Abstract

COSTA, Ana Célia et al. Sublingual immunotherapy with peach (Pru p 3): Efficacy and safety. Rev Port Imunoalergologia [online]. 2015, vol.23, n.4, pp.211-222. ISSN 0871-9721.

Introduction: Peach allergy is prevalent, persistent, and potentially severe. The Pru p 3 (lipid transfer protein, LTP) is the main allergen involved. The high risk of severe reactions and the possibility of the majority of patients react to other foods containing LTPs (LTP syndrome), makes this type of allergy an important target for specific immunotherapy (IT). Aims: Demonstrate the efficacy and safety of sublingual IT(SLIT) with peach (Pru p 3) in patients with systemic reactions(SR) associated with peach ingestion, by evaluation of clinical and immunological parameters during 12 months. Methods: Ten patients (8F,2M;19-41; 26.2 years) with a history of peach allergy, confirmed by Oral Food Challenge (OFC) or anaphylaxis symptoms, undergoing SLIT-Prup3 during 1 year.100% patients had SR (80% anaphylaxis) associated with peach ingestion (60% symptoms with other foods containing LTPs). Patients underwent skin prick tests(SPT) with aeroallergens battery, peach extract peel and pulp, other foods according to symptoms, Pru p 3 and Pho d 2. The SLIT-Prup3 had an induction phase (4days), followed by a maintenance phase (3 years). We performed SPT and quantified specific IgE, IgA, IgG4 for peach and Pru p 3 before (T0), 1 (T1), 6 (T6) and 12 months (T12) after SLIT initiation; Basophil Activation Test (BAT) with Pru p 3 extract in three concentrations (0.05, 0.5 and 5ug/mL) at the same times; OFC with peeled peach at T12. Results: T0-T12: significant decrease of the mean wheal diameter of SPT with peel and pulp peach (p=0.0039), Pru p 3 (p=0.0078), sIgE to peach (p=0.0046) and Pru p 3 (p=0.0089); significant increase of sIgG4 (p=0.0020) and no changes of sIgA for the same allergens; significant decrease between time points and concentrations in BAT; negative OFC with peeled peach in all pts at T12. Local reactions (itching) occurred only during the induction phase in 60% of patients(spontaneous resolution), without other reactions along 12 months. Conclusions: These data suggests that SLIT-Prup3 seems to be a promising and safe therapeutic option for patients with severe peach allergy.

Keywords : Peach allergy; specific IgE; specific IgG4; sublingual immunotherapy; oral food challenge; lipid transfer proteins; Pru p 3; LTP syndrome; basophil activation test.

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