Respiratory Allergy to Lipid Transfer Protein

• Published in: International archives of allergy and immunology Vol. 147; no. 2; pp. 161 - 165
• Main Authors: Borghesan, Franco, Mistrello, Gianni, Roncarolo, Daniela, Amato, Stefano, Plebani, Mario, Asero, Riccardo
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2008; S. Karger AG
• Subjects: Allergens - immunology; Allergic diseases; Arachis hypogaea; Biological and medical sciences; Carrier Proteins - immunology; Corylus; Digestive allergic diseases; Female; Food allergies; Food Hypersensitivity - blood; Food Hypersensitivity - diagnosis; Food Hypersensitivity - immunology; Fruit - immunology; Fruits; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunoglobulin E - blood; Immunoglobulin E - immunology; Immunopathology; Inhalation Exposure - adverse effects; Lycopersicon esculentum; Medical sciences; Nasal Provocation Tests; Novel Insights from Clinical Practice; Occupational Exposure - adverse effects; Proteins; Prunus; Prunus - immunology; Respiratory Hypersensitivity - blood; Respiratory Hypersensitivity - diagnosis; Respiratory Hypersensitivity - immunology; Respiratory system; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Food allergy; Lipid transfer protein; Peach; Respiratory allergy; Immunopathology; Immunology; Digestive diseases; Respiratory system
• ISSN: 1018-2438; 1423-0097
• DOI: 10.1159/000137285

Background: Due to unclear reasons, allergy to lipid transfer protein (LTP) is frequent in Mediterranean countries but rare in Northern Europe. Objective: We report a paradigmatic case of primarily airborne sensitization to LTP that might explain the geographical distribution of this type of food allergy. Methods: A 21-year-old woman began having severe perennial rhinitis 6 months after she started working in a wholesale fruit storehouse in Southern Italy where large amounts of fruits, including peaches, were handled; symptoms subsided when she left the workplace for >5 days and relapsed as soon as she was back at work. Later on, she developed severe food allergies to peach, hazelnut, peanut, apricot, plum and tomato. The patient underwent a nasal challenge with peach peel extract, and IgE reactivity was assessed by immunoblot analysis. Results: In vivo and in vitro analyses showed sensitivity to LTP. The nasal challenge with peach peel extract (6 µg protein) induced acute, severe respiratory symptoms. On immunoblot with peach peel extract patient’s serum reacted uniquely against LTP, as demonstrated by inhibition assays with the recombinant peach protein. Conclusion: LTP may induce sensitization via the respiratory tract due to inhalation of air-dispersed food particles, and this may precede the onset of food allergy. If this way of sensitization were effective in the majority of LTP allergic patients (e.g. by exposure to peaches showing intact fuzz in areas where peaches are grown and directly sold on the market) our findings could explain the strange geographical distribution of this type of food allergy.