Clinical Management of Plant Food Allergy in Patients Sensitized to Lipid Transfer Proteins Is Heterogeneous: Identifying the Gaps

Abstract

Background and objectives: Patients sensitized to lipid transfer protein (LTP) are characterized by wide clinical variability. The lack of practical diagnostic and therapeutic guidelines complicates their management. The aim of the study was to describe the clinical approach of Spanish allergists to sensitization to LTP.

Methods: We used a survey designed following the PICO method and subsequent validation using the Delphi approach.

Results: The survey was completed by 224 allergists (75% women; 57.1% with >20 years of professional experience). Clinical practice for the main points of diagnosis of LTP allergy was homogeneous, except for patients with suspected hypersensitivity to nonsteroidal anti-inflammatory drugs (44.6% frequently included skin testing with LTP). Oral food challenges were not frequently performed (63.6% occasionally to never) and were generally (75.5%) used to confirm tolerance. It was common to recommend fruit skin avoidance (77.2%) and to maintain consumption of foods to which patients were sensitized but tolerant (99.1%). The results were heterogeneous for other dietary indications, modifications due to cofactors, and trace avoidance. Peach sublingual immunotherapy (SLIT) was considered very/quite effective by 55.9% of allergists. Most (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 impairment of quality of life/nutrition (91.5%). Practice with respect to prescription of SLIT varied based on cofactor involvement.

Conclusions: These data suggest that there is a need to increase evidence to reduce heterogeneity in the clinical management of LTP allergy.

Keywords: Avoidance diet; Diagnosis; Food allergy; Lipid transfer protein; Management; Peach allergy; Sublingual immunotherapy; Treatment.