D1.209 - Pollen and Food Non-Specific Lipid Transfer Proteins: Clinical Presentations and Sensitization Profiles in a Mediterranean Population

Non-specific lipid transfer proteins (nsLTPs) are a leading cause of food-induced allergies in Mediterranean adults, with peach as the most common trigger. Cross-reactivity between pollen and food nsLTPs enables sensitization via ingestion or inhalation, leading to polysensitization. Clinical manifestations range from mild oral symptoms to severe anaphylaxis, complicating diagnosis and treatment.

Retrospective descriptive study of all patients evaluated in a third level hospital Allergy Department during 2024 with respiratory allergy to aeroallergens and food allergy due to nsLTPs sensitization, assessed via ImmunoCAP ISAC.

A total of 61 patients were analyzed, with a median age of 25 years and a male predominance (53%). All 29 asthma patients also had allergic rhinitis. Among sensitizations unrelated to nsLTP, grass pollen was the most prevalent (80%), followed by dust mites (29%), Alternaria fungi (19%), and animal dander (26%). For pollen nsLTPs, sensitization rates were highest for Pla a 3 (68% of patients, with 11 symptomatic cases), followed by Art v 3 (54%, 3 symptomatic) and Ole 7 (21%, 6 symptomatic).

Regarding food nsLTPs, cofactor involvement was observed in only 13% of cases, exercise being the most frequent. 60% of patients experienced mild reactions such as urticaria or rhinitis-conjunctivitis following food intake. Anaphylaxis occurred in 27% of cases, with 70% of these cases involving male patients. Sensitization patterns were, Pru p 3 (83%), Ara h 9 (63%), Cor a 8 (50%), Jur r 3 (48%) and Tri a 14 (11%). Tolerance assessments showed sunflower seeds (39%) as the most tolerated dried fruit, while walnuts were tolerated by only 21% (69% of whom were sensitized to Jurg r 3). 70% of patients tolerated stone fruits, of which 32% tolerated peach, and of the 14 patients who tolerated peach, 9 were sensitized to Pru p 3.

Sensitization to Pru p 3 was most prevalent (83%), reflecting its role as a primary sensitizer in Mediterranean populations. Cofactor involvement was low, contrasting with Mediterranean studies where cofactors are more frequently implicated. Among 13 walnut-tolerant patients, 9 were sensitized to Jug r 3, and out of 14 peach-tolerant patients, 9 were sensitized to Pru p 3, highlighting tolerance despite sensitization. This suggests the need to reconsider strict elimination measures. Personalized oral food challenges may lead to a more precise dietary recommendations, enhancing quality of life.