Anaphylaxis to Wheat Flour-Derived Foodstuffs and the Lipid Transfer Protein Syndrome: A Potential Role of Wheat Lipid Transfer Protein Tri a 14

Abstract

Background: Food allergy to wheat-derived foodstuffs is on the rise. Tri a 14, a wheat flour lipid transfer protein (LTP) allergen, has been described as a major allergen associated with baker’s asthma and wheat food allergy. Cross-reactivity among LTP allergens leads to the so-called ‘LTP syndrome’. Methods: Eight adult patients showing anaphylaxis after ingestion of wheat-derived foodstuffs were selected. A homemade wheat extract, purified natural (n) and recombinant (r) Tri a 14, and peach fruit and Artemisia pollen LTP allergens Pru p 3 and Art v 3 were subjected to skin prick test, specific IgE determination (ELISA) and IgE immunodetection assays. Results: All tests were positive in the 8 selected patients with the homemade extract. Positive skin prick test responses to nTri a 14, Pru p 3 and Art v 3 were found in 5/8, 6/8 and 4/4 patients, respectively. Specific IgE determined by ELISA assays was detected in 6 to nTri a 14 and rTri a 14, in 4 to Pru p 3 and in 3 to Art v 3 out of 8 individual sera tested, whereas all these sera showed IgE binding to nTri a 14 and Pru p 3 in immunodetection after SDS-PAGE separation. Conclusions: Tri a 14 seems to be a relevant allergen in patients with anaphylaxis after ingestion of wheat flour foodstuffs, according to in vitro and in vivo results. Clinical history of the analyzed patients, together with sensitization to peach Pru p 3 and Artemisia pollen Art v 3, suggests that 6 of them suffer from LTP syndrome.

Immunoglobulin‐E‐binding epitopes of wheat allergens in patients with food allergy to wheat and in mice experimentally sensitized to wheat proteins

“…However, a major difference is the specific and strong binding of regions 31-60 and 82-93 by mouse IgE. This first fragment (31-60) contains a peptide sequence (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) that is close to a peptide active in celiac disease, another pathology linked to wheat. Response of mouse IgE is also close to that of human IgE for g-and o2-gliadin peptides.…”

Immunoblotting Analysis of nsLTP1 in Cereal Grains with Antiserum Raised against Recombinant Rice nsLTP1

“…Their high resistance to heat treatment and proteolytic digestion together with their association with severe systemic symptoms has led nsLTP1 to be proposed as a model of true plant food allergens (Salcedo et al, 2004). nsLTP1s from different sources were found to show a wide range of IgE cross-reactivity, which is the basis of the so-called "LTP-syndrome" (Palacin et al, 2009). Rice nsLTP1 has been reported to be involved in rhinoconjunctivitis and asthma arising from the inhalation of rice powder (Enrique et al, 2005).…”

A Baker with Asthma and Wheat Flour Food Allergy

“…Tri a 14 , a wheat flour LTP allergen, seems to be exclusively associated with wheat-induced allergy by inhalation having a high diagnostic value (13). In addition, Tri a 14 seems to be a relevant allergen in patients with allergic reaction after ingestion of wheat flour foodstuffs, according to in vitro and in vivo results (11). Therefore wheat LTP and α-amylase inhibitors are among the most possible allergens responsible for gastrointestinal symptoms accompanied by respiratory symptoms in our case.…”

“…As our patient described gastrointestinal symptoms after ingestion of bread besides his respiratory complaints, the mechanism of development of sensitivity should be different from cases having either baker's asthma or food allergy. A difference in the route of sensitization (inhalation versus ingestion) and allergenic source (wheat flour versus processed wheat foodstuffs) could explain this fact, although some wheat allergens, like α-amylase inhibitors or LTP, are implicated in both types of allergy (5,10,11). The earlier microarray studies demonstrate that thioredoxin h, glutathione transferase, 1-Cys-peroxiredoxin and dehydrin are mainly recognized by sera from patients suffering from wheat-induced respiratory allergy but not from patients with wheatinduced food allergy (12).…”