CASE REPORTS

The Role of Lipid Transfer Proteins in the

Almond Tree and Almond Fruit as Contact
and Airborne Allergens
S Garrido-Fernández,1 BE Garcia,2 ML Sanz,3 S Ariz,3 AI Tabar2
1
Allergology Unit, Hospital Reina Sofía, Tudela, Navarra, Spain
2
Allergology Service, Hospital Virgen del Camino, Pamplona, Navarra, Spain
3
Allergology and Clinical Immunology Department, Clínica Universitaria, Pamplona, Navarra, Spain

Key words: Prunus dulcis. Almond. Lipid transfer protein. Peach.

Contact allergy.
Palabras clave: Prunus dulcis. Almendra. Proteínas trasportadoras
de lípidos. Melocotón. Alergia de contacto.

The almond, which is a member of the Rosaceae family,

is the fruit of the almond tree (Prunus dulcis). It has a hard
endocarp that contains a seed covered by a rough, brownish
skin. Unlike other prunoid fruits, which have an edible 2
1
mesocarp and an outer skin known as the epicarp, the almond
fruit has an epicarp and a mesocarp that are difficult to separate 4 1. Almond Tree Leaf
2. Epicarp-Mesocarp
and have no nutritional or commercial value (Figure 1). 3. Almond Skin
3 4. Seed or Almond
We report the case of a 17-year-old atopic patient referred
for consultation due to eyelid angioedema and rash in exposed
areas related to exposure to or contact with almond tree Figure 1. Parts of almond tree and fruit.
leaves and almond fruit epicarp/mesocarp on the family farm.
Symptoms appeared when he touched or was near almond tree
leaves and/or epicarp/mesocarp. He reported good tolerance seeds used and for the almond seed, skin, and endocarp
to contact with and ingestion of both peeled and unpeeled extracts. Serum specific immunoglobulin (Ig) E (CAP System;
almonds. He also had a history of oral pruritus following the Pharmacia, Uppsala, Sweden) was negative for almond fruit
ingestion of unpeeled peach and rhinoconjunctivitis due to and positive for peach (4.63 kU/L).
house dust mite and cat dander. To aid diagnosis, we performed basophil activation tests
Almond fruit extracts (seed, skin, endocarp, and epicarp/ (BAT) [1] and assessed antigen-specific sulphidoleukotriene
mesocarp) (20% w/v) and almond tree leaf extracts derived production using the cellular antigen stimulation test (CAST)
from raw material were prepared for in vitro analysis and [2] with epicarp/mesocarp (5.8 µg/µL and 1.45 µg/µL), almond
glycerinated at 50% for in vivo analysis. Commercial extracts leaf (1.1 µg/µgL and 0.3 µg/µL), peach pulp (1.25 mg/mL and
of almond seed and peach skin and pulp (Bial Arístegui, Bilbao, 0.31 mg/mL), and peach skin (2.09 mg/mL and 0.52 mg/mL).
Spain) were also used for in vitro analysis. In vitro stimulation was positive for epicarp/mesocarp in BAT
Skin prick tests (SPTs) performed with airborne allergens, and for epicarp/mesocarp, peach skin, and peach pulp in CAST.
food, fruits (including peach skin and pulp), nPru p 3, almond BAT was negative for almond leaf, peach skin, and peach pulp
leaf, seed, skin, endocarp, and epicarp/mesocarp were positive and CAST for almond leaf. Negative SPTs and in vitro results
for peach skin, nPru p 3, almond leaf and epicarp/mesocarp, were also obtained in 5 nonatopic control patients.
among others. They were negative for the 3 types of almond Proteins from epicarp/mesocarp and almond tree leaf

© 2009 Esmon Publicidad J Investig Allergol Clin Immunol 2009; Vol. 19(1): 61-63
62 S Garrido-Fernández, et al

were separated by electrophoresis, which revealed a protein almond (both members of the Rosaceae family) and the
band pattern with molecular weights of between 9 kDa and existence of previous sensitization to peach LTPs could
63 kDa. account for the allergy to LTPs in different almond tree sources,
Immunodetection performed on epicarp/mesocarp and tree with peach LTPs acting as the primary sensitizer through a
leaf extracts with an anti-Pru p 3 monoclonal antibody revealed mechanism of cross-reactivity.
an uptake band of approximately 9 kDa for both structures but The only almond fruit allergens registered in the
which was more intense in the case of the leaf extracts. When official allergen nomenclature of the International Union
immunodetection was performed using the same extracts with of Immunological Societies are Pru du 4 (profilin) [6] and
the patient’s serum and anti-IgE as a secondary antibody, a band Pru du 5 (60S acidic ribosomal protein, unpublished).
of approximately 9 kDa was observed for the epicarp/mesocarp Recently, other allergens such as 2S albumins [7],
extract (Figure 2). conglutinin γ [7], and the almond major storage protein,
Our study found that both almond tree leaves and almond amandin (legumin-like protein) [8] have been described, as has
fruit epicarp/mesocarp were allergenic sources, indicating an LTP in Prunus dulcis sequenced at the RNAm level [9]. Our
the existence of lipid transfer proteins (LTPs) with allergenic findings constitute the first explicit report of the presence of
potential. This is indeed plausible as LTPs are mainly located LTPs (Pru du LTP) in almond fruit and almond tree leaves.
in the external part of plants and vegetables. We conclude that the LTPs present in nonpollinic structures
Although basophils were poorly reactive, evidenced by such as almond fruit epicarp/mesocarp and almond tree leaves
the negative response to anti-IgE (positive control), a positive may behave as contact or airborne allergens and that these
result was obtained for epicarp/mesocarp in BAT and sLT. This panallergens are present and relevant in the almond tree and
might explain the negative response to almond tree leaves in almond fruit.
both these tests.
Although allergies due to members of the Rosaceae
family and LTPs following inhalation [3], contact [4], and Acknowledgments
ingestion [5] have been well documented, we did not find any
reports of airborne urticaria or angioedema caused by either M.L.S. is supported by grant RD07/0064 from the Spanish
of these sources in the literature. Research Network on Adverse Reactions to Allergens and
Prevailing sensitization to LTPs was evidenced by the Drugs (Red de Investigación de Reacciones Adversas a
positive SPT for nPru p 3 and the presence of a protein Alérgenos y Fármacos) of the Carlos III Health Institute.
weighing approximately 9 kDa in epicarp/mesocarp and
almond leaf extracts recognized by the anti-Pru p 3 monoclonal
antibody in both cases and by IgE-detection in the case of References
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 LTPs in almond trees and almond fruit 63

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Email: sara.garrido.fernandez@cfnavarra.es

© 2009 Esmon Publicidad J Investig Allergol Clin Immunol 2009; Vol. 19(1): 61-63