Orange allergy is estimated to account for up to 3–4% of food allergies. Major allergens identified in orange (Citrus sinensis) include Cit s 1 (germin-like protein) and Cit s 2 (profilin), while Cit s 3 (non-specific lipid transfer protein, nsLTP) and Cit s 7 (gibberellin-regulated protein) have also been described. The objective of this study was to investigate the presence and IgE-binding capacity of germin-like proteins in citrus fruits other than oranges. We describe five patients with immediate allergic reactions after orange ingestion. All patients underwent skin prick tests (SPT) to aeroallergens and common food allergens, prick-by-prick testing with orange, lemon, and mandarin (pulp, peel, seeds), total IgE, specific IgE (sIgE), anaphylaxis scoring (oFASS), and the Food Allergy Quality of Life Questionnaire (FAQLQ-AF). Protein extracts from peel and pulp of orange, lemon, and mandarin were analyzed by Bradford assay, SDS-PAGE, and IgE immunoblotting using patient sera. Selected bands were identified by peptide mass fingerprinting. A 23 kDa band was recognized by all five patients in orange (pulp and peel), lemon (peel), and mandarin (peel). This band was consistent with Cit s 1, a germin-like protein already annotated in the IUIS allergen database for orange but not for lemon or mandarin. Peptide fingerprinting confirmed the germin-like identity of the 23 kDa bands in all three citrus species. Germin-like proteins of approximately 23 kDa were identified as IgE-binding components in peel extracts of orange, lemon, and mandarin, and in orange pulp. These findings suggest a potential shared allergen across citrus species that may contribute to allergic reactions independent of LTP sensitization.

Orange allergy is estimated to account for 3% of food allergies. Cit s 1 (germin-like protein) and Cit s 2 (profilin) have been identified as major allergens. Also, Cyt s 3 (lipid transfer protein) and Cyt s 7 (gibberellin-regulated protein) have been described as orange allergens. This study focuses on the unusual occurrence of orange allergy in five patients. Materials and methods: We report five cases of patients with immediate allergic manifestations after ingestion of orange. Skin prick-tests to common aeroallergens, and different foods. Prick by prick with orange, lemon pulp mandarin (peel, pulp and seeds). Anaphylaxis score; Total IgE, Serum-specific IgE and food allergy quality of life questionnaire. Allergenic extracts were prepared from orange (Citrus sinensis), lemon (Citrus lemon) and mandarin (Citrus reticulata) peel and pulp. Protein characterization was determined by Bradford and SDS-PAGE and sera by immunoblot. Selected proteins were identified by peptide fingerprinting. Results: A 23 kD band was recognized by all 5 patients in orange (pulp and peel), lemon (peel) and mandarin (pulp and peel), having already been annotated in IUIS in the case of orange as germin (Cit s 1). To send the 23 kDa bands for peptide fingerprinting, SDS-PAGE of the 3 fruits was performed and as a positive control we used the 23 kDa band from orange. Together, the 23 kDa bands from orange, lemon and mandarin peel were cut out and sent for peptide fingerprint analysis, yielding the germin like protein sequence in all cases. Conclusions: A band of 23 kDa (germin-like protein) appears common in orange (annotated in IUIS as germin), lemon and tange-rine peel. Not previously described in IUIS in lemon and mandarin and confirmed as germin. Germin was in the peel of the 3 fruits and in the orange pulp, but not in lemon or mandarin.

Lipid transfer proteins (LTPs) are widely distributed plant defense proteins and represent one of the most frequent causes of plant food allergy in Mediterranean countries. Due to their resistance to heat and enzymatic digestion, foods containing LTPs may induce immediate allergic reactions ranging from mild local symptoms to severe systemic reactions, including anaphylaxis. Sensitization to peach lipid transfer protein (Pru p 3) is considered the primary sensitizer in Southern Europe and is frequently associated with reactions to multiple plant-derived foods. In clinical practice, one of the main challenges in the management of patients with LTP syndrome is the accurate identification of foods that truly trigger allergic reactions, those that are well tolerated, and those that are unnecessarily avoided due to fear or positive sensitization tests without clinical relevance. The aim of this position paper is to describe the development and clinical use of a structured, patient-completed food list designed to facilitate dietary assessment and clinical history-taking in patients with LTP syndrome. The proposed tool records foods that are consumed and tolerated, foods associated with allergic reactions, foods avoided due to fear or medical advice, foods excluded for nonallergic reasons, and foods with positive skin test results. Foods are organized according to plant-derived food groups and associated plant allergen families. Based on our clinical experience in a specialized allergy consultation focused on LTP syndrome, the systematic use of this structured food list facilitates dietary history-taking, supports clinical decision-making, and may help reduce unnecessary dietary restrictions during patient follow-up.

Background: The GALERNA study is a retrospective real-world observational study conducted across 21 hospitals in Spain, aiming to evaluate long-term clinical benefits and adherence to benralizumab in 255 adult patients with severe eosinophilic asthma (SEA) over a follow-up period of up to 144 weeks. Objectives: Primary objectives focused on assessing adherence to benralizumab, while secondary objectives included the description of severe asthma exacerbation rates, systemic corticosteroid (SCS) use, persistence to benralizumab, lung function, asthma control, and the proportion of patients achieving super-response or clinical remission. Data were collected at baseline (48 weeks prior to benralizumab initiation/index date), follow-up 1 (FUP1) (0–48 weeks), FUP2 (49–96 weeks), and FUP3 (97–144 weeks) after the index date. Results: At baseline, patients demonstrated a substantial disease burden characterised by impaired lung function, poorly controlled asthma, and frequent severe exacerbations. The results indicated high adherence rates to benralizumab, with 92.9% of patients receiving each of the prescribed doses of benralizumab at week 48 and 70.6% at week 144. Patients showed substantial and sustained clinical improvements, with a reduction in the proportion of individuals presenting at least one severe exacerbation from baseline to FUP3 and a 74% decrease in SCS use for the same period. Lung function also improved, with the proportion of patients achieving pre-bronchodilator FEV₁ ≥ 80% rising to 52% at 144 weeks. Furthermore, mean Asthma Control Test (ACT) scores increased to 20.5, with 68.5% of patients achieving well-controlled asthma (ACT ≥ 20). By the end of the study, 63.6% of patients achieved super-response and 39.1% showed clinical remission, with an overall benralizumab persistence of 79.8% during all follow-up periods. Conclusions: The GALERNA study provides compelling real-world evidence that benralizumab affords marked and sustained clinical benefits together with high long-term adherence in Spanish SEA patients, reinforcing its usefulness as a long-term therapeutic option in routine clinical practice.