Diagnosis and Management of Lipid Transfer Protein Allergy—A BSACI Clinical Practice Statement

Although the most prevalent plant food allergy in the United Kingdom (UK) is pollen food syndrome (PFS), there is increasing evidence that reactions to plant foods could also be due to sensitisation to Lipid Transfer Proteins (LTP). These proteins, highly resistant to heat and processing, are present in raw, cooked and processed plant foods and often provoke moderate to severe symptoms. LTP allergy is common in Mediterranean countries, but there is a lack of epidemiological data from Northern Europe, although small case series have been published characterising LTP allergy in both England and Scotland. To gather further information and aid the development of a clinical practice statement on LTP allergy, a survey was conducted by the British Society of Allergy and Clinical Immunology (BSACI). The results confirmed that LTP allergy is being diagnosed in both children and adults in all areas of the UK. The survey results, along with published UK data, confirm that tree nuts, peanuts, apples, stone fruits, tomatoes and processed foods, such as pizza or curry, are common food triggers. Anaphylactic reactions are not uncommon and are often facilitated by the presence of co-factors such as exercise or alcohol. Unlike LTP allergy in Spain and Italy, UK individuals are also more likely to be sensitised to birch and grass pollen, but this does not appear to reduce the severity of the condition. Diagnosis can be complex; a positive test to individual LTP allergens can only be confirmatory of a diagnosis of LTP allergy when accompanied by a typical clinical history. Management can be difficult, and individualised advice is vital to avoid the exclusion of multiple foods and minimise the likelihood of co-factors. Given the diverse range of foods, co-factor involvement and highly idiosyncratic nature of LTP allergy, the need for adrenaline autoinjectors should always be considered.