Pollen-related food allergy: an update

Abstract

The vast majority of IgE-mediated food allergies in adults are based on sensitization to pollen, followed by reactions to structurally related, often unstable allergens, in particular in fruit (including edible nuts), vegetables, and spices. This article provides an up-to-date overview of selected scientific works on pollen-related food allergy and has been drawn-up on the basis of PubMed research, the German Study on Adult Health (Studie zur Gesundheit Erwachsener in Deutschland, DEGS) conducted by the Robert Koch Institute, as well as the national and international guideline registries. Birch pollen-related symptoms are generally the commonest form of pollen-related allergy observed in Northern Europe. The types of fruit that most frequently cause symptoms belong to the Rosaceae (e. g., apple, cherry) and Fagales families (hazelnut). Reactions to legumes (e. g., peanut, soy) and vegetables, including celery, carrot, tomato, and bell pepper, are also worthy of note. In addition to oropharyngeal contact urticaria, the clinical symptoms of pollen-related food allergy can range from the involvement of other organ systems to anaphylactic shock. The main plant food allergens belong to a handful of protein families: Bet v 1 homologs, profilins, lipid transfer proteins, storage proteins, and thaumatin-like proteins. The diagnosis of pollen-related food allergy has seen significant advances in recent years in the wake of component-resolved/molecular allergology, thereby, enabling reliable identification. Treatment comprises dietary counseling and the prescription of emergency medication. In addition, allergen-specific immunotherapy for cross-reactive pollen allergens appears to positively affect concomitant food allergies in some patients.