Allergy to lipid transfer proteins (LTP) in a pediatric population.

SUMMARY: Lipid transfer proteins (LTP) are considered important plant-food allergens in the Mediterranean area, but little is known about LTP allergy in pediatric age. Our aim was to characterize LTP allergy in children.We reviewed the clinical data from all children evaluated in our department with LTP allergy. From the 76 patients with LTP allergy, 26 children were included, 50% female, median age 10 years (1-17). Symptoms included urticaria in 58% (n = 15), 168 anaphylaxes in 46% (n = 12) and OAS in 42% (n = 11). Multiple reactions with different foods occurred in 69%. Cofactors were reported in 27% (n = 7). All patients had positive SPT to peach LTP extract and sIgE Pru p 3. No association between the occurrence of severe reactions and sIgE to Pru p 3 (p = 0.462), sIgE to Cor a 8 (p = 0.896), SPT to peach LTP extraxt (p = 0.846) or the number of positive SPT to fruits/tree nuts (p = 0.972; p = 0.676) was found. Ninety-two percent of the patients tolerated fruits from Rosacea family without peel. Twelve percent reported reactions to new LTP containing foods during follow-up. LTP allergy can occur since early childhood. Since anaphylaxis is common and cofactors act as severity enhancers, it is fundamental to recognize LTP allergy in children. Currently available diagnostic tests (SPT and sIgE) cannot accurately predict food tolerance or anticipate reaction severity.