Table of contents

Pollen-food allergy syndrome


Key sources

The following summarized guidelines for the evaluation and management of pollen-food allergy syndrome are prepared by our editorial team based on guidelines from the British Society for Allergy and Clinical Immunology (BSACI 2022), the German Society for Pediatric Allergology and Environmental Medicine (GPA/DDG/AWMF/VDOE/DGVS/GPGE/BVKJ/ÖGAI/DAAB/DGP/DKG/DGAKI/AeDA/DGHNOKHC/DGKJ/DGE 2015), and the American Academy of Allergy, Asthma & Immunology (AAAAI/ACAAI 2014). ...
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Screening and diagnosis

Common triggers: as per BSACI 2022 guidelines, recognize that:
typical birch-related triggers include raw apples, stone fruits, kiwi fruit, carrot, celery, soya milk, raw peanuts, and raw tree nuts (usually hazelnuts, almonds, and walnuts)
symptoms can also occur when peeling potatoes or other root vegetables
freshly prepared fruit/vegetable juices or smoothies, celery, soya milk, raw nuts, large quantities of roasted nuts, and concentrated nut products, can provoke more severe reactions.
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  • Diagnosis

  • Differential diagnosis

Diagnostic investigations

Indications for allergy testing
As per BSACI 2022 guidelines:
Consider obtaining allergy tests to foods in the following situations:
more severe or atypical symptoms to characteristic raw food triggers
uncertainty whether reactions also occur to roasted hazelnuts, almonds, walnuts, Brazil nuts, or peanuts, either on their own or when present in composite foods, such as chocolates, spreads, desserts, and snacks
triggers include other soy products or cooked/processed fruits/vegetables, such as smoothies and juices
reactions are reported specifically to cashew, pistachio, or macadamia nuts
Do not obtain further testing in patients with seasonal allergic rhinitis reporting characteristic immediate-onset mild symptoms to typical raw food triggers.

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  • Skin prick test

  • Oral food challenge

  • IgE testing

Medical management

Pharmacotherapy: as per BSACI 2022 guidelines, recognize that reactions following accidental exposure often resolve without medication and, although antihistamines May be needed, self-injectable epinephrine devices are rarely required.

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  • Specific immunotherapy

Nonpharmacologic interventions

Dietary avoidance: as per BSACI 2022 guidelines, provide individually tailored dietary advice to avoid nutritional imbalance, minimize anxiety and consequent unnecessary food restrictions and improve QoL.