D2.149 - EFFECTIVENESS AND SAFETY OF SPECIFIC SUBLINGUAL IMMUNOTHERAPY WITH Pru p3 EXTRACT IN PATIENTS WITH LTP ALLERGY

Non-specific lipid transfer proteins (nsLTPs) are widely distributed in the plant kingdom and are the most common cause of food allergy in adults from Mediterranean countries. Pru p3 (the LTP from peach) is the most relevant allergen and is usually the primary sensitizer. The dietary management of patients with LTP allergy must be personalized according to their sensitization profile. Currently, a purified extract of Pru p3 is available for sublingual administration, which has demonstrated efficacy and safety in the adult population, with limited evidence in pediatric cases.

Retrospective observational case series study of patients diagnosed with lipid transfer protein (LTP) allergy treated with specific sublingual immunotherapy (SLIT) using Pru p3 extract. Baseline characteristics and effectiveness were assessed after a controlled oral food challenge (OFC) with GRANINI peach juice one year following the initiation of immunotherapy. Results were expressed as median values.

A total of 11 patients were included. Age at onset of symptoms: 3 (1-7) years, weight 15.8 (10.4-29) kg, and height 98.4 (81.6-134) cm. Time from first reaction to diagnosis: 3 months (1 month-4 years). 64% were female. The most frequent comorbidity was asthma (54.5%). The food most commonly implicated in the first allergic reaction was peach (3 patients), followed by walnut and almond (2 patients for each nut). The most prevalent clinical manifestation in the first allergic reaction was anaphylaxis (45.5%). 40% of anaphylactic reactions received intramuscular epinephrine. 100% experienced an allergic reaction to another food containing LTP, with 2 patients suffering more than one anaphylactic episode. 100% had a positive prick test to LTP, and the IgE level to Pru p3 was 9 kUA/l (1.93-93.3 kUA/l). Nine patients have started SLIT, with two still pending initiation. No side effects from SLIT were reported. Three patients underwent a controlled oral food challenge (OFC), showing good tolerance. One of these three patients later experienced an anaphylactic reaction to a nut.

SLIT with Pru p3 is effective and safe in patients with LTP allergy, demonstrating good tolerance to peach juice one year after treatment initiation.