ALEX³ Case #3

Nestor, 22 years from Valencia

Clinical history

Since late childhood: Perennial rhinoconjunctivitis with accentuated severity from end of April to beginning of June; In-vitro tests and SPTs: positive for mites, olive and mugwort; AIT for olive and mites was initiated and significantly relieved the respiratory symptoms

Family history

Both parents do not have any allergic disease

Present situation

Oral allergy syndrome and nausea/vomiting was reported after the ingestion of peach and other stone fruits

Nestor's ALEX³ test results

Allergen source Allergen

European ash

Fra e 1

Olive

Ole e 1

Olive

Ole e 7

Mugwort

Art v 3

D. farinae

Der f 1

D. farinae

Der f 2

D. pteronyssinus

Der p 1

D. pteronyssinus

Der p 2

Allergen source Biochemical designation

European ash

Ole e 1 family

Olive

Ole e 1 family

Olive

nsLTP

Mugwort

nsLTP

D. farinae

Cysteine protease

D. farinae

NPC2

D. pteronyssinus

Cysteine protease

D. pteronyssinus

NPC2

Allergen source IgE Level [kUA/L]

European ash

19.07

Olive

22.14

Olive

15.03

Mugwort

10.65

D. farinae

23.05

D. farinae

7.08

D. pteronyssinus

36.32

D. pteronyssinus

28.92

Allergen source Allergen

Apple

Mal d 3

Peach

Pru p 3

Cherry

Pru av 3

Hazelnut

Cor a 8

Walnut

Jug r 3

Sunflower seed

Hel a 3

Peanut

Ara h 9

Allergen source Biochemical designation

Apple

nsLTP

Peach

nsLTP

Cherry

nsLTP

Hazelnut

nsLTP

Walnut

nsLTP

Sunflower seed

nsLTP

Peanut

nsLTP

Allergen source IgE Level [kUA/L]

Apple

19.8

Peach

24.36

Cherry

15.43

Hazelnut

0.46

Walnut

1.06

Sunflower seed

0.72

Peanut

3.87

Analysis

Tree and weed pollen

  • Genuine sensitisation to olive pollen Ole e 1, positivity to cross-reactive ash allergen, olive nsLTP positive, linking pollen exposure with the LTP pattern
  • Positive SPT result against mugwort pollen was confirmed: Art v 3 is cross-reactive to Pru p 3

House dust mites

  • Confirmation of mite allergy

Fruit and nut allergens

  • Fruit and nut sensitisation (apple, peach, cherry, hazelnut, walnut, sunflower seed, peanut) all nsLTPs, forming a typical LTP syndrome profile
  • No clinical reactions to nuts have been reported so far, however, the detected nsLTPs are considered high-risk allergens associated with systemic reactions and anaphylaxis in sensitised individuals