Clinical severity of LTP syndrome is associated with an expanded IgE repertoire, FDEIA, FDHIH, and LTP mono reactivity

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Authors Information

1Clinical and Laboratory Molecular Allergy Unit, IDI-IRCCS, Rome, Italy
2Health Services Research Unit, IDI-IRCCS, Rome, Italy
3Immunology and Allergology Unit, S. Maria degli Angeli Hospital, Pordenone, Italy
4SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy
5Department of Internal Medicine, IRCCS Foudation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
6Allergology Clinic, Clinica San Carlo, Paderno Dugnano, Milan, Italy 


Published: 15 September 2023
Accepted: 12 September 2023
Received: 28 July 2023 


Background. 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.

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