D1.35 - Lipid transfer protein and Profilin-associated food-dependent exercise-induced anaphylaxis: A case series

Food-dependent exercise-induced anaphylaxis (FDEIA) is a rare but severe form of immunoglobulin E (IgE)-mediated food allergy, characterized by the onset of anaphylaxis with physical exercise. The food triggers of FDEIA vary by geographic region and dietary habits. Lipid transfer proteins (LTPs) and profilin are important allergens causing reactions to fruits, vegetables, and nuts in children, and they are also implicated in food-induced anaphylaxis, playing a pivotal role in FDEIA. 

This report presents four cases of Turkish children experiencing anaphylaxis suspected to be triggered by LTPs and profilin.

Case 1: A 16-year-old male presented with a 6-month history of three episodes of exercise-induced anaphylaxis: two occurring after consuming corn and one after consuming grapes. Multiplex microarray  testing (ALEX2) revealed sensitization to grass pollen Phl p 1 (1.68 kUA/L), corn Zea m 14 (1.35 kUA/L), and grape Vit v 1 (0.43 kUA/L).

Case 2: A 15-year-old male presented with exercise-induced anaphylaxis triggered after consuming melon. Skin prick testing revealed sensitizations to multiple pollens. Pollen food syndrome was also present with apple. Multiplex microarray testing (ALEX2) revealed sensitization to grass pollen Phl p 1 (1.74 kUA/L), Phl p 6 (44.96 kUA/L), profilin Cuc m 2 (6.07 kUA/L) and LTP component Mal d 3 (6.07 kUA/L) also.

Case 3: A 16-year-old male presented with anaphylaxis triggered by exercise after consuming grapes. Multiplex microarray testing (ALEX2) revealed sensitization to lipid transfer proteins, including Vit v 1 (1.71 kUA/L) and Mal d 3 (6.97 kUA/L).

Case 4: A 12-year-old female presented with anaphylaxis triggered by exercise after consuming peanuts. Multiplex microarray testing (ALEX2) revealed sensitization to grass pollen Phl p 1 (44.72 kUA/L), Ara h 9 (22.07 kUA/L), while Ara h 2 and Ara h 6 were not detected.

We recommended that all patients carry an epinephrine autoinjector, avoid exercising alone, and refrain from consuming relevant sensitizing foods for at least 4 hours before exercise.

The four cases presented here suggest that LTP and/or profilin sensitization should be considered in individuals experiencing anaphylaxis triggered by exercise. Multiplex microarray testing can be a valuable tool in the diagnosis of FDEIA, provided there are no methodological interferences, such as age or low levels of total IgE. This is the first report documenting FDEIA cases related to LTP and/or profilin consumption in Turkish children. We believe that increased awareness of this condition may lead to more accurate diagnoses in similar cases.