Achieving remission with peach sublingual immunotherapy in adults and children with Lipid transfer protein syndrome without associated cofactor

Abstract

Introduction: Lipid transfer protein (LTP) allergy is the leading cause of food allergy and food anaphylaxis in adults in the Mediterranean region. Treatment options include avoidance of the implicated foods and specific sublingual peach immunotherapy (Pru p3 SLIT). This study aims to determine the effectiveness of Prup3 SLIT in patients with cofactor-induced and noncofactor-induced LTP syndrome, assessing the change in food tolerance before and after treatment.

Methods: We conducted a retrospective observational study of 23 patients diagnosed with LTP allergy who were treated with Pru p3 SLIT. To assess food tolerance before and after treatment, all patients underwent an oral challenge with unpeeled peach, as well as other foods to which they were allergic or sensitized.

Results: Fifty-five percent of patients were female, with a mean age of 25.8 years, 39% of whom were under 14 years of age. Thirteen percent were allergic only to pink fruits, 4.3% to nuts, 43.4% to two families, and 39.1% to more than two families of vegetables. Eighty-six percent of the reactions were systemic, including 47% anaphylaxis. After a mean of 2.7 years of treatment, 95.6% of the patients tolerated oral provocation with unpeeled peach and all foods to which they were allergic. However, none of the seven patients with cofactor-induced or cofactor-enhanced allergic reactions to food showed improved tolerance following Pru p3 SLIT.

Conclusion: Pru p3 SLIT can induce clinical remission of LTP food allergy in both adult and pediatric populations. However, it doesn´t resolve cofactor-triggered LTP reactions; therefore, patients with this profile should continue to avoid such triggers.