Lettuce Allergy Is a Lipid Transfer Syndrome-Related Food Allergy With a High Risk of Severe Reactions

Abstract

Background and Objectives: Lipid transfer protein (LTP) sensitization is the most common cause of food allergy in the Mediterranean area, with peach allergy acting as the primary sensitizer in most cases. Lettuce has been described as a common offending food in patients with LTP syndrome. The aim of the study was to investigate the frequency and clinical expression of LTP syndrome in a sample of lettuceallergic patients. Methods: We determined specific IgE to Pru p 3 and lettuce in a sample of 30 patients with a diagnosis of lettuce allergy. Symptoms elicited by other LTP-containing plant-derived foods and the presence of cofactors were assessed. Results: The clinical symptoms of lettuce allergy were frequently severe, with 18 of the 30 patients experiencing anaphylaxis. All the patients had allergic reactions to other plant foods. Cofactors were involved in the clinical reactions of 13 of the 30 patients. Sensitization to pollens was found in 90% of patients. Conclusions: Lettuce allergy is found not as an isolated condition but in the context of LTP syndrome and it is characterized by severe reactions and frequent cofactor association.

Immunological Changes Induced in Peach Allergy Patients with Systemic Reactions by Pru p 3 Sublingual Immunotherapy

“…The major peach allergen is Pru p 3, a nonspecific lipid transfer protein (nsLTP) . NsLTPs are panallergens highly distributed among all plant‐food species, being therefore associated with sensitization to multiple, nontaxonomically related plant‐derived foods, inducing a complex clinical manifestation defined as LTP‐syndrome . This is considered a serious health problem and is increasing in prevalence .…”

“…[7] NsLTPs are panallergens highly distributed among all plantfood species, being therefore associated with sensitization to multiple, nontaxonomically related plant-derived foods, inducing a complex clinical manifestation defined as LTP-syndrome. [8] This is considered a serious health problem and is increasing in prevalence. [9] Current treatment is based on the avoidance of peach, however this does not rule out the possibility of accidental ingestion.…”

The diagnosis and management of allergic reactions in patients sensitized to non‐specific lipid transfer proteins

“…26 Even when peach is not the initial reported food trigger, it is still often cited by patients as provoking reactions. 17,28 In other parts of Europe, nsLTP sensitization linked to clinical reactions is reported in an increasing number of publications and the food sensitizations are also similar. A study from Belgium found 25% were sensitized to nsLTP in apple, peach, hazelnut and peanut.…”

“…Most individuals with nsLTP allergy are polysensitized to many LTP allergens 17 . It has been described that nearly 90% of adult patients with peanut ( Arachis hypogaea ) allergy in the Mediterranean area are sensitized to Ara h 9, with Pru p 3 being the primary sensitizer, indicating that Pru p 3 sensitization could be a risk factor for developing peanut allergy 107,108 .…”

“…In northern Spain, peaches are still the dominant food trigger, alongside peanuts and tree nuts 26 . Even when peach is not the initial reported food trigger, it is still often cited by patients as provoking reactions 17,28 . In other parts of Europe, nsLTP sensitization linked to clinical reactions is reported in an increasing number of publications and the food sensitizations are also similar.…”