D2.206 - Successful treatment of LTP syndrome using allergen immunotherapy: a clinical case

Lipid transfer protein (LTP) syndrome is an IgE-mediated food allergy caused by sensitization to plant-derived LTPs, which are highly stable allergens associated with systemic and potentially severe allergic reactions. Although food-derived LTP sensitization is usually primary, cross-reactivity with pollen allergens, particularly Artemisia vulgaris LTP (Art v 3), may play a clinically relevant role.

To describe a clinical case of LTP syndrome with predominant sensitization to Artemisia vulgaris LTP and to evaluate the clinical effect of allergen immunotherapy (AIT).

Clinical case

A 23-year-old female presented with a 6-month history of severe generalized atopic dermatitis and recurrent urticaria with two episodes of angioedema after consumption of grapes and mandarins. She also reported seasonal allergic rhinitis since childhood (August–September).Component-resolved diagnostics were performed using ImmunoCAP ISAC.

IgE sensitization to multiple LTPs was detected: Tri a 14 (1.7 ISU-E), Ara h 9 (0.4 ISU-E), Cor a 8 (1.2 ISU-E), Jug r 3 (7.6 ISU-E), Pru p 3 (2.7 ISU-E), Pla a 3 (1.6 ISU-E), Ole e 7 (0.4 ISU-E), with a marked sensitization to Art v 3 (69 ISU-E). Sensitization to Artemisia defensin Art v 1 (25 ISU-E) was also identified.An LTP-avoidance diet (raw and processed foods) and symptomatic treatment with antihistamines and emollients were initiated. Despite high-dose antihistamines, atopic dermatitis remained poorly controlled. After the pollen season, AIT with Artemisia  allergoid was started following a standard protocol.After 6 months of AIT, antihistamines were successfully discontinued without recurrence of urticaria, and a significant improvement in skin condition was observed.

Conclusion

LTP syndrome with predominant sensitization to Artemisia vulgaris LTP (Art v 3) can be successfully managed with pollen allergen immunotherapy, suggesting a potential role of AIT in selected patients with LTP syndrome.