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Lettuce Allergy Is a Lipid Transfer Syndrome-Related Food Allergy With a High Risk of Severe Reactions

Muñoz-García E1,2,3, Luengo-Sánchez O1,4, Moreno-Pérez N1,4, Cuesta-Herranz J5, Pastor-Vargas C2*, Cardona V1,4*

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
*These authors contributed equally to this work

J Investig Allergol Clin Immunol 2017; Vol 27(2) : 98-103
doi: 10.18176/jiaci.0110

Background and Objectives: 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 has been described as a common offending food in patients with LTP syndrome. The aim of the study was to investigate the frequency and clinical expression of LTP syndrome in a sample of lettuceallergic patients.
Methods: We determined specific IgE to Pru p 3 and lettuce in a sample of 30 patients with a diagnosis of lettuce allergy. Symptoms elicited by other LTP-containing plant-derived foods and the presence of cofactors were assessed.
Results: The clinical symptoms of lettuce allergy were frequently severe, with 18 of the 30 patients experiencing anaphylaxis. All the patients had allergic reactions to other plant foods. Cofactors were involved in the clinical reactions of 13 of the 30 patients. Sensitization to pollens was found in 90% of patients.
Conclusions: Lettuce allergy is found not as an isolated condition but in the context of LTP syndrome and it is characterized by severe reactions and frequent cofactor association.

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