Background and objective: Patients sensitized to lipid transfer protein (LTP)
present a wide clinical variability. The lack of practical diagnostic and therapeutic
guidelines complicate their management. The aim of the study was to describe
the clinical approach of Spanish allergists to this pathology using a survey
designed by PICO method and subsequent Delphi approach validation.
Methods: Designed survey was answered by 224 allergists (75% women; 57.1%
with >20 years of professional experience). Homogeneity regarding clinical
practice on the main points of LTP allergy diagnosis was observed, except for
patients with suspected NSAID hypersensitivity (44.6% frequently include LTP
skin testing). Oral food challenges were not frequently performed (63.6%
occasionally to never), and they were generally (75.5%) used to confirm
tolerance. It was common to recommend fruit skins avoidance (77.2%) and
maintaining consumption of foods to which patients are sensitised but tolerant
(99.1%).
Results: There was heterogeneity on other dietary indications, modifications due
to co-factors, or traces avoidance. Peach sublingual immunotherapy (SLIT) was
considered very/quite effective by 55.9% of allergists. The majority (79.5%)
consider SLIT indicated in <25% of LTP allergic patients, based on severity
(95.2%), frequency of reactions (99.4%), allergy to multiple food families (97.4%),
and the quality of life/nutrition impairment (91.5%). There was different practice
on SLIT prescription based on co-factor involvement.
Conclusion: These data suggest that there is a need to increase evidence to
reduce the clinical practice heterogeneity in the management of LTP allergy
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