The diagnosis and management of allergic reactions in patients sensitized to non-specific Lipid Transfer Proteins

Sensitization to one or more non-specific lipid transfer proteins(nsLTP), initially thought to exist mainly in southern Europe,is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond.The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen, and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a co-factor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa)to be present for a food to elicit a reaction. The variability in the food and co-factor triggers make it essential to include an allergy focused diet and clinical history in the diagnostic work-up. Testing on suspected food triggers, should also establish whether sensitization to nsLTP is present, usingpurified or recombinant nsLTP allergens such as Pru p 3. Theavoidance of known trigger foods and advice on co-factors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of co-factors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.