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Lettuce allergy is a lipid transfer syndrome-related food allergy with high risk of severe reactions

Esther Muñoz-García1,2,3, Olga Luengo-Sánchez1,4, Nuria Moreno-Pérez1,4, Javier Cuesta-Herranz5, Carlos Pastor-Vargas2*, Victoria Cardona1,4*

1Allergy Section, Department of Internal Medicine, Hospital Vall d´Hebron, Barcelona, Spain
2Department of Immunology, IIS- Fundación Jimenez Diaz, UAM, Madrid, Spain
3Hospital Universitario de Getafe, Madrid, Spain.
4Allergy Research Unit, Institut de Recerca Vall d’Hebron, Barcelona, Spain
5Department of Allergy, Fundación Jiménez Díaz, Madrid, Spain

J Investig Allergol Clin Immunol 2017; Vol. 27(2)
doi: 10.18176/jiaci.0110

Background: Lipid transfer protein (LTP) sensitization is the most common cause of food allergy in the Mediterranean area, with peach allergy acting as the primary sensitizer in most cases. Lettuce allergy has been reported as a common offending food in patients affected of LTP syndrome.
Objectives: The aim of the study was to investigate the frequency of LTP syndrome in a sample of lettuce allergic patients and assess its clinical expression.
Methods: We determined sIgE to Pru p 3 and lettuce in a sample of 30 patients with a diagnosis of lettuce allergy. Symptoms with other LTP-containing plant-derived foods, and the presence of cofactors were assessed.
Results: Clinical symptoms in lettuce allergy were frequently severe, 18/30 patients experiencing anaphylaxis. All patients experienced allergic reactions to other plant-foods. In 13/30 patients, cofactors were involved in clinical reactions. Sensitization to pollens was found in 90% of patients.
Conclusions: Lettuce allergy is not found as an isolated condition, but in the context of an LTP syndrome and is characterized by the severity of reactions and frequent cofactor association.

Key words: Anaphylaxis, Cofactor, Food allergy, Lettuce allergy, Lipid transfer protein, LTP syndrome.