{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:24:41Z","timestamp":1765185881099,"version":"3.46.0"},"reference-count":10,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Lipid transfer protein (LTP) syndrome is a leading cause of primary food allergy in Mediterranean countries, often associated with severe reactions. Due to in vitro cross-reactivity among plant foods, clinical manifestations are unpredictable, frequently requiring multiple oral food challenges (OFC) to assess nut tolerance. These procedures increase healthcare burden and patient anxiety. This study evaluated the safety and utility of a mixed-nut oral food challenge (MixNut) in LTP-sensitized patients. Methods: In this prospective observational multi-center study, patients with LTP syndrome were enrolled. Group A included individuals allergic to fruits or vegetables who had avoided nuts; Group B included patients with suspected or confirmed nut allergy. Participants underwent a MixNut challenge comprising 2\u20134 nuts (\u22653 g protein per nut). Results: Nineteen patients (73.7% male; median age 32.5 years) underwent MixNut, testing 52 individual nuts. All challenges were negative. The MixNut approach reduced the number of OFC by 63% (from 52 to 19) and total testing time from 208 to 76 h. Specific IgE levels to LTP allergens (Pru p 3, Cor a 8, Ara h 9) varied widely and did not predict clinical reactivity. Conclusions: MixNut is an efficient diagnostic tool for LTP syndrome, significantly reducing testing time, costs, and patient burden. It facilitates accurate dietary management and prevents unnecessary food avoidance. Further studies should optimize MixNut protocols and identify predictive markers for clinical reactivity.<\/jats:p>","DOI":"10.3390\/nu17243822","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:17:36Z","timestamp":1765185456000},"page":"3822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mixed Nut Challenge Test (MixNut) as an Efficient Procedure in the Management of Lipid Transfer Protein Allergy"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2765-3581","authenticated-orcid":false,"given":"Diana","family":"Betancor","sequence":"first","affiliation":[{"name":"Department of Allergy, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez Diaz, D\u00edazAv Reyes Cat\u00f3licos, 2, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-9758","authenticated-orcid":false,"given":"Elisa","family":"Haroun","sequence":"additional","affiliation":[{"name":"Department of Allergy, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"De las Heras Gozalo","sequence":"additional","affiliation":[{"name":"Department of Allergy, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez Diaz, D\u00edazAv Reyes Cat\u00f3licos, 2, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4678-7967","authenticated-orcid":false,"given":"Carlos","family":"Pastor-Vargas","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2766-2955","authenticated-orcid":false,"given":"Javier","family":"Cuesta-Herranz","sequence":"additional","affiliation":[{"name":"Department of Allergy, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez Diaz, D\u00edazAv Reyes Cat\u00f3licos, 2, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Betancor, D., Gomez-Lopez, A., Villalobos-Vilda, C., Nu\u00f1ez-Borque, E., Fern\u00e1ndez-Bravo, S., De Las Heras Gozalo, M., Pastor-Vargas, C., Esteban, V., and Cuesta-Herranz, J. (2021). LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later. Nutrients, 13.","DOI":"10.3390\/nu13072165"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"156","DOI":"10.23822\/EurAnnACI.1764-1489.57","article-title":"Allergy to LTP: To eat or not to eat sensitizing foods? A follow-up study","volume":"50","author":"Asero","year":"2018","journal-title":"Eur. Ann. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"AB249","DOI":"10.1016\/j.jaci.2017.12.790","article-title":"Safety of Mixed Tree Nut Oral Food Challenges in the Management of Multi-Tree Nut Allergic Children and Adolescents","volume":"141","author":"Carlisle","year":"2018","journal-title":"J. Allergy Clin. 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Allergy"},{"key":"ref_7","unstructured":"Australasian Society of Clinical Immunology and Allergy (ASCIA) (2023). ASCIA Health Professional Food Allergy Challenge (FAC) Protocol: Mixed Tree Nuts, ASCIA. Available online: https:\/\/www.allergy.org.au\/images\/stories\/pospapers\/fac\/ASCIA_HP_FAC_Protocol_Mixed_Tree_Nuts_2023.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"41","DOI":"10.53151\/2531-3916\/2024-600","article-title":"Oral food challenge with a mix of tree nuts for IgE-mediated nuts allergy in children: Oral food challenge in nuts allergy","volume":"38","author":"Camarda","year":"2025","journal-title":"Ital. J. Pediatr. Allergy Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e14276","DOI":"10.1111\/pai.14276","article-title":"AAAAI-EAACI PRACTALL: Standardizing oral food challenges-2024 Update","volume":"35","author":"Sampson","year":"2024","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.jaci.2017.05.008","article-title":"ImmunoCAP assays: Pros and cons in allergology","volume":"140","author":"Hamsten","year":"2017","journal-title":"J. Allergy Clin. Immunol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/24\/3822\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:20:25Z","timestamp":1765185625000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/24\/3822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":10,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["nu17243822"],"URL":"https:\/\/doi.org\/10.3390\/nu17243822","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,6]]}}}