D3.235 - A Combined SLIT and OIT Approach for Desensitization in LTP Syndrome: A Promising Strategy

 Lipid Transfer Protein (LTP) syndrome is characterized by multiple plant food allergies, primarily involving fruits and nuts, due to cross-reactivity among non-specific lipid transfer proteins (nsLTPs) in plants. Given its prevalence and clinical impact, effective management strategies are essential. A desensitization protocol combining sublingual immunotherapy (SLIT) with peach extract and subsequent oral immunotherapy (OIT) using commercial peach juice offers a potential solution for managing this syndrome.

Three patients with confirmed moderate to severe allergic reactions to multiple plant foods, diagnosed through positive skin prick tests (SPT) and specific IgE for LTP, were enrolled. Patients began a two-day cluster induction phase of SLIT with peach extract ALK® (50 µg/mL) in our Allergy Unit, reaching a maintenance dose of 4 drops daily for one year at home. OIT was then followed using Granini® peach juice (21.16 µg/mL), with doses escalated biweekly to a maintenance dose of 200 mL daily. Final food provocations with the culprit foods were performed after six months.

Two women and one man aged 20 to 40 years were included, all with a history of pollen allergies. All of them had symptoms with different plant-based foods. Diagnostic tests confirmed positive SPT and specific IgE for LTP in Rosaceae and nsLTP from nuts, vegetables, and wheat. One patient initiated directly with OIT. One patient presented lip angioedema during OIT at a 100 mL dose, she maintained the same dose for three weeks before upgrading, without further incidents. All patients showed reduced specific IgE levels for LTP and nsLTP after three months of OIT. Two patients underwent a final provocation with nuts and fruits with no reactions and tolerated all food groups. The other patient tolerates different vegetables and fruits but does not consume them frequently, the final provocation with nuts has not been realized yet.

The combined SLIT and OIT protocol demonstrated efficacy and safety in managing LTP syndrome, and suggests that cross-desensitization between nsLTPs from other food families is possible, demonstrating a promising approach for desensitization in these patients, improving their quality of life and offering a cost-effective solution.