IgE-mediated lipid transfer protein allergy in children.

Lipid Transfer Protein (LTP) allergy, traditionally more prevalent in adults from Southern Europe, is increasingly recognized in pediatric populations worldwide. This review explores the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of LTP allergy in children. LTP allergy can present with severe systemic symptoms both in children and adults; in children-only studies, anaphylaxis is reported in up to half of the patients. Moreover, children often display polysensitization to multiple plant-based foods. The prevalence of LTP allergy among children remains under-researched, contributing to diagnostic and clinical practice variability. Key allergenic sources involved include peach (Pru p 3) and other Rosaceae fruits, as well as tree nuts, with cofactors such as physical activity frequently triggering or exacerbating reactions. Advancements in understanding natural tolerance and targeted therapies, along with expanding LTP immunotherapy, offer promising directions for improving the management of this challenging condition in pediatric patients.