Dietary Interventions in Pollen-Related Food Allergy.

Sarah Lyons,Harmieke Os-Medendorp,Thuy-My Le,Eleonora Alquati,André Knulst,Anne Dijk

doi:10.3390/nu10101520

Sarah Lyons, Harmieke Os-Medendorp + Show 4 more

Open Access

https://doi.org/10.3390/nu10101520

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Abstract

In practice, it remains unclear what the best dietary approach is in subjects with pollen-related food allergy (PRFA). Our objective was to evaluate the effect of (1) dietary avoidance advice, (2) oral immunotherapy (OIT), (3) (heat) processing, and (4) consumption of hypoallergenic cultivars on frequency, severity, and eliciting dose of pollen-related food allergic reactions. A systematic search was conducted in PubMed, Embase, and Cochrane. All studies performing an in vivo investigation of one of the four interventions in adults with PRFA were included. Each study was assessed for quality and validity. Available data on frequency, severity, and eliciting dose of allergic reactions were extracted. Ten studies matched the eligibility criteria. No studies were retrieved on dietary avoidance advice. Two studies (N = 92) on apple OIT reported that tolerance was induced in 63% and 81% of subjects. Four studies (total N = 116) focused on heat processing. Heating was found to completely eradicate symptoms in 15–71% of hazelnut allergic and 46% of celery allergic individuals. Four studies (N = 60) comparing low to high allergenic apple cultivars revealed that Santana (and possibly Elise) apples seemed to cause milder reactions than Golden Delicious. In the awareness that overall level of evidence was low, we conclude that OIT, heat processing, and hypoallergenic cultivars may diminish or completely prevent allergic reactions in some but not all subjects with PRFA.

Highlights

Up to 90% of pollen-sensitised individuals are allergic to foods that cross-react with pollen [1,2,3,4].This pollen-related food allergy (PRFA) is generally characterised by the rapid onset of oropharyngeal symptoms after ingestion and spontaneous resolution within 30 min; systemic reactions are possible but rare [5,6]
Relevant synonyms for our domain and determinants were combined to develop an extensive search strategy (Appendix A), which was entered into PubMed, Embase, and The Cochrane Library on 6 July 2018 using keywords and Medical Subject Headings
Three predetermined dietary interventions were incorporated in the search: oral immunotherapy (OIT), processing, and consumption of hypoallergenic cultivars

Summary

Introduction

Up to 90% of pollen-sensitised individuals are allergic to foods that cross-react with pollen [1,2,3,4]. This pollen-related food allergy (PRFA) is generally characterised by the rapid onset of oropharyngeal symptoms after ingestion and spontaneous resolution within 30 min; systemic reactions are possible but rare [5,6]. The increasing incidence of pollen allergy will probably lead to a further increase in PRFA [5,6,7,8,9]. Primary dietary therapy for food allergy consists of the avoidance of triggering foods [5,6,10,11]

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