Clinical severity of LTP syndrome is associated with an expanded IgE repertoire, FDEIA, FDHIH, and LTP mono reactivity
Enrico Scala firstname.lastname@example.org
, Damiano Abeni2
, Valeria Villella1
, Danilo Villalta3
, Lorenzo Cecchi4
, Valerio Pravettoni5
, Mauro Giani1
, Elisabetta Caprini1
, Riccardo Asero6Show more: Authors information and Publication history
Clinical and Laboratory Molecular Allergy Unit, IDI-IRCCS, Rome, Italy2
Health Services Research Unit, IDI-IRCCS, Rome, Italy3
Immunology and Allergology Unit, S. Maria degli Angeli Hospital, Pordenone, Italy4
SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy5
Department of Internal Medicine, IRCCS Foudation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy6
Allergology Clinic, Clinica San Carlo, Paderno Dugnano, Milan, Italy
Published: 15 September 2023
Accepted: 12 September 2023
Received: 28 July 2023
LTP allergy is often a challenge for clinicians. We evaluated a multiplex diagnostic approach with diverse cofactors to stratify LTP syndrome risk. Methods.
Of the 1,831 participants screened with 'Allergy Explorer-ALEX-2', 426 had reactions to at least one LTP. Data was gathered and recorded via an electronic database. Results.
Reactivity to peach Pru p 3 was found in 77% of individuals with LTP allergy. Higher levels of specific IgE and concurrent sensitization to more than 5 molecules (50% of all LTP-sensitised participants, 62% of symptomatic cases) were significantly associated with an increased risk of severe reactions (p = 0.001). Several cofactors, either alone or in combination, also influenced patients' clinical outcomes. Some cofactors increased the risk of severe reactions, such as mono reactivity to LTP in 44.6% of cases (p = 0.001), FDEIA in 10.8% of patients (p = 0.001), and FDNIH in 11.5% (p = 0.005). On the other hand, reactivity to PR10 (24.2%; p = 0.001), profilin hypersensitivity (10.3%; p = 0.001), and/or atopic dermatitis (16.7%; p = 0.001) had a mitigating effect on symptom severity. Conclusions.
Clinical severity of LTP syndrome is associated with an expanded IgE repertoire in terms of the number of LTP components recognized and increased IgE levels in individual molecules. Ara h 9, Cor a 8, and Mal d 3 showed the strongest association with clinical severity. In addition, several cofactors may either exacerbate (FDEIA, FDHIH, and LTP monoreactivity) or ameliorate (atopic dermatitis and co-sensitization to profilin and/or PR10) individual patient outcomes. These factors may be utilized for the daily clinical management of LTP syndrome.
Lipid transfer protein; Profilin; PR10; Macroarray; IgE; allergen; Atopic Dermatitis. FULL TEXT