Allergy to lipid transfer proteins (LTP) in a pediatric

Background. Lipid transfer proteins (LTP) are considered important plant -food allergens in the Mediterranean area, but little is known about LTP allergy in pediatric age. Our aim was to characterize LTP allergy in children. Methods. We reviewed the clinical data from all children evaluated in our department with LTP allergy. From the 76 patients with LTP allergy, 26 children were included, 50% female, median age 10 years (1-17). Symptoms included urticaria in 58% (n = 15), anaphylaxis in 46% (n = 12) and OAS in 42% (n = 11). Results. Multiple reactions with different foods occurred in 69%. Cofactors were reported in 27% (n = 7). All patients had positive SPT to peach LTP extract and slgE Pru p 3. No association between the oc-currence of severe reactions and slgE to Pru p 3 (p = 0.462), slgE to Cor a 8 (p = 0.896), SPT to peach LTP extract (p = 0.846) or the number of positive SPT to fruits/tree nuts (p = 0.972; p = 0.676) was found. Ninety-two per-cent of the patients tolerated fruits from Rosacea family without peel. Twelve percent reported reactions to new LTP containing foods during follow-up. LTP allergy can occur since early childhood. Conclusions. Since anaphylaxis is common and cofactors act as severity enhancers, it is fundamental to recog-nize LTP allergy in children. Currently available diagnostic tests (SPT and slgE) cannot accurately predict food tolerance or anticipate reaction severity.