Lipid transfer protein-linked hazelnut allergy in children from a non-Mediterranean birch-endemic area.

Research paper by Annebeth E AE Flinterman, Jaap H JH Akkerdaas, Constance F CF den Hartog Jager, Neil M NM Rigby, Montserrat M Fernandez-Rivas, Maarten O MO Hoekstra, Carla A CA Bruijnzeel-Koomen, André C AC Knulst, Ronald R van Ree, Suzanne G SG Pasmans

Indexed on: 27 Nov '07Published on: 27 Nov '07Published in: Journal of Allergy and Clinical Immunology


Hazelnut allergy in birch pollen-exposed areas is usually due to cross-reactivity (Cor a 1 and 2) and is usually mild in nature (oral allergy). In areas without birches, severe reactions are more prevalent and linked to sensitization to the lipid transfer protein (LTP) Cor a 8.We sought to investigate whether sensitization to LTP plays a role in more severe (objective) hazelnut-induced symptoms in children from a birch-endemic area.Sensitization to Cor a 8, Cor a 2, Cor a 1, and Bet v 1 was determined by means of RASTs and immunoblotting in hazelnut-sensitized children with (n = 8) and without (n = 18) objective reactions during double-blind, placebo-controlled food challenges. Additionally, samples from 191 hazelnut-sensitized nonchallenged children were analyzed.Children with objective reactions during double-blind, placebo-controlled food challenge had higher IgE titers to hazelnut (P < .001) and recognized more allergens on immunoblotting (P = .001) than those without such reactions. All children with objective symptoms were sensitized to Cor a 8 (0.51-23.3 IU/mL) compared with only 1 child without objective reactions (0.90 IU/mL). In a multivariate analysis only IgE against Cor a 8 remained as an independent risk factor (undefined odds ratio; P < .0001). In the group of nonchallenged children (n = 191), the prevalence of LTP sensitization was greater than 30%. Unexpectedly, sensitization to Cor a 1 was observed in children not sensitized to Bet v 1.Sensitization to hazelnut LTP is a risk factor for objective symptoms in children from a birch-endemic area.

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