title: Asymptomatic LTP sensitisation is common in plant-food allergic children from the Northeast of Spain.
abstract: BACKGROUND
  The sensitisation profile at molecular level in plant-food allergy is complex. Several allergens may be involved, with different potential for severe reactions. lipid transfer proteins (LTP) are considered the most relevant plant-food allergens in adults in Mediterranean countries, but less is known in children.
  
  
  OBJECTIVE
  To describe the clinical pattern and sensitisation profile of children with plant-food allergy and LTP sensitisation from Northeast Spain.
  
  
  METHODS
  Children with history of immediate reaction to plant-food(s), positive skin-prick-test to the culprit plant-food(s) and specific-IgE to plant-food LTPs were analysed.
  
  
  RESULTS
  130 children were included. 69.2% (90/130) had reacted to ≥2 taxonomically unrelated plant-foods. Peach, walnut, hazelnut and peanut were most frequently involved. Reactions severity ranged from anaphylaxis (45.4%, 59/130) to oral symptoms only. Sensitisation to a particular plant-food LTP not always caused clinical symptoms with that plant-food; 69% (40/58) and 63% (17/27) of peach- and walnut-tolerant subjects had positive rPru p 3 and nJug r 3 specific IgE, respectively. 65.4% (85/130) of children were also sensitised to storage proteins, which was associated to anaphylaxis and nut allergy. However, 60% of patients without nuts/seeds allergy were sensitised to storage proteins. Specific-IgE levels to LTPs and/or storage proteins were not useful to predict allergy (vs. tolerance) to peach, walnut, peanut or hazelnut.
  
  
  CONCLUSIONS
  Sensitisation to LTP and/or storage proteins without clear clinical significance is relatively common. Prospective longitudinal studies are required to evaluate the relevance of these silent sensitisations over time. Caution is required when interpreting the results of molecular-based diagnostic tools in clinical practice.
authors.affiliation: Immunology Department, CDB, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain. Electronic address: mpascal@clinic.ub.es.
authors.forename: M
authors.initials: M
authors.lastname: Pascal
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Vazquez-Ortiz
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: M M
authors.initials: MM
authors.lastname: Folque
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Jimenez-Feijoo
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Lozano
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Dominguez
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Piquer-Gibert
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Giner
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alvaro
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Dias da Costa
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: García-Paba
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Machinena
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Alsina
authors.affiliation: Immunology Department, CDB, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Yagüe
authors.affiliation: Pediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
authors.forename: A M
authors.initials: AM
authors.lastname: Plaza-Martin
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000175:diagnosis* / Q000276:immunology; D052179:Antigens, Plant / Q000276:immunology*; D058070:Asymptomatic Diseases; D002352:Carrier Proteins / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003429:Cross Reactions; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis / Q000276:immunology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D046228:Microarray Analysis; D009754:Nuts / Q000276:immunology*; D010940:Plant Proteins / Q000276:immunology*; D011446:Prospective Studies; D000068239:Prunus persica / Q000276:immunology; D012189:Retrospective Studies; D012882:Skin Tests; D013030:Spain
chemical_list: D052179:Antigens, Plant; D002352:Carrier Proteins; D010940:Plant Proteins; C511920:lipid transfer proteins, plant; D007073:Immunoglobulin E
keywords: Asymptomatic sensitisation; Children; Component resolved diagnosis; Lipid transfer protein; Northeast Spain; Plant-food allergy; Storage proteins