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Pasioti M, Xepapadaki P, Mathioudakis AG, Lakoumentas J, Efstathiou E, Papadopoulos NG. Current options in the management of tree nut allergy: A systematic review and narrative synthesis. Pediatr Allergy Immunol 2024; 35:e14132. [PMID: 38727626 DOI: 10.1111/pai.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/19/2024] [Accepted: 04/10/2024] [Indexed: 07/12/2024]
Abstract
Tree nut allergy is a lifelong and potentially life-threatening condition. The standard of care is strictly avoiding the culprit nut and treating accidental reactions symptomatically. To evaluate potential therapeutic options for desensitizing patients with IgE-mediated tree nut allergy, we systematically searched three bibliographic databases for studies published until January 2024. We looked for active treatments of IgE-mediated allergy to tree nuts (walnut, hazelnut, pistachio, cashew, almond, pecan, macadamia nut, and brazil nut). We focused on allergen-specific immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous (EPIT), or subcutaneous (SCIT) delivery, or other disease-modifying treatments. We found 19 studies that met our criteria: 3 studies investigated sublingual immunotherapy, 5 studied oral immunotherapy to a single tree nut, and 6 used multi-food oral immunotherapy with or without omalizumab. The remaining studies investigated the effectiveness of monoclonal antibodies or IgE-immunoadsorption in multi-food allergic patients, including patients with tree nut allergy. The heterogeneity of the studies prevented pooling and meta-analysis. Oral immunotherapy, single or multi-nut, with or without omalizumab, was the most studied approach and appears effective in conferring protection from accidental exposures. Omalizumab monotherapy is the only approved alternative management for reducing allergic reactions that may occur with accidental exposure.
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Affiliation(s)
- Maria Pasioti
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - John Lakoumentas
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Elvira Efstathiou
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Brasal-Prieto M, Fernández-Prades L, Dakhaoui H, Sobrino F, López-Enríquez S, Palomares F. Update on In Vitro Diagnostic Tools and Treatments for Food Allergies. Nutrients 2023; 15:3744. [PMID: 37686776 PMCID: PMC10489659 DOI: 10.3390/nu15173744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Food allergy (FA) is an adverse immunological reaction to a specific food that can trigger a wide range of symptoms from mild to life-threatening. This adverse reaction is caused by different immunological mechanisms, such as IgE-mediated, non-IgE-mediated and mixed IgE-mediated reactions. Its epidemiology has had a significant increase in the last decade, more so in developed countries. It is estimated that approximately 2 to 10% of the world's population has FA and this number appears to be increasing and also affecting more children. The diagnosis can be complex and requires the combination of different tests to establish an accurate diagnosis. However, the treatment of FA is based on avoiding the intake of the specific allergenic food, thus being very difficult at times and also controlling the symptoms in case of accidental exposure. Currently, there are other immunomodulatory treatments such as specific allergen immunotherapy or more innovative treatments that can induce a tolerance response. It is important to mention that research in this field is ongoing and clinical trials are underway to assess the safety and efficacy of these different immunotherapy approaches, new treatment pathways are being used to target and promote the tolerance response. In this review, we describe the new in vitro diagnostic tools and therapeutic treatments to show the latest advances in FA management. We conclude that although significant advances have been made to improve therapies and diagnostic tools for FA, there is an urgent need to standardize both so that, in their totality, they help to improve the management of FA.
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Rossi CM, Lenti MV, Merli S, Licari A, Marseglia GL, Di Sabatino A. Immunotherapy with Pru p 3 for food allergy to peach and non-specific lipid transfer protein: a systematic review. Clin Mol Allergy 2023; 21:3. [PMID: 37259099 DOI: 10.1186/s12948-023-00184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/28/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Non-specific lipid-transfer protein (nsLTP) is a pan-allergen in the plant world, and a cause of significant concern as food allergen in the Mediterranean area, due to its general heat- and acid-resistance and hence the risk of severe allergic reactions. Pru p 3, the peach nsLTP, is considered the primary sensitizer to this allergen family and this allergy is usually persistent. Allergen-free diet and acute treatment of manifestations are the main recognized management goals in food allergy. MAIN TEXT The role of immunotherapy for treating food allergy in adult patients is controversial, but immunotherapy for Pru p 3 could potentially represent a relevant therapeutic strategy. We systematically searched databases for studies assessing the role of immunotherapy Pru p 3 in food allergy. Overall, nine studies were included. Immunotherapy with Pru p 3 appears to be effective and with a good safety profile in both peach and LTP allergy for some foods, such as peanut, in both RCT and real-life studies. CONCLUSIONS Immunotherapy with Pru p 3 is a possible treatment option for food allergy to the peach LTP in the Mediterranean area, although at present have not reached routinary clinical practice. Larger studies are needed to confirm these findings and identify predictive biomarkers.
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Affiliation(s)
- Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Stefania Merli
- First Department of Internal Medicine, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Amelia Licari
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy.
- First Department of Internal Medicine, Fondazione IRCCS San Matteo, Pavia, Italy.
- Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università Di Pavia, Viale Golgi 19, 27100, Pavia, Italy.
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Martin Iglesias MA, Garcia Rodriguez R, Palacios Cañas A, Meneses Sotomayor JV, Clar Castello M, Feo Brito F. Combined LTP Sublingual and Oral Immunotherapy in LTP Syndrome: Efficacy and Safety. J Clin Med 2023; 12:jcm12051823. [PMID: 36902611 PMCID: PMC10003230 DOI: 10.3390/jcm12051823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION SLIT for the treatment of plant food allergies has been demonstrated to be safe but less effective than OIT, but the latter is associated with more adverse reactions. The aim of the study was to evaluate the efficacy and safety of a new protocol starting with SLIT-peach followed by OIT with commercial peach juice in patients with LTP syndrome. METHODS This was a prospective, noncontrolled, open study on patients with LTP syndrome who are not sensitized to storage proteins. SLIT peach ALK was followed by OIT with Granini® peach juice after 40 days of the SLIT maintenance phase. At home, the Granini® juice dose was progressively increased during the 42 days until reaching 200 ml. After achieving the maximum dose, an open oral food challenge was carried out with the food that had caused the most severe reaction. If negative, the patient was instructed to progressively introduce the foods that were avoided before starting immunotherapy at home. Patients were reviewed 1 month later. The quality-of-life questionnaire FAQLQ-AF was completed at the beginning of the study and one month after the final challenge. RESULTS Forty-five patients were included, most of them with LTP anaphylaxis. Peach SLIT was well tolerated in 80.5%, and OIT with Granini® was well tolerated in 85%, with no severe adverse reactions. The final provocation was successful in 39/45 (86.6%). One month after the final provocation, 42/45 (93.3%) patients had no dietary restrictions. FAQLA-AF was significantly reduced. CONCLUSIONS This combination of peach SLIT and OIT with commercial peach juice provides a new, fast, effective, and safe immunotherapy option for selected patients with LTP syndrome who are not allergic to storage proteins, improving their quality of life. This study suggests that cross-desensitization relative to the nsLTPs of several plant foods can be achieved by using Prup3.
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Wolters P, Ostermann T, Hofmann SC. Lipid‐Transfer‐Protein‐Allergie: Charakterisierung und Vergleich mit birkenpollenassoziierter Nahrungsmittelallergie. J Dtsch Dermatol Ges 2022; 20:1430-1440. [DOI: 10.1111/ddg.14881_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Paula Wolters
- Zentrum für Dermatologie Allergologie und Dermatochirurgie Helios Universitätsklinikum Wuppertal Universität Witten/Herdecke Wuppertal
| | - Thomas Ostermann
- Lehrstuhl für Forschungsmethodik und Statistik in der Psychologie Fakultät für Gesundheit Universität Witten/Herdecke Witten
| | - Silke C. Hofmann
- Zentrum für Dermatologie Allergologie und Dermatochirurgie Helios Universitätsklinikum Wuppertal Universität Witten/Herdecke Wuppertal
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Wolters P, Ostermann T, Hofmann SC. Lipid transfer protein allergy: characterization and comparison to birch‐related food allergy. J Dtsch Dermatol Ges 2022; 20:1430-1438. [DOI: 10.1111/ddg.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 12/12/1912] [Accepted: 07/25/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Paula Wolters
- Department of Dermatology Allergy and Dermatosurgery Helios University Hospital Wuppertal University Witten/Herdecke Wuppertal Germany
| | - Thomas Ostermann
- Department for Psychology and Psychotherapy, Faculty of Health University Witten/Herdecke Witten Germany
| | - Silke C. Hofmann
- Department of Dermatology Allergy and Dermatosurgery Helios University Hospital Wuppertal University Witten/Herdecke Wuppertal Germany
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Barni S, Caimmi D, Chiera F, Comberiati P, Mastrorilli C, Pelosi U, Paravati F, Marseglia GL, Arasi S. Phenotypes and Endotypes of Peach Allergy: What Is New? Nutrients 2022; 14:998. [PMID: 35267973 PMCID: PMC8912752 DOI: 10.3390/nu14050998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Peach allergy is emerging as a common type of fresh-fruit allergy in Europe, especially in the Mediterranean area. The clinical manifestations of peach allergy tend to have a peculiar geographical distribution and can range from mild oral symptoms to anaphylaxis, depending on the allergic sensitization profile. The peach allergen Pru p 7, also known as peamaclein, has recently been identified as a marker of peach allergy severity and as being responsible for peculiar clinical features in areas with high exposure to cypress pollen. This review addresses the latest findings on molecular allergens for the diagnosis of peach allergy, the clinical phenotypes and endotypes of peach allergy in adults and children, and management strategies, including immunotherapy, for peach allergy.
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Affiliation(s)
- Simona Barni
- Allergic Unit, Department of Pediatric, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France;
- IDESP, UMR A11–INSERM, Université de Montpellier, 34093 Montpellier, France
| | - Fernanda Chiera
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Carla Mastrorilli
- Department of Pediatrics, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy;
| | - Umberto Pelosi
- Pediatric Unit, Santa Barbara Hospital, 09016 Iglesias, Italy;
| | - Francesco Paravati
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Gian Luigi Marseglia
- Department of Pediatrics, University of Pavia, San Matteo Foundation IRCCS Policlinico, 27100 Pavia, Italy;
| | - Stefania Arasi
- Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
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LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later. Nutrients 2021; 13:nu13072165. [PMID: 34202484 PMCID: PMC8308245 DOI: 10.3390/nu13072165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 01/27/2023] Open
Abstract
Introduction: Allergy to nonspecific lipid transfer protein (nsLTP) is the main cause of plant-food allergy in Spain. nsLTPs are widely distributed in the plant kingdom and have high cross-reactivity but extremely variable clinical expression. Little is known about the natural evolution of this allergy, which complicates management. The objective of this study was to assess the development of allergy to new plant foods in nsLTP-sensitized patients 10 years after diagnosis. Methods: One hundred fifty-one patients showing specific IgE to nsLTP determined by ISAC (Thermofisher) were included. After clinical workup (i.e., anamnesis, skin test, and challenge when needed), these patients were divided into two groups: 113 patients allergic to one or more plant food (74.5%) and 38 patients not allergic to any plant food (25.1%). Ten years later, a telephone interview was conducted to check whether patients had developed additional allergic reactions to plant foods. Results: Ten years after diagnosis, 35 of the 113 (31%) plant-food-allergic patients sensitized to nsLTP reported reactions to new, previously tolerated plant foods, mainly Rosaceae/Prunoideae fruits and nuts followed by vegetables, Rosacea/Pomoideae fruits, legumes, and cereals. Five out of 38 (13.2%) patients previously sensitized to nsLTP but without allergy to any plant food had experienced allergic reactions to some plant food: two to Rosaceae/Prunoideae fruits, two to Rosaceae/Prunoideae fruit and nuts, and one to legumes. Conclusion: Patients sensitized to nsLTP developed allergic reactions to other plant foods, mainly Rosaceae-Prunoideae fruits and nuts. This was more frequent among plant-food-allergic patients than among those who had never had plant-food allergy.
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