Abstract

COSTA, Ana Célia et al. Efficacy and tolerance of sublingual immunotherapy with Pru p 3 in patients with peach severe allergy: clinical and immunological follow-up during 12 months. Rev Port Imunoalergologia [online]. 2015, vol.23, n.1, pp.11-19. ISSN 0871-9721.

Background: Peach allergy is prevalent, persistent and potentially severe, involving LTPs (Pru p 3) and profilins (Pru p 4) as main allergens. The hidden presence of LTPs in foodstuffs can trigger severe reactions, including anaphylaxis, being considered an important target for immunotherapy (IT). Aims: Evaluation of clinical and immunological parameters, during 12 months, to demonstrate the efficacy and safety of SLIT with Pru p 3 (SLIT -Pru p 3) in patients with systemic reactions (SR) associated with peach ingestion. Material and Methods: 8 patients (7F,1M; mean age-25.6; 19 -41 years) with a history of peach allergy, confirmed by Oral Food Challenge (unless evidence of anaphylaxis and peach sensitization) undergoing SLIT-Pru p 3 during 1 year, were evaluated. 100% of patients had SR (75% anaphylaxis) associated with peach ingestion (62.5% reported symptoms with other foods containing LTPs). All patients underwent skin prick tests (SPT) to aeroallergens), to peach extract (peel and pulp), to other foods according to symptoms, and to Pru p 3 and Pho d 2 (to excluded profilin sensitization). SLIT-Pru p 3 had an induction phase (4 days in Immunoallergology Department), followed by outpatient maintenance phase (3 years). In all patients were performed SPT and quantified specific IgE and IgG4 (sIgE, sIgG4) to peach and Pru p 3 before (T0), 1 (T1), 6 (T6) and 12 months (T12) after SLIT initiation. Basophil Activation Test (BAT) was performed with Pru p 3 extract in three concentrations 0.05, 0.5, 5ug/ml at the same time points. Results: There was a significant decrease of the mean wheal diameter of SPT in T0-T12, with peel and pulp peach (p=0.0039) and Pru p 3 (p=0.0078). Quantification of sIgE to peach and Pru p 3: significant decrease of T0-T12 (p=0.0122 and p<0.001, respectively); sIgG4: significant increase of T0-T12 (p<0.001) for the same allergens; BAT: significant decrease between all time points and concentrations. Local reactions (itching) occurred only during the induction phase in 50% of patients with spontaneous resolution. No other reactions occurred along 12 months. Conclusions: These data sugest that SLIT with Pru p 3 seems to be a promising and safe therapy for patients with severe peach allergy

Keywords : peach allergy; sublingual immunotherapy; Pru p 3; LTP syndrome.

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