Lipid transfer protein allergy: characterization and comparison to birch-related food allergy

Lipid transfer proteins (LTP) are a frequent elicitor of anaphylaxis to plant-derived food allergens in southern Europe.

15 German patients with LTP allergy were compared to 17 patients with birch-related food allergy (BRFA) using a detailed anamnesis, serology, skin tests, and the FAQLQ-AF quality of life questionnaire.

While patients with BRFA mainly reacted to tree nuts, and pome and stone fruits, LTP allergic individuals reported vegetables, berry fruits, cereals, and seeds as common additional elicitors. Anaphylaxis was associated with cofactors in 73 % of LTP allergic patients compared to only 6 % in BRFA (P < 0.001). Symptoms occurred delayed by more than one hour in 40 % and were triggered by raw and cooked foodstuffs in 86 % of LTP allergic patients, compared to only 6 % and 41 % of BRFA patients, respectively. A peach prick test was positive in all LTP allergic patients, but only in 15 % of BRFA patients (P < 0.001). Although patients with LTP allergy reported severe anaphylaxis more frequently, quality of life did not differ between groups.

Anaphylaxis to plant-derived foodstuffs warrants assessment by IgE detection to Pru p 3 and skin tests with peach extract, particularly if cofactors and intolerance to heated foodstuffs are related.