Lipid transfer proteins: the most frequent sensitizer in <scp>I</scp>talian subjects with food‐dependent exercise‐induced anaphylaxis

<jats:title>Summary</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Specific food‐dependent exercise‐induced anaphylaxis (<jats:styled-content style="fixed-case">S</jats:styled-content>‐<jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n) is a distinct form of food allergy in which symptoms are elicited by exercise performed after ingesting food to which the patient has become sensitised. Non‐specific <jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n (<jats:styled-content style="fixed-case">NS</jats:styled-content>‐<jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n) is a syndrome provoked by exercise performed after ingesting any food.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>We sought to identify the culprit allergenic molecules in patients with <jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n, combining ‘classic’ allergy testing with an allergenic molecule‐based microarray approach for <jats:styled-content style="fixed-case">I</jats:styled-content>g<jats:styled-content style="fixed-case">E</jats:styled-content> detection.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All subjects were evaluated who reported at least one episode of anaphylaxis in association with physical exercise performed within 4 h after a meal. We performed skin prick tests (<jats:styled-content style="fixed-case">SPT</jats:styled-content>) with commercial food extracts, prick plus prick tests (<jats:styled-content style="fixed-case">P</jats:styled-content> + <jats:styled-content style="fixed-case">P</jats:styled-content>) with fresh foods (<jats:styled-content style="fixed-case">P</jats:styled-content> + <jats:styled-content style="fixed-case">P</jats:styled-content>), and serum specific <jats:styled-content style="fixed-case">I</jats:styled-content>g<jats:styled-content style="fixed-case">E</jats:styled-content> assays by means of both the <jats:styled-content style="fixed-case">I</jats:styled-content>mmuno<jats:styled-content style="fixed-case">CAP</jats:styled-content> (<jats:styled-content style="fixed-case">CAP</jats:styled-content>) and the <jats:styled-content style="fixed-case">ISAC</jats:styled-content> 89 microarray system (<jats:styled-content style="fixed-case">ISAC</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among our 82 <jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n patients, the most frequent suspected foods were tomato, cereals, and peanut. <jats:styled-content style="fixed-case">SPT</jats:styled-content>,<jats:styled-content style="fixed-case"> P</jats:styled-content><jats:italic> </jats:italic>+<jats:italic> </jats:italic><jats:styled-content style="fixed-case">P</jats:styled-content>, and <jats:styled-content style="fixed-case">CAP</jats:styled-content> displayed different degrees of sensitivity. Each test disclosed some positivities not discovered by others. Seventy‐nine subjects were positive to at least one food (49 to more than 20), whereas three were negative. All suspected foods were positive to at least one of <jats:styled-content style="fixed-case">SPT</jats:styled-content>,<jats:styled-content style="fixed-case"> P</jats:styled-content><jats:italic> </jats:italic>+<jats:italic> </jats:italic><jats:styled-content style="fixed-case">P</jats:styled-content>, and <jats:styled-content style="fixed-case">CAP</jats:styled-content>. When tested using the <jats:styled-content style="fixed-case">ISAC</jats:styled-content>, 64 (78%) subjects were positive to <jats:styled-content style="fixed-case">P</jats:styled-content>ru p 3 [peach lipid transfer protein (<jats:styled-content style="fixed-case">LTP</jats:styled-content>)], 13 were positive to other food allergen molecules, and five displayed negative results to all food allergenic molecules. Overall, 79 patients probably had <jats:styled-content style="fixed-case">S</jats:styled-content>‐<jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n and the other 3 <jats:styled-content style="fixed-case">NS</jats:styled-content>‐<jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Multiple food hypersensitivity represents a clinical hallmark of a large percentage of <jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n patients. The very high prevalence of <jats:styled-content style="fixed-case">I</jats:styled-content>g<jats:styled-content style="fixed-case">E</jats:styled-content> to the <jats:styled-content style="fixed-case">LTP</jats:styled-content> suggests a role of this allergen group in causing <jats:styled-content style="fixed-case">S</jats:styled-content>‐<jats:styled-content style="fixed-case">FDEIA</jats:styled-content>n.</jats:p></jats:sec>