Pectin Intervention Study and Long-term Follow-up in Lipid Transfer Proteins Allergic Patients
- Conditions
- Food Allergy
- Interventions
- Dietary Supplement: Apple pectin (DE 57%)Dietary Supplement: Placebo
- Registration Number
- NCT06558526
- Lead Sponsor
- Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud
- Brief Summary
Pectins are dietary fibers that have shown a health effect on patients with food allergy, as they are capable of modifying the composition of gastrointestinal microbiota, and producing an immunomodulatory effect. Preliminary results by the investigators show that the intervention for 2 months with pectins produces an increase in tolerance to peach, and changes in the microbiota compared to the group of patients treated with placebo. In this project, the investigators aim to study these clinical effects and the involved mechanisms. Moreover, the long-term effect (clinical reactivity to nsLTP and immunomodulatory effect) of the dietary intervention will be prospectively evaluated 6 months after the intervention.
- Detailed Description
Patients of 3 different Allergy Units with clinical history of allergic reactions with peach and with/without reactions with peanut due to sensitization to nsLTP will be informed about the intervention study and potential risks. After obtention of written informed consent, screening phase evaluation will be performed (skin prick tests (SPT), obtention of blood and feces samples and double-blind placebo-controlled food challenges (DBPCFC) with peach and peanut). Participants who meet the eligibility requirements will be randomized in a ratio 1:1 to pectin (apple pectin 10 mg + maltodextrin 5 mg; once daily) or placebo (maltodextrin 5 mg; once daily). The dietary intervention will last 6 months and a follow-up visit in month 3 will be performed. After completing the dietary intervention all participants will be clinically assessed (SPT and DBPCFC) and new blood and feces samples will be collected. Finally, patients who receive the active will be clinically evaluated with DBPCFC to peach and peanut after 6 months of completing the dietary intervention. Also, new blood and feces samples will be obtained.
The main objective is to analyze the clinical efficacy of a pectin dietary supplement administered once a day for 6 months as a treatment for nsLTP allergy in a randomized double-blind placebo-controlled multicenter intervention study. In addition, the investigators will study changes in clinical reactivity to nsLTP and the immunomodulatory effect (immunological humoral and cellular, metabolomics and microbiota profiles). Furthermore, long-term effects of the dietary intervention will be analyzed in participants from the active group (pectin) 6 months after completing the intervention.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 62
- Adults with a clear clinical history of food allergy after eating peach (oral allergy syndrome and/or systemic symptoms) and with or without clinical history of food allergy with peanut.
- Sensitization to Pru p 3 by positive skin prick test (SPT wheal area >7 mm2) and specific IgE (sIgE >0.35 kUA/L)
- Positive DBPCFC with peach juice.
- If clinical history of food allergy with peanut, sensitization must be confirmed by positive SPT to peanut and sIgE >0.35 kUA/L to Ara h 9 and clinical reactivity through a positive DBPCFC with peanut.
- Signed informed consent.
- Food allergy to corn.
- Food allergy to peanut due to sensitization to storage proteins.
- Previous/active treatment with sublingual immunotherapy to Pru p 3.
- Pregnancy/lactation.
- Active infections.
- Inflammatory, autoimmune, and/or oncological diseases.
- Severe immunodeficiency.
- Metabolic syndrome.
- Increased liver parameters and/or any liver disease.
- Alcohol disorder.
- Mental illness.
- Mast cell activation syndrome.
- Severe atopic dermatitis.
- FEV1 < 70%
- Treatment with immunomodulators in the last five years.
- Vitamin supplements, probiotics, prebiotics, antibiotics, metformin, statins, proton pump inhibitors, or corticosteroids in the last three months.
- Any clinical condition contraindicating performance of DBPCFC.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Pectin intervention group Apple pectin (DE 57%) This group will orally take 10 g of apple pectin (DE 57%) + 5 g of maltodextrin once a day during 6 months. Placebo group Placebo This group will orally take 5 g of maltodextrin once a day during 6 months.
- Primary Outcome Measures
Name Time Method Clinical efficacy of a six-month dietary intervention with pectins in patients with food allergy to peach and peanut due to sensitization to nsLTP. 15 months Clinical efficacy will be defined as an increase in oral tolerance to peach and/or peanut determined through the DBPCFCs performed pre- and post- dietary intervention, compared to the Placebo.
- Secondary Outcome Measures
Name Time Method Changes in Pru p 3 and Ara h 9 (nsLTP of peach and peanut, respectively) specific immunoglobulin production (IgE and IgG4) induced by the pectin dietary intervention. 15 months Results will be expresses as kUA/L.
Changes on serum metabolome induced by the pectin dietary intervention. 15 months Metabolomic profile from serum samples will be analyzed by a combination of liquid chromatography-mass spectrometry (LC-MS) and gas chromatography coupled to mass spectrometry (GC-MS). Results will be expressed as μg/mL.
Changes in Pru p 3 and Ara h 9-specific basophil activation induced by the pectin dietary intervention 15 months Results will be presented as the percentage of activated basophils (CD63+CD203c+CCR3+) and basophil allergen threshold sensitivity (CD-Sens).
Changes on gastrointestinal microbiota induced by the pectin dietary intervention. 15 months Analysis of bacteria composition: relative abundance (%) and alpha-, beta diversity as Jensen Shannon divergence (JSD) (PChao1 vs PChao2).
Pectin dietary intervention long-term clinical efficacy. 12 months Peach and peanut oral tolerance after 6 months of completing the dietary intervention with the active (pectin) will be determine through DBPCFCs.
Pectin dietary intervention long-term effect on the gastrointestinal microbiota. 12 months Analysis of gastrointestinal microbiota composition after 6 months of completing the dietary intervention with the active (pectin). Relative abundance (%) and alpha-, beta diversity as Jensen Shannon divergence (JSD) (PChao1 vs PChao2).
Pectin dietary intervention long-term effect on serum metabolome. 12 months Analysis by a combination of mass spectrometry techniques after 6 months of completing the dietary intervention with the active (pectin). Results will be expressed as μg/mL.
Pectin dietary intervention long-term effect on feces metabolome. 12 months Analysis by a combination of mass spectrometry techniques after 6 months of completing the dietary intervention with the active (pectin). Results will be expressed as μg/g.
Maturational changes in Pru p 3 and Ara h 9-specific dendritics cells induced by the pectin dietary intervention. 15 months Results will be expressed as maturation index (MI).
Changes on feces metabolome induced by the pectin dietary intervention. 15 months Metabolomic profile from feces samples will be analyzed using a combination of untargeted mass spectrometry techniques: liquid chromatography-mass spectrometry (LC-ESI-QTOF-MS) and capillary electrophoresis-mass spectrometry (CE-TOF-MS). Results will be expressed as μg/g.
Correlation between the induced changes in oral tolerance to peach and/or peanut and the reactivity in skin prick test (SPT). 15 months Changes in oral tolerance to peach and/or peanut (see Primary outcome). Reactivity in SPT to Pru p 3 and peanut will be defined by the size of the papule area (mm2) measured pre- and post- dietary intervention.
Pru p 3 and Ara h 9-specific proliferative response of different lymphocytes cell subpopulations after the pectin dietary intervention. 15 months The specific proliferation responses of different lymphocytes subpopulations will be measured: Th1, Th2, Th9, and Plasma-cells/IgE+, T regulatory cells (Treg), Treg/IL10+ and B regulatory cells/ IL10+. The results will be expressed as fold change of proliferation index (PI).
Pectin dietary intervention long-term effect on the immunological profile. 12 months Determination and analysis of Pru p 3 and Ara h 9-specific IgE and IgG4 production, basophil activation, dendritic cell maturation and proliferative response of different lymphocytes cell subpopulations, after 6 months of completing the dietary intervention with the active (pectin). Each determination will be performed and measured as same as for the related previous outcomes mentioned.