Treatment with lipid transfer protein sublingual immunotherapy: slowing down new sensitizations

Abstract

Food allergy (FA) is a potentially life-threatening condition, food allergen immunotherapy, targeting the underlying mechanisms, is a potentially curative strategy in FA. A 46-year-old woman had an episode of facial angioedema and urticaria after mandarin ingestion and other episode of urticaria, abdominal pain, and facial angioedema after eating hazelnuts and almonds 4 years ago and contact urticaria (CU) with the manipulation of the peach skin. Three years ago, she suffered a facial and glottis angioedema, generalized urticaria, vomiting, and abdominal pain 10-15 minutes after eating green beans. She was treated with intravenous corticosteroids and antihistamines and intramuscular epinephrine, with complete resolution within a few hours. She no longer consumed nuts, and she avoided vegetables or fruits that caused her symptoms. Prick-prick test were performed, being positive with lettuce, eggplant, and cabbage and negative for cauliflower and broccoli. Total IgE (UniCAP method, kU/L) was 39.3, specific IgE Prup3 lipid transfer protein (LTP), 3.9; specific IgE to peanut, peach, pear, lemon, almond, avocado, walnut, cherry, and green bean were also positive. We decided to try to stop the march of the LTP sensitizations. Sublingual immunotherapy with a peach extract quantified in 12 μg/mL of peach allergen Prup3 was then initiated without any adverse event, and she has good adherence to the treatment. After 1 year, single-blind oral challenge test with peach, mandarin, and aubergine, were performed up to a portion dose (approximately 100 g) with all good tolerances.

Phenotypes and Endotypes of Peach Allergy: What Is New?

“…Furthermore, Beitia et al showed the effectiveness of Pru p 3 SLIT in a real-life study, including 29 patients, showing that, one year after starting SLIT, 73% had a negative challenge to peach, and, after 2 years, 95% of them did not react to the fruit [ 86 ]. In this study, the possibility of using Pru p 3 SLIT to treat patients suffering from LTP syndrome was confirmed, as also shown in other papers, with a positive impact on patients’ quality of life as well [ 87 , 88 ]. Indeed, in the paper by González-Pérez et al, the authors showed that, in 18 adult patients treated for 3 consecutive years with Pru p 3 SLIT, the results on the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) significantly decreased, showing a favorable impact on the patients’ quality of life [ 87 ].…”