Lettuce Allergy Is a Lipid Transfer Syndrome-Related Food Allergy With a High Risk of Severe Reactions

J Investig Allergol Clin Immunol. 2017;27(2):98-103. doi: 10.18176/jiaci.0110. Epub 2016 Sep 9.


Background and objective: Lipid transfer protein (LTP) sensitization is the most common cause of food allergy in the Mediterranean area, with peach allergy acting as the primary sensitizer in most cases. Lettuce has been described as a common offending food in patients with LTP syndrome. The aim of the study was to investigate the frequency and clinical expression of LTP syndrome in a sample of lettuceallergic patients.

Methods: We determined specific IgE to Pru p 3 and lettuce in a sample of 30 patients with a diagnosis of lettuce allergy. Symptoms elicited by other LTP-containing plant-derived foods and the presence of cofactors were assessed.

Results: The clinical symptoms of lettuce allergy were frequently severe, with 18 of the 30 patients experiencing anaphylaxis. All the patients had allergic reactions to other plant foods. Cofactors were involved in the clinical reactions of 13 of the 30 patients. Sensitization to pollens was found in 90% of patients.

Conclusions: Lettuce allergy is found not as an isolated condition but in the context of LTP syndrome and it is characterized by severe reactions and frequent cofactor association.

Keywords: Anaphylaxis; Cofactor; Food allergy; LTP syndrome; Lettuce allergy; Lipid transfer protein.

MeSH terms

  • Adolescent
  • Adult
  • Anaphylaxis / blood
  • Anaphylaxis / diagnosis
  • Anaphylaxis / immunology*
  • Antigens, Plant / administration & dosage
  • Antigens, Plant / adverse effects*
  • Antigens, Plant / immunology
  • Biomarkers / blood
  • Carrier Proteins / adverse effects*
  • Carrier Proteins / immunology
  • Female
  • Food Hypersensitivity / blood
  • Food Hypersensitivity / diagnosis
  • Food Hypersensitivity / immunology*
  • Fruit / adverse effects
  • Fruit / immunology
  • Humans
  • Immunoglobulin E / blood
  • Immunologic Tests
  • Lettuce / adverse effects*
  • Lettuce / immunology
  • Male
  • Middle Aged
  • Plant Leaves / adverse effects*
  • Plant Leaves / immunology
  • Plant Proteins / administration & dosage
  • Plant Proteins / adverse effects*
  • Plant Proteins / immunology
  • Predictive Value of Tests
  • Prunus persica / adverse effects
  • Prunus persica / immunology
  • Rhinitis, Allergic, Seasonal / diagnosis
  • Rhinitis, Allergic, Seasonal / immunology
  • Risk Factors
  • Severity of Illness Index
  • Young Adult


  • Antigens, Plant
  • Biomarkers
  • Carrier Proteins
  • Plant Proteins
  • Pru p 3 allergen
  • lipid transfer proteins, plant
  • Immunoglobulin E