Dupilumab to induce tolerance to SLIT-Melocotón®

Area of Science:

• Allergy and Immunology
• Clinical Medicine
• Immunotherapy

Background:

• Food allergy, particularly to nonspecific lipid transfer proteins (nsLTPs), is a growing health concern.
• Lipid transfer protein (LTP) syndrome is characterized by sensitization to nsLTPs, leading to cross-reactivity among various plant-based foods.
• The primary allergen in this syndrome is rPru p3, found in peaches and numerous other fruits, vegetables, nuts, and grains.

Observation:

• A 40-year-old woman with anaphylactic reactions to plant foods due to nsLTP sensitization (LTP syndrome) was treated with sublingual immunotherapy (SLIT-peach).
• Initial SLIT with rPru p3 was interrupted due to immediate reactions; subsequent treatment with omalizumab also resulted in anaphylaxis.
• After four months of dupilumab therapy, rPru p3 SLIT-peach was successfully reintroduced, achieving maintenance dose without adverse reactions.

Findings:

• Dupilumab facilitated the successful reintroduction and maintenance of sublingual immunotherapy (SLIT-peach) in a patient with severe nsLTP syndrome.
• The patient achieved tolerance to rPru p3 SLIT-peach, indicating a potential therapeutic role for dupilumab in managing immunotherapy-related adverse events.
• This case highlights a novel strategy for managing complex food allergies when standard immunotherapy is initially unsuccessful.

Implications:

• This case suggests dupilumab may be a valuable adjunct in managing severe food allergies and facilitating tolerance induction through immunotherapy.
• Successful rPru p3 SLIT-peach treatment improved the patient's quality of life, reduced dietary restrictions, and alleviated the severity of allergic reactions.
• Further research is warranted to explore the efficacy and safety of dupilumab in conjunction with sublingual immunotherapy for nsLTP syndrome and other food allergies.