Um caso de alergia a romã e a noz – qual o papel da proteína de transferência lipídica Pru p 3?
A case of allergy to pomegranate and walnut: what is the role of lipid transfer protein Pru p 3?
Alexandra Fernandes; Cristina Madureira; Sylvia Jacob; Susana Lopes; Fernanda Carvalho
Resumo
As proteínas de transferência lipídica (LTPs) são pan-alergênios responsáveis pela reatividade cruzada entre frutos, vegetais e polens. A Pru p 3 (LTP presente no pêssego) é reconhecida como marcador de gravidade na alergia alimentar. A romã e a noz são frutos relatados como causas de reações alérgicas devido à existência de LTPs. Reportamos o caso de um adolescente admitido por urticária e edema labial após ingestão de romã, com história prévia semelhante após ingestão de noz. Os testes cutâneos revelaram positividade para extratos comerciais de noz e para a polpa de romã, e foram negativos para gramíneas e pêssego. Apresentava um doseamento de imunoglobulina E (IgE) total de 87,2 UI/mL e IgE específicas (sIgE) para noz e avelã positivas. O doseamento de sIgE pelo método ISAC (immuno-solid-phase allergen chip) revelou positividade para os alergênios da avelã (Cor a 8), do pêssego (Pru p 3) e da noz (Jug r 3). Não havia história de reação alérgica à ingestão de pêssego. O caso questiona a relevância da sensibilização ao Pru p 3 em doentes não alérgicos ao pêssego, e se este será o único marcador de reação cruzada com a romã.
Palavras-chave
Abstract
Lipid transfer proteins (LTPs) are pan-allergens that are responsible for cross-reactivity between fruits, vegetables, and pollen. Pru p 3, the LTP present in the peach, is recognized as a marker of severity in food allergy. Pomegranate and walnut have been reported to be involved in allergic reactions due to the existence of LTPs. We report the case of a teenager admitted with rash and swollen lips after the ingestion of pomegranate, and reporting a similar reaction in the past after ingesting walnut. Skin tests showed positive results for commercial extracts of walnut and pomegranate pulp, and were negative for grass and peach. The total immunoglobulin E (IgE) was 87.2 IU/mL and specific IgE (sIgE) testing for walnut and hazelnut was positive. sIgE determination using the ISAC method (immuno-solid-phase allergen chip) was positive for hazelnut (Cor A 8), peach (Pru p 3) and walnut (Jug r3). There was no history of allergic reaction after the ingestion of peach. The present case questions the relevance of Pru p 3 in patients who are not allergic to peach, and whether this is the only cross-reactive marker with pomegranate.
Keywords
References
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Submitted date:
06/09/2017
Accepted date:
08/15/2017
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