D3.207 - Exercise-Induced Anaphylaxis: A Case Study on Pea Consumption and Allergenic Protein Profiling

Exercise-induced anaphylaxis (EIA) is a rare but potentially life-threatening condition, often triggered by the synergistic effects of physical activity and specific food intake. While lipid transfer proteins (LTPs) are well-known allergens implicated in such reactions, their role in less common food sources, such as peas, remains underexplored.

A 13-year-old male patient, with no chronic conditions and no prior respiratory allergies, experienced palmo-plantar pruritus, generalized urticaria, and pharyngeal tightness during afootball training session.  The reaction occurred four hours after consuming raw peas and a ham-and-cheese pizza. Emergency treatment with adrenaline and fluid therapy was required. Subsequent testing revealed tolerance to peas and pizza without exercise. Sensitivity to lipid transfer proteins (Pru p 3 and Pru p 7) was found. The patient was diagnosed with exercise-induced anaphylaxis related to pea and wheat consumption, likely mediated by cofactor activation. 

Protein extracts were obtained from raw peas through PBS incubation,centrifugation, filtration, and lyophilization. Protein concentration was assessedusing the Bradford method. SDS-PAGE and Western blot analyses were performedto evaluate protein and allergenic profiles, using the patient’s serum for IgE-specific detection. Bioinformatics tools were employed to compare identifiedproteins with allergenic databases.

Microarrays negative to Omega-5 Gliadina, Tri a 14 and Tri a aA_TI. Western blot analysis revealed no IgE binding to pea storage proteins (globulins or 2S-7S albumins). However, IgE binding was detected in peach skin extracts, specifically to:

• An 11 kDa band under non-reducing conditions, consistent with gibberellin-regulated protein (Pru p 7).
• A 10 kDa band under reducing conditions, corresponding to nsLTP (Pru p 3).
• A novel 65 kDa allergen not previously described.

These findings underscore the role of nsLTPs as major allergens and highlight the complexity of allergenic profiles in exercise-induced reactions.

This case highlights exercise-induced anaphylaxis triggered by pea and wheat consumption, likely mediated by cofactor activation. Although no IgE sensitization to pea storage proteins was observed, reactivity to LTPs (Pru p 3 and Pru p 7) and a novel 65 kDa allergen was identified. These results emphasize the need for advanced molecular diagnostics and further research into emerging allergens to develop tailored prevention strategies for patients with cofactor-mediated anaphylaxis.