Diagnosis and management of Pollen Food Syndrome/Oral Allergy Syndrome

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Summary:

Pollen Food Syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitised children and adults. Sufferers experience allergic symptoms when consuming raw fruit, nuts or vegetables, due to the homology between the pollen allergens and unstable proteins in raw plant foods. A need was identified for guidelines outlining the correct diagnosis and management of this common condition and ensure the avoidance of a misdiagnosis of a peanut or tree nut allergy, or confusion with another plant food allergy to non-specific Lipid Transfer Proteins. The characteristic foods involved, and rapid-onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk, or severe/atypical reactions to fruits and vegetables require additional diagnostic tests. The best approach is to undertake SPT to raw and roasted nuts, soya milk or fresh raw fruits and vegetables, or test for sensitisation to the major allergens in tree nuts, peanuts, soya milk and fruits using component-resolved diagnostics. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre-existing food allergy, or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual IT to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life.  

Click here to view the Pollen Food Syndrome Leaflet for GPs in the UK.

Keywords

Food allergy, pollen food syndrome, birch, oral allergy syndrome, diagnosis  

Authors

Isabel Skypala, Hannah Hunter, Helena Rey Garcia, George du Toit, Stephen Till, Thirumala Krishna, Sarah Baker, Elizabeth Angier, Kostadin Stoenchev.

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