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Clinical management of plant food allergy in patients sensitized to lipid transfer proteins is heterogeneous: identifying the gaps

García BE1,2,3, Mateo-Borrega MB4,5, Garrido S1, D’Amelio CM2,5,6, Compés E7, Villareal O8, García-Núñez I9, Goikoetxea MJ2,5,6

1Department Allergology, Hospital Universitario de Navarra, Pamplona, Spain
2Health Research Institute (IDISNA, Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain
3CIBER de Enfermedades Respiratorias (CIBERES), Spain
4Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
5RICORS Red De Enfermedades Inflamatorias (REI) - RD21/0002/0028, Madrid, Spain
6Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
7Allergy Service. Royo Villanova Hospital, Zaragoza, Spain
8Allergy Service. Hospital Universitario de Álava, Vitoria, Spain
9Allergy Service. Quirón Salud Córdoba and Quirón Salud Campo de Gibraltar, Spain

J Investig Allergol Clin Immunol 2024; Vol. 34(6)
doi: 10.18176/jiaci.0947

Background and objective: Patients sensitized to lipid transfer protein (LTP) present a wide clinical variability. The lack of practical diagnostic and therapeutic guidelines complicate their management. The aim of the study was to describe the clinical approach of Spanish allergists to this pathology using a survey designed by PICO method and subsequent Delphi approach validation.
Methods: Designed survey was answered by 224 allergists (75% women; 57.1% with >20 years of professional experience). Homogeneity regarding clinical practice on the main points of LTP allergy diagnosis was observed, except for patients with suspected NSAID hypersensitivity (44.6% frequently include LTP skin testing). Oral food challenges were not frequently performed (63.6% occasionally to never), and they were generally (75.5%) used to confirm tolerance. It was common to recommend fruit skins avoidance (77.2%) and maintaining consumption of foods to which patients are sensitised but tolerant (99.1%).
Results: There was heterogeneity on other dietary indications, modifications due to co-factors, or traces avoidance. Peach sublingual immunotherapy (SLIT) was considered very/quite effective by 55.9% of allergists. The majority (79.5%) consider SLIT indicated in <25% of LTP allergic patients, based on severity (95.2%), frequency of reactions (99.4%), allergy to multiple food families (97.4%), and the quality of life/nutrition impairment (91.5%). There was different practice on SLIT prescription based on co-factor involvement.
Conclusion: These data suggest that there is a need to increase evidence to reduce the clinical practice heterogeneity in the management of LTP allergy.

Key words: Avoidance-diet, Diagnosis, Food allergy, Lipid transfer protein, Management, Peach allergy, Sublingual immunotherapy, Treatment