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