy-nine subjects were positive to at least one food (49 to more than 20), whereas three were negative. All suspected foods were positive to at least one of SPT, P + P, and CAP. When tested using the ISAC, 64 (78%) subjects were positive to Pru p 3 [peach lipid transfer protein (LTP)], 13 were positive to other food allergen molecules, and five displayed negative results to all food allergenic molecules. Overall, 79 patients probably had S-FDEIAn and the other 3 NS-FDEIAn.
  
  
  CONCLUSIONS
  Multiple food hypersensitivity represents a clinical hallmark of a large percentage of FDEIAn patients. The very high prevalence of IgE to the LTP suggests a role of this allergen group in causing S-FDEIAn.
authors.affiliation: Allergy Unit, Complesso Integrato Columbus, Rome, Italy. antoninoromano@h-columbus.it
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.forename: E
authors.initials: E
authors.lastname: Scala
authors.forename: G
authors.initials: G
authors.lastname: Rumi
authors.forename: F
authors.initials: F
authors.lastname: Gaeta
authors.forename: C
authors.initials: C
authors.lastname: Caruso
authors.forename: C
authors.initials: C
authors.lastname: Alonzi
authors.forename: M
authors.initials: M
authors.lastname: Maggioletti
authors.forename: R
authors.initials: R
authors.lastname: Ferrara
authors.forename: P
authors.initials: P
authors.lastname: Palazzo
authors.forename: V
authors.initials: V
authors.lastname: Palmieri
authors.forename: P
authors.initials: P
authors.lastname: Zeppilli
authors.forename: A
authors.initials: A
authors.lastname: Mari
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D002352:Carrier Proteins / Q000276:immunology*; D002648:Child; D015444:Exercise; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007558:Italy; D008297:Male; D008875:Middle Aged; D012882:Skin Tests; D044465:White People; D055815:Young Adult
chemical_list: D000485:Allergens; D002352:Carrier Proteins; C030363:lipid transfer protein; D007073:Immunoglobulin E