Pollen Food Allergy Syndrome-Two Decades Apart: A Follow-up AAAAI Survey.

Previous studies have shown an increased prevalence of eosinophilic gastrointestinal disease (EGID) in pediatric liver and heart transplant recipients. However, EGID after other solid organ and bone marrow transplantations has not been extensively evaluated. The purpose of this study is to determine relationships between subsets of EGID with different solid organ and bone marrow transplants in pediatric patients. We performed a single-center retrospective chart review of pediatric patients with transplant and EGID between 2007 and 2023. For comparison between transplant groups, ANOVA was used for statistical analysis of continuous variables, and Fisher's exact test was used for categorical variables. There were 30 patients with EGID (eosinophilic esophagitis [EoE] = 21; eosinophilic gastritis [EoG] = 4; EoE + EoG = 3; EoE + eosinophilic colitis [EoC] = 1; eosinophilic duodenitis [EoD] = 1) and history of transplant (liver = 15; heart = 9; bone marrow = 3; multivisceral liver + small bowel + pancreas = 2; kidney = 1). When comparing the transplant groups, there was a significant difference in EoE + EoG incidence (p = 0.011), specifically, EoE + EoG was present in 2 (100%) multivisceral and in 1/15 (7%) liver transplant patients. A statistically significant difference in the presence of gastroesophageal reflux (GER) and oral allergy syndrome between groups was noted (p = 0.036, p = 0.033). There was no significant difference in the symptoms leading to EGID work-up: incidence; morphologic features; achievement of histologic remission; medications; or family history of atopy between groups. This retrospective biopsy-confirmed cohort demonstrates that EGID subtype varies by transplant type, with higher rates of EoE + EoG in multivisceral recipients. Findings are exploratory and hypothesis-generating; larger multicenter studies including more non-liver and non-heart transplant patients are needed.

Diagnostic approaches for differentiating between true fruit allergy and oral allergy syndrome

Background:Oral allergy syndrome (OAS) is an immediate allergic reaction triggered by specific foods, often linked to pollen-food allergy syndrome (PFAS). With the increasing prevalence of pollinosis in Japan, especially among younger populations, OAS and PFAS are expected to rise. However, few studies have investigated their prevalence in pediatric populations, particularly in relation to different families of causative foods.Objective:In this study, we examined the comparative prevalences of oral symptoms suggestive of OAS based on survey data from parents of a general population of children attending elementary and junior high schools, focusing on the differences between causative food families.Methods:We conducted a questionnaire-based survey among parents of 6,853 elementary and junior high school students in Omihachiman, Japan. Oral symptom was identified based on reported oral symptoms following the consumption of specific raw fruits and vegetables. Data were analyzed using trend analysis and multivariable logistic regression.Results:Among 4,991 respondents (72.8%), 12.4% had oral symptoms. Prevalence was significantly higher in females than in males (14.4% vs. 10.4%). Older age groups showed higher prevalence trends, except for Cucurbitaceae (melon/watermelon). Actinidiaceae (kiwi) and Bromeliaceae (pineapple) had significantly higher prevalence in females, while Cucurbitaceae (melon/watermelon) showed no sex differences. No significant sex differences were observed in cases requiring avoidance.Conclusion:This study provides the first prevalence estimates of oral symptoms suggestive of OAS by sex, age, and causative food family in Japanese children. These findings contribute to improved diagnosis, treatment, and prevention strategies for pediatric OAS and PFAS.

Food-related reactions in eosinophilic esophagitis: pathophysiology and treatment.

Thaumatin-like proteins (TLPs) are conserved plant pathogenesis-related proteins with IgE-binding capacity, but their clinical relevance remains poorly defined. Unlike well-characterized panallergens, TLPs are underrepresented in diagnostic panels, and their role in food allergy is largely unexplored. To assess the prevalence, quantitative IgE levels, co-sensitization patterns, and clinical significance of IgE reactivity to two TLPs-Act d 2 (kiwi) and Mal d 2 (apple)-in a large Italian allergic cohort. We conducted a cross-sectional study of 7176 consecutive patients referred to Italian tertiary allergy centers. Specific IgE to TLPs and other plant allergens was measured using ALEX2. Clinical outcomes were evaluated, and associations with IgE levels and co-sensitizations were examined using multivariate models. ROC analyses were applied to evaluate the discriminatory ability of Act d 2 IgE for clinical severity. TLP sensitization occurred in 137 patients (1.9%), predominantly to Act d 2. Isolated TLP sensitization was rare (n = 20) and associated with low IgE levels (mean 0.61 ± 0.98 kUA/L) and minimal symptoms. Co-sensitized patients (n = 117) had higher and more variable IgE levels (mean 1.41 ± 3.49 kUA/L) and experienced more clinically relevant reactions, including oral allergy syndrome and food-dependent exercise-induced anaphylaxis. ROC analyses indicated limited discriminatory power of Act d 2 IgE for predicting reaction severity (AUC 0.51-0.61). Multivariate adjustment confirmed no independent association between TLP-specific IgE and moderate or severe symptoms. TLP sensitization is uncommon and generally clinically silent when isolated. Co-sensitization with other panallergens appears to drive allergic manifestations. Quantitative TLP-specific IgE alone provides limited predictive value, emphasizing the importance of integrating molecular diagnostics with clinical phenotyping in precision allergy management.

Background:Some regions of the world have experienced increases in the prevalence of diseases such as asthma, allergic rhinitis, and atopic dermatitis; however, little is known about whether the same has occurred with the prevalence of adverse food reactions.Objective:To determine the temporal trend in the prevalence of adverse food reactions among adults in western Mexico.Methods:The results of 2 cross-sectional studies conducted 11 years apart (2012–2013 and 2023-2024) are compared. Data were obtained through a standardized survey administered to adults participating in physical activities in the “vía recreactiva” of Guadalajara and were included through stratified sampling based on sex and age.Results:The first and second studies included 471 and 485 adults, respectively. Comparatively, the prevalence of adverse food reactions was 19.5% and 19.4% (P = 0.953). For oral allergy syndrome, urticaria, and self-reported anaphylaxis, the prevalence was 6.8% and 9.7% (P = 0.104), 5.9% and 4.3% (P = 0.258), and 2.3% and 0.6% (P = 0.032), respectively. Multivariate analyses identified female sex (adjusted odds ratio: 1.52, P = 0.013), age between 25 and 50 years (adjusted odds ratio: 0.59, P = 0.002), personal history of allergic rhinitis (adjusted odds ratio: 2.10, P = 0.004), and atopic dermatitis (adjusted odds ratio: 4.99, P < 0.001) as factors associated with adverse food reaction.Conclusion:Overall, the prevalence of adverse food reactions, their clinical manifestations, and the most implicated foods did not change during the analysis period. Sex, age, and atopic comorbidities were associated with adverse food reactions.

Background: Pollen-Food Allergy Syndrome (PFAS) typically presents as mild oral symptoms but can rarely progress to systemic reactions. Pathogenesis-related proteins group 10 (PR-10) are proteins usually associated with oral allergy syndrome due to their thermolabile and gastrolabile properties. Case Presentation: We report a 12-year-old boy with birch pollen allergy who developed anaphylaxis after raw carrot consumption without identified cofactors. Previously, he experienced only oral allergy syndrome with raw carrot and fennel. Molecular diagnostics confirmed isolated PR-10 sensitization. The reaction occurred during birch pollen season, and the patient tolerated cooked carrot, consistent with PR-10's thermal instability. Conclusions: This case highlights how PFAS, typically characterized by mild and localized symptoms, can occasionally manifest with systemic reactions. High levels of specific IgE for Bet v 1 and pollen season may represent risk factors for systemic reactions in PFAS patients. Clinicians must be aware that allergies due to pollen cross-reactive allergens can be associated with systemic reactions.

Practical guideline for the management of allergic rhinitis in Japan 2024.

Deoxynojirimycin (DNJ), the first isolated iminosugar, is a natural alkaloid acting as a potent inhibitor of α-glucosidase with high nutritional value. It naturally occurs in plants (especially Morus spp.), microbes, and insects or can be synthesized. Diverse biological activities, such as antihyperglycemic, lipid-lowering, antitumor, antiviral, and anti-inflammatory, have been recognized for this compound. However, DNJ has not been approved as a food supplement until now. Several studies, also in clinics, are carried out on Morus spp. containing DNJ. Among Morus spp., Morus alba L. (white mulberry), Morus nigra L. (black mulberry), and Morus rubra L. (red mulberry) are the three main species that grow all over the world. Some spurious studies have been conducted on Reducose® and Glubloc™, two products that contain DNJ and Morus alba, respectively. However, mulberry allergy, including respiratory allergy, airborne contact urticaria, anaphylaxis, oral allergy syndrome, and food induced urticaria, may be observed. This review aims to explore a crucial and timely question: how DNJ exerts its biological effects and what role it may play in therapeutic applications. We provide a comprehensive summary of the current understanding of DNJ's pharmacological potential and the methods used for its production. We also report recent developments in clinical studies on Morus alba, Reducose® and Glubloc™.

Background and objectives. Oral allergy syndrome (OAS) is often undiagnosed in children because it is considered a condition that primarily affects adults. The aim of this study was to investigate the prevalence, risk factors, and clinical course of OAS in children. Materials and methods. A survey was conducted among 512 children aged 4 to 17 years, from which 87 (16.9%) children with confirmed OAS were identified by questionnaire, clinical symptoms, testing for the presence of specific IgE and positive skin prick tests. Results. Boys predominated in OAS group – 63.2% (χ2 = 11.43, p&lt;0.05). In the structure of sensitization of the examined children, pollinosis caused by beech tree pollen and weeds prevailed (52.5% and 39.6%, respectively). The most frequent adverse food reactions were associated with peanuts (67 out of 87; 77%) and apples (56 out of 87; 64.3%). Among vegetables, tomatoes (54 out of 87; 62.1%) and carrots (46 out of 87; 52.8%) were the most common triggers. Some children with OAS reacted to several causal plant allergens – 29 out of 87; 33.3%. Male gender, late manifestation of the disease, severe allergic history, sensitization to beech tree pollen were statistically significant risk factors for OAS in children. Conclusions. The main predictors for the development of OSA, clinical features of the course, frequency distribution of plant allergens and their combinations were identified, which allow for the early identification of children at increased risk of developing the syndrome and enable the timely implementation of treatment and preventive measures.

Pollen food allergy syndrome (PFAS) primarily presents as oral allergy syndrome (OAS) with occasional systemic symptoms. Few studies have examined the systemic symptoms of PR-10-related PFAS, which are common among pediatric patients in Japan. Two surveys were conducted to investigate the possibility of more severe patients in medical institutions and misdiagnoses among school children: one for patients diagnosed with PR-10-related PFAS at medical institutions and another for elementary and junior high school children whose parents completed an online questionnaire. We examined allergenic foods/symptoms, incidence of OAS, and systemic symptoms in PR-10-related PFAS patients allergic to Rosaceae fruits/soybeans. Among 221 patients with PR-10-related PFAS at medical institutions, 205 and 86 developed allergic symptoms to Rosaceae fruits and soybeans, respectively. The incidence of systemic symptoms was significantly higher in the soybean group (43/86, 50.0%) than in the Rosaceae fruits group (43/205, 21.0%) (p < .001). Among the 29,906 school children, 3309 (11.1%) responded; 202 were children with PR-10-related PFAS, 194 and 29 developed allergic symptoms to Rosaceae fruits and soybeans, respectively. The incidence of systemic symptoms was higher in the soybean group (12/29, 41.4%) than in the Rosaceae fruits group (46/194, 23.7%), although not significantly (p = .067). Two surveys were conducted targeting patients with confirmed diagnoses and general students. The incidence of systemic symptoms associated with PR-10-related PFAS was similar at 20% for Rosaceae fruits and 40%-50% for soybeans in both surveys. Attention should be given to the potential for systemic symptoms in patients with PR-10-related PFAS.

Birch pollen allergy is widespread globally and ranks among the leading allergic diseases in Russia. Cross-reactive food allergy, often observed in patients with birch pollen allergy, is an underestimated issue that exacerbates the course of pollinosis. The presence of cross-reactive food allergy significantly impacts the quality of life of patients with pollinosis. Unlike reactions to pollen, reactions to plant foods can occur year-round and may sometimes have severe, even life-threatening manifestations (e.g., angioedema of the lips and tongue, laryngeal edema, urticaria, anaphylaxis). In many patients, сross-reactive food allergy symptoms first appear during or immediately after the pollen season. According to existing scientific data, this may be due to an increase in the levels of specific immunoglobulin E during the flowering season, both to the causative pollen allergens and to cross-reacting food allergens. The article presents two clinical cases of development of oral allergy syndrome after consuming raw apple during the birch flowering season, demonstrating possible differences in the mechanisms of cross-reactive food allergy to apple in patients sensitized to birch pollen allergen.

Oral Allergy Syndrome (OAS) is an allergic reaction that occurs upon contact of the mouth and throat with food, leading to symptoms primarily affecting the oral mucosa. In patients with allergic rhinitis, OAS may develop due to cross-reactivity between the pollen allergens responsible for allergic rhinitis, and specific plant-derived foods. This particular type of OAS is known as Pollen Food Allergy Syndrome (PFAS). The difference in prevalence of PFAS across different regions of the world is attributed to various factors, including environmental exposure and dietary habits. Southern Europe’s temperate climate favors the blooming of many allergenic plants, making respiratory allergies and PFAS significant public health concerns. There is a regional variation in pollen in Southern Europe, contributing to differences in the presence of panallergens—such as profilins, pathogenesis-related class 10 (PR-10) proteins and lipid transfer proteins (LTPs)—which mediate PFAS. In order to examine the epidemiology, pathogenesis, and diagnostic approaches of OAS and PFAS, focusing on their prevalence and impact in Southern European adults, a narrative review was performed. Data from Portugal, Spain, France, Italy, Albania, Greece, and Türkiye were retrieved. The main outcome of this review was that the frequency of PFAS varies across studies, not only between countries but also within the same country, due to vegetation variability across regions as well as methodological differences and the year of study. However, despite these differences, PFAS emerges as a common issue in Southern Europe, underscoring the need for effective diagnosis and management.

Background: Oral Allergy Syndrome (OAS) is a localized IgE-mediated food allergy triggered by certain fruits and vegetables in patients with atopic history. This case report describes two siblings with Oral Allergy Syndrome (OAS) presenting as allergic angioedema triggered by specific food allergens. Case Presentation: Case 1 involves a 25-year-old female who developed lip swelling, a burning sensation, numbness, multiple oral ulcers on the lower lip, and surrounding redness 30 minutes after consuming mint sauce in an Indian dish. Case 2 details a 21-year-old male who experienced immediate lip and soft palate swelling with numbness after eating Chinese food suspected to contain nuts. Discussion: Both siblings share a history of childhood atopy, predisposing them to IgE-mediated reactions. Their symptoms were characteristic of localized allergic responses in the oral mucosa, consistent with OAS. Case Management: Management involved a combined therapeutic approach: topical corticosteroids were applied to the affected oral areas to reduce local inflammation and promote healing of the mucosal lesions, while oral corticosteroids provided systemic anti-inflammatory effects. Additionally, cetirizine, an H1 receptor antagonist, was administered to block histamine-mediated symptoms such as swelling and itching. Patients were also advised to avoid mint-containing and peanut-containing foods as predisposing factors. Conclusion: This report highlights not only the clinical presentation and successful management of OAS in individuals with familial atopy but also underscores the potential genetic predisposition contributing to food-induced allergic reactions.

To determine the prevalence of OAS in Mexican adults and identify the main foods and factors associated with this condition. A survey was conducted on a sample of adults aged 18 to 50 years using stratified probabilistic sampling based on the participants' age and sex. Multivariate analyses were performed to identify factors associated with OAS, and adjusted odds ratios (aOR) were calculated. The study included 1,091 adults (46.7% women; mean age 27.6 years). Of these, 196 (18.0%) had food hypersensitivity and 64 out of 1,091 had OAS (prevalence: 5.9%; 95% CI: 4.5 - 7.4%). The food groups most associated with OAS were fruits (28/64, 43.8%), seafood (21/64, 32.8%), and nuts (12/64, 18.8%). Individually, the most frequent foods were shrimp (31.3%), pecans (14.1%), peach (10.9%), kiwi (10.9%), and strawberry (7.8%). There was a significant association of OAS with allergic rhinitis (aOR: 2.85, p = 0.001), urticaria (aOR: 18.48, p < 0.001), and a family history of atopy (aOR: 2.29, p = 0.006). This study suggests that the prevalence of OAS in adults as a manifestation of food hypersensitivity is a common event (64/196, 32.6%). Foods such as fruits, seafood, and nuts are strongly related to its occurrence.

Thaumatin-like proteins (TLPs) are a class of allergens that are predominantly found in fruits. These proteins are involved in plant defense mechanisms and exhibit antifungal activity. TLPs are classified as pathogenesis-related proteins (PR-5) and are typically synthesized in response to biotic stress, such as pathogen attacks. Sensitization to TLPs can result in a broad spectrum of allergic reactions, ranging from localized symptoms, such as oral allergy syndrome, to severe manifestations, including anaphylaxis. Key allergens within this group include Mal d 2 (apple), Pru p 2 (peach), and Pru av 2 (cherry). The list of allergens belonging to the TLP protein group continues to expand with newly discovered molecules. Diagnostic approaches for TLP allergies remain limited. Allergen component-resolved diagnostics can detect specific TLPs. The epidemiology of TLP-induced allergies is underexplored, and further research is needed to elucidate the prevalence, natural course, and clinical outcomes of these allergic conditions.

Mango (Mangifera indica), from the Anacardiaceae family, originates from Asia and has grown globally. Despite its wide nutritional benefits, mango can induce allergic processes in some individuals. Mango allergy occurs from the body’s immune response to various proteins found in the mango fruit, peel, stem, sap, or tree. Oral allergy syndrome (burning sensation and swelling in the mouth), to severe conditions, including anaphylaxis is included in the spectrum of symptoms observed. Contact dermatitis, a delayed hypersensitivity reaction that manifests as rash, pruritus, and blisters, is also observed in patients after direct contact with mango or exposure to related allergens from the Anacardiaceae family, such as poison ivy or oak. This narrative review aims at reviewing the cutaneous manifestations of mango allergy, examining the allergenic profiles of affected individuals, cross-reactivity with other allergens, diagnostic methods, and shed light on the importance of recognizing mango allergy in clinical practice, despite its relative rarity.

BackgroundThis study aimed to assess the distribution of esophageal inflammation in patients with eosinophilic esophagitis (EoE) and its impact on diagnosis and outcome. Aims and MethodsData from consecutive adult EoE patients who were followed-up at four Italian referral centers from October 2022 to October 2023 were retrospectively collected. ResultsOne hundred forty-nine patients were included. Proximal EoE was observed in 8.1 % of patients; distal EoE in 27.5 %; and diffuse EoE in 64.4 %. Allergic rhinitis was more prevalent in distal and diffuse than proximal EoE (72.5 % vs. 61.5 % vs 33.3 %; P = 0.049). The prevalence of asthma, atopic dermatitis, oral allergy syndrome, and gastroesophageal reflux disease was not significantly different among the three EoE extent groups. Endoscopic inflammatory features at diagnosis were more prevalent in proximal EoE (91.7 % vs. 53.8 % distal [P = 0.01] vs. 66 % diffuse[P = 0.05]). No significant differences in fibrotic features and esophageal stenoses were observed. The clinical and histological remission rates after first-line therapy were comparable in all groups. ConclusionEsophageal inflammation in EoE more frequently involves the entire esophagus, followed by isolated distal and proximal involvement. No clear correlation was observed between the histological extent of EoE at diagnosis and comorbidities or treatment response.

Pollen–food allergy syndrome (PFAS), also known as oral allergy syndrome, is a common condition affecting individuals sensitized to pollens such as birch, ragweed, and grass. This syndrome arises from immunological cross-reactivity between pollen allergens and structurally similar proteins found in various fruits, vegetables, and nuts. Although typically presenting with mild oral and pharyngeal symptoms, PFAS can occasionally result in severe allergic reactions, underscoring its clinical significance. This review explores the pathophysiology of PFAS, highlighting the molecular mechanisms underlying cross-reactivity and examining the main protein families involved, including those contributing to variations in symptom severity. Current diagnostic approaches, including skin prick testing, specific immunoglobulin E measurements, and component-resolved diagnostics, are discussed. Emerging diagnostic tools and biomarkers with potential to enhance accuracy are also examined. Therapeutic strategies for PFAS primarily focus on symptom management and avoidance of trigger foods. However, novel approaches such as allergen immunotherapy and biologics targeting key immune pathways are gaining traction as potential interventions for more severe or refractory cases. By addressing the diagnostic and therapeutic challenges of PFAS, this paper aims to provide clinicians and researchers with a comprehensive understanding of this condition, fostering improved patient care and the development of innovative treatment strategies.