1- Allergy and Clinical Immunology Department, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, E.P.E, Lisbon, Portugal
- Apresentação sob a forma de poster, EAACI- Congresso anual da European Academy of Allergy and Clinical Immunology- Lisboa, 1 a 5 Junho 2019
Background: Profilins and Lipid transfer proteins (LTPs) are the panallergens with more importance in the pollen and plant food allergic patient’s management. Our aims were to evaluate the frequency of co-sensitization to LTP and profilin in a group of patients sensitized to pollens/fruits or vegetables and investigate the onset of food allergies (FA).
Method: In 2013, for 4 months, skin prick tests (SPT) with LTP (Pru p 3) and profilin (Pho d 2) were performed to all the patients that had positive SPT for pollens/fruits or vegetables. The patients also filled a questionnaire to evaluate the presence of food allergy (FA) at the moment. Patients co-sensitized to LTP and Profilin were selected and their clinical evolution was evaluated for over 5-years.
Results: 233 patients were evaluated, 5 (2.2%) were co-sensitized and four of them had no FA at baseline evaluation and maintained asymptomatic along the study. Only one patient had already FA and developed new ones on follow-up: a 32 years-old female with melon Oral Allergy Syndrome (OAS) and rhinoconjunctivitis. In the initial evaluation, SPT were positive for pollens, cat, LTP, profilin and melon. Months later she referred cutaneous pruritus when peeling peach and OAS for tomato and cherry. SPT for peach, strawberry, plum, cherry, apricot, apple, tomato and nectarine were positive. At the time, she ate apple without symptoms. Two months later, the patient referred OAS with apple skin and an anaphylactic reaction with pomegranate. Pomegranate’s prick-prick tested positive. The molecular profile ISAC was positive for cross-reactivity components LTPs and Profilin. Months later she referred a new cantaloupe OAS. She initiated Pru p 3 SLIT and had recurrent lip angioedema during the build-up phase, only achieving the target dose on the 5th month. She referred new OAS with lettuce 4 days after starting the SLIT and with watermelon 10 months after. The patient is currently under SLIT for 14 months without intercurrences and has already eaten cherry again without symptoms.
Conclusion: In our sample co-sensitization doesn’t seemed to be a determinant factor for the development of FA given the fact that four out of five patients co-sensitized to LTP/Profilin stayed asymptomatic and only one developed FA. Pru p 3 SLIT seems to be already inducing tolerance to some previously sensitized foods. In order to find the culprit to each new symptom future inhibition studies should be performed.