Olive pollen allergy and nsLTP food allergy:
One of the best models to understand the link between pollen exposure,
sensitization profiles, and clinical impact is the olive pollen allergy
model. Minor allergen sensitization is frequent in areas of very high
exposure. Interestingly, sensitization to Ole e 7 − the nsLTP from olive
pollen − is associated with a unique clinical phenotype29,35.
Patients living in areas with high olive pollen exposure and sensitized
to Ole e 7 develop a severe respiratory allergic phenotype. These
patients do not respond to AIT and constitute another model to
understand evolution to severe allergic phenotypes. In Figure 2 an
algorithm to support the selection of olive pollen AIT is shown.
There are other pollens where nsLTPs play a preponderant role, asParietaria judaica , whose main allergen is a LTPs, orArtemisia artimisifolia and Platanus orientalis , whose Art
v 3 or Pla a 3 are LTPs. Art v 3 and Pla a 3 cross-react with Pru p 3
which complicates the differential diagnosis of the primary
sensitization (to pollen or peach).
LTP-mediated allergy is the predominant food allergy in adults in the
Mediterranean Area and Southern European countries44,45.
Pru p 3 − the peach LTP − is the best marker for LTP allergy. Sublingual
AIT has proved to be effective for the treatment of LTP allergy, with
clinical effect not only against allergy to closely related food species
such as Rosaceae fruits46, but also against
allergy to species with about only 60% sequence identity, such as the
Peanut LTP, Ara h 947,48.
Evaluating the spectrum of recognition to multiple LTPs is needed to
make a potential AIT therapeutic decision. Patients sensitized to LTPs
distant to Pru p 3 such as wheat Tri a 14 might not benefit completely
from AIT based on Pru p 3. Unfortunately, SLIT AIT for LTP allergy is
only available in a limited number of Countries. Figure 3 summarizes
decision trees for LTP mediated AIT