Pollen–Food Allergy Syndrome: Allergens, Clinical Insights, Diagnostic and Therapeutic Challenges

In the paper

“Similarly, exercise can amplify the severity of allergic reactions by increasing gastrointestinal permeability and altering blood flow dynamics, particularly to the digestive system.”

What the sources say

• Check pendingcites [35] Shin, 2021, Food Allergies and Food-Induced Anaphylaxis: Role of Cofactors, Clin. Exp. Pediatr. source

In the paper

“PFAS is more frequently observed in regions where certain pollens, such as birch, ragweed, or grass pollens, are highly prevalent.”

In the paper

“For example, birch pollen-related PFAS is more common in Northern and Central Europe [31,47].”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Kato, Y., Morikawa, T., and Fujieda, S. (2024). Comprehensive Review of Pollen-Food Allergy Syndrome: Pathogenesis, Epidemiology, and Treatment Approaches. Allergol. Int. source
• ?Not checked — no full text of the sourcecites [47] Biedermann, 2019, Birch Pollen Allergy in Europe, Allergy source

In the paper

“Individuals with disrupted microbial diversity or dysbiosis may exhibit heightened allergic reactions due to altered immune regulation.”

What the sources say

• Not checked yetcites [75] Silva, Y.P., Bernardi, A., and Frozza, R.L. (2020). The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front. Endocrinol., 11. source
• Check pendingcites [76] Huang, 2023, Short-Chain Fatty Acids Ameliorate Allergic Airway Inflammation via Sequential Induction of PMN-MDSCs and Treg Cells, J. Allergy Clin. Immunol. Glob. source

In the paper

“Alcohol, for example, is known to affect the permeability of the gastrointestinal lining, allowing allergens to cross into the bloodstream more readily [80].”

What the sources say

• ?Not checked — no full text of the sourcecites [80] Samadi, 2018, The Role of Gastrointestinal Permeability in Food Allergy, Ann. Allergy Asthma Immunol. source

In the paper

“They are primarily responsible for localized allergic reactions, which typically manifest as itching or swelling in the mouth and throat after consuming raw plant-based foods.”

What the sources say

• Check pendingcites [42] Popescu, 2015, Cross-Reactivity between Aeroallergens and Food Allergens, World J. Methodol. source

In the paper

“In contrast, ragweed pollen-related PFAS is more dominant in North America, Central and Eastern Europe, and Japan [49].”

What the sources say

• Check pendingcites [49] Hwang, 2022, Relationship among Airborne Pollen, Sensitization, and Pollen Food Allergy Syndrome in Asian Allergic Children, PeerJ source

In the paper

“This syndrome arises from immunological cross-reactivity between pollen allergens and structurally similar proteins found in various fruits, vegetables, and nuts.”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Kato, Y., Morikawa, T., and Fujieda, S. (2024). Comprehensive Review of Pollen-Food Allergy Syndrome: Pathogenesis, Epidemiology, and Treatment Approaches. Allergol. Int. source

In the paper

“One critical factor is the concentration of the allergen in the food, as higher levels of allergenic proteins are more likely to elicit a stronger immune response.”

What the sources say

• Check pendingcites [78] Dubois, 2018, How Does Dose Impact on the Severity of Food-Induced Allergic Reactions, and Can This Improve Risk Assessment for Allergenic Foods?: Report from an ILSI Europe Food Allergy Task Force Expert Group and Workshop, Allergy source

In the paper

“PFAS tends to be more prevalent in adults and adolescents than in young children [60]”

What the sources say

• Check pendingcites [60] Sicherer, 2020, Food Allergy from Infancy Through Adulthood, J. Allergy Clin. Immunol. Pract. source

In the paper

“Environmental and physiological cofactors, such as alcohol, exercise, or medications, can further amplify the immune response, making the reaction more severe [79].”

What the sources say

• ?Not checked — no full text of the sourcecites [79] Bartra, 2023, Cofactors in Food Anaphylaxis in Adults, Ann. Allergy Asthma Immunol. source

In the paper

“Conversely, certain processing techniques, such as fermentation, can enhance the immunogenic properties of allergens, highlighting the importance of dietary habits in PFAS pathophysiology [72].”

What the sources say

• Check pendingcites [72] Zhou, 2024, Characterization of Physicochemical and Immunogenic Properties of Allergenic Proteins Altered by Food Processing: A Review, Food Sci. Hum. Wellness source

In the paper

“A reduction in SCFA levels could impair Treg function, exacerbating the allergic response in PFAS [76].”

What the sources say

• Check pendingcites [76] Huang, 2023, Short-Chain Fatty Acids Ameliorate Allergic Airway Inflammation via Sequential Induction of PMN-MDSCs and Treg Cells, J. Allergy Clin. Immunol. Glob. source

In the paper

“In addition to protein sequence similarity, the three-dimensional conformation of these proteins plays a pivotal role in cross-reactivity.”

What the sources say

• ?Not checked — no full text of the sourcecites [71] Geng, 2023, Allergenicity of Peanut Allergens and Its Dependence on the Structure, Compr. Rev. Food Sci. Food Saf. source

In the paper

“The allergens Amb a 8 (profilin) and Amb a 6 (LTP) cross-react with proteins in foods such as melons, bananas, and cucumbers, leading to the development of PFAS symptoms in sensitized individuals [42,50].”

What the sources say

• Check pendingcites [42] Popescu, 2015, Cross-Reactivity between Aeroallergens and Food Allergens, World J. Methodol. source
• Check pendingcites [50] Grijincu, M., Tănasie, G., Zbîrcea, L.-E., Buzan, M.-R., Tamaș, T.-P., Cotarcă, M.-D., Huțu, I., Babaev, E., Stolz, F., and Dorofeeva, Y. (2024). Non-Specific Lipid Transfer Protein Amb a 6 Is a Source-Specific Important Allergenic Molecule in Ragweed Pollen. Int. J. Mol. Sci., 25. source

In the paper

“It also impacts the immune system by modulating the activity of mast cells and basophils, leading to an exaggerated release of histamine and other inflammatory mediators.”

What the sources say

• Check pendingcites [60] Sicherer, 2020, Food Allergy from Infancy Through Adulthood, J. Allergy Clin. Immunol. Pract. source

In the paper

“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.”

What the sources say

• Check pendingcites [33] Carlson, 2019, Pollen Food Allergy Syndrome (PFAS): A Review of Current Available Literature, Ann. Allergy Asthma Immunol. source
• ?Not checked — no full text of the sourcecites [44] Poncet, 2020, Update on Pollen-Food Allergy Syndrome, Expert Rev. Clin. Immunol. source
• Not checked yetcites [45] Karakaya, 2023, Prevalence and Clinical Features of Pollen-Food Allergy Syndrome in Adults with Seasonal Allergic Rhinitis, Eur. Rev. Med. Pharmacol. Sci.

In the paper

“Short-chain fatty acids (SCFAs) produced by commensal bacteria have been shown to influence the activity of regulatory T cells (Tregs), which are essential for maintaining immune tolerance [75].”

What the sources say

• Not checked yetcites [75] Silva, Y.P., Bernardi, A., and Frozza, R.L. (2020). The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front. Endocrinol., 11. source

In the paper

“These allergens, such as PR-10 proteins, profilins, and lipid transfer proteins (LTPs), are the ones commonly implicated in PFAS.”

What the sources say

• Check pendingcites [42] Popescu, 2015, Cross-Reactivity between Aeroallergens and Food Allergens, World J. Methodol. source

In the paper

“Despite its widespread occurrence, PFAS (as well as genuine food allergies) remains underdiagnosed and underreported, especially in regions with limited access to advanced diagnostic tools [64].”

What the sources say

• Check pendingcites [64] Hossny, 2019, Challenges of Managing Food Allergy in the Developing World, World Allergy Organ. J. source

In the paper

“The gut microbiota also plays a role in modulating the immune response to food allergens.”

What the sources say

• Not checked yetcites [75] Silva, Y.P., Bernardi, A., and Frozza, R.L. (2020). The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front. Endocrinol., 11. source
• Check pendingcites [76] Huang, 2023, Short-Chain Fatty Acids Ameliorate Allergic Airway Inflammation via Sequential Induction of PMN-MDSCs and Treg Cells, J. Allergy Clin. Immunol. Glob. source

In the paper

“Moreover, the stability of the allergenic proteins influences whether the cross-reactive epitopes remain intact during food processing or digestion, directly impacting the severity and type of allergic reaction [72].”

What the sources say

• Check pendingcites [72] Zhou, 2024, Characterization of Physicochemical and Immunogenic Properties of Allergenic Proteins Altered by Food Processing: A Review, Food Sci. Hum. Wellness source

In the paper

“For example, LTPs, known for their robust stability, are frequently implicated in severe PFAS cases [73].”

What the sources say

• Check pendingcites [73] Pekar, 2018, Stability of Allergens, Mol. Immunol. source

In the paper

“Class II allergens are proteins that typically do not cause primary sensitization through the gastrointestinal tract but instead trigger allergic reactions due to cross-reactivity with aeroallergens (such as pollen) that have already sensitized the immune system.”

What the sources say

• Check pendingcites [33] Carlson, 2019, Pollen Food Allergy Syndrome (PFAS): A Review of Current Available Literature, Ann. Allergy Asthma Immunol. source
• Check pendingcites [43] Jeon, 2020, Pollen-Food Allergy Syndrome in Children, Clin. Exp. Pediatr. source

In the paper

“Another important determinant is the amount of food consumed, as consuming larger quantities of a triggering food increases the overall allergen load, thereby amplifying the risk and severity of the reaction [78].”

What the sources say

• Check pendingcites [78] Dubois, 2018, How Does Dose Impact on the Severity of Food-Induced Allergic Reactions, and Can This Improve Risk Assessment for Allergenic Foods?: Report from an ILSI Europe Food Allergy Task Force Expert Group and Workshop, Allergy source

In the paper

“For example, soy and soy-based products, such as tofu and soy milk, are significant triggers in East Asian countries and Japan, where soy is a dietary staple [56].”

What the sources say

• Check pendingcites [56] Sasaki, 2020, The Prevalence of Oral Symptoms Caused by Rosaceae Fruits and Soybean Consumption in Children; a Japanese Population-Based Survey, Allergol. Int. source

In the paper

“For cross-reactivity to occur, a significant degree of similarity-typically more than 70%-is required between the primary protein sequences of the pollen allergens and those in the triggering food [70].”

What the sources say

• Check pendingcites [70] Francis, 2020, Common Food Allergens and Cross-Reactivity, J. Food Allergy source

In the paper

“Lastly, individual genetic predispositions, including polymorphisms in genes encoding cytokines or immune receptors, may influence susceptibility to PFAS.”

What the sources say

• Check pendingcites [77] Devonshire, 2023, Multi-Omics Profiling Approach in Food Allergy, World Allergy Organ. J. source

In the paper

“as the development of PFAS often follows prolonged sensitization to pollen allergens over time [61].”

What the sources say

• Check pendingcites [61] Yasudo, H., Yamamoto-Hanada, K., Yang, L., Saito-Abe, M., Sato, M., Miyaji, Y., Shimada, M., Hirai, S., Toyokuni, K., and Ishikawa, F. (2022). Pollen Food Allergy Syndrome in Allergic March. Nutrients, 14. source

In the paper

“Profilin-mediated allergic reactions are generally mild and confined to the oropharyngeal region, manifesting as itching, tingling, or mild swelling of the lips, tongue, and throat [137].”

What the sources say

• Check pendingcites [137] Barber, 2021, Molecular Allergology and Its Impact in Specific Allergy Diagnosis and Therapy, Allergy Eur. J. Allergy Clin. Immunol. source

In the paper

“Gastrointestinal symptoms, including nausea, abdominal pain, vomiting, and diarrhea, have been reported in some cases [94].”

What the sources say

• Check pendingcites [94] Varshney, 2020, Clinical Manifestations of Immunoglobulin E-Mediated Food Allergy, Including Pollen-Food Allergy Syndrome, J. Food Allergy source

In the paper

“Cofactors such as physical exercise, alcohol consumption, or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) can exacerbate symptoms, potentially tipping mild reactions into severe systemic responses [35].”

What the sources say

• Check pendingcites [35] Shin, 2021, Food Allergies and Food-Induced Anaphylaxis: Role of Cofactors, Clin. Exp. Pediatr. source

In the paper

“In contrast, LTP-related allergies are less common in Northern and Central Europe, where PR-10 proteins (e.g., Bet v 1) and profilins dominate the allergenic landscape [100].”

What the sources say

• ?Not checked — no full text of the sourcecites [100] Andersen, 2011, Identification of European Allergy Patterns to the Allergen Families PR-10, LTP, and Profilin from Rosaceae Fruits, Clin. Rev. Allergy Immunol. source

In the paper

“This regional variation reflects differences in dietary habits, pollen exposure, and environmental factors.”

In the paper

“Pork-cat syndrome is an IgE-mediated allergic condition where individuals sensitized to cat dander, specifically the protein Fel d 2 (a serum albumin), develop allergic reactions upon consuming pork.”

What the sources say

• Check pendingcites [83] Shiratsuki, 2020, A Case of Pork-Cat Syndrome That Developed as Food-Dependent Exercise-Induced Anaphylaxis, Acta Derm. Venereol. source

In the paper

“Three additional families-thaumatin-like proteins (TLPs), β-1,3-glucanases, and isoflavone reductases (IFRs)-have also been implicated in PFAS, though they are less well understood [44,117].”

What the sources say

• ?Not checked — no full text of the sourcecites [44] Poncet, 2020, Update on Pollen-Food Allergy Syndrome, Expert Rev. Clin. Immunol. source
• Check pendingcites [117] Palacín, A., Rivas, L.A., Gómez-Casado, C., Aguirre, J., Tordesillas, L., Bartra, J., Blanco, C., Carrillo, T., Cuesta-Herranz, J., and Bonny, J.A.C. (2012). The Involvement of Thaumatin-like Proteins in Plant Food Cross-Reactivity: A Multicenter Study Using a Specific Protein Microarray. PLoS ONE, 7. source

In the paper

“For instance, a person might tolerate a certain fruit on one occasion but experience systemic symptoms like gastrointestinal distress or respiratory issues when that same food is consumed after exercise or with alcohol [79].”

What the sources say

• ?Not checked — no full text of the sourcecites [79] Bartra, 2023, Cofactors in Food Anaphylaxis in Adults, Ann. Allergy Asthma Immunol. source

In the paper

“Advances in molecular allergology and component-resolved diagnostics have further enhanced the ability to distinguish between cross-reactive and primary food allergens, providing better tools for predicting symptom severity and guiding patient care, and offering promising avenues for managing these conditions [31].”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Kato, Y., Morikawa, T., and Fujieda, S. (2024). Comprehensive Review of Pollen-Food Allergy Syndrome: Pathogenesis, Epidemiology, and Treatment Approaches. Allergol. Int. source

In the paper

“LTPs are also unique among panallergens in their potential to elicit allergic reactions to wheat and other cereals, especially in the context of exercise.”

In the paper

“In these cases, ingestion of wheat followed by physical activity amplifies the immune response, leading to severe systemic reactions, including anaphylaxis.”

In the paper

“The type of food consumed and the patient's underlying pollen sensitization profile also play a significant role [54,63,100].”

What the sources say

• Check pendingcites [54] Barni, S., Caimmi, D., Chiera, F., Comberiati, P., Mastrorilli, C., Pelosi, U., Paravati, F., Marseglia, G.L., and Arasi, S. (2022). Phenotypes and Endotypes of Peach Allergy: What Is New?. Nutrients, 14. source
• Check pendingcites [63] Kim, 2019, Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome, Yonsei Med. J. source
• ?Not checked — no full text of the sourcecites [100] Andersen, 2011, Identification of European Allergy Patterns to the Allergen Families PR-10, LTP, and Profilin from Rosaceae Fruits, Clin. Rev. Allergy Immunol. source

In the paper

“Additionally, the lability of PR-10 proteins explains why cooked or processed forms of implicated foods are generally well-tolerated by most patients [129].”

What the sources say

• Check pendingcites [129] Führer, S., Unterhauser, J., Zeindl, R., Eidelpes, R., Fernández-Quintero, M.L., Liedl, K.R., and Tollinger, M. (2022). The Structural Flexibility of PR-10 Food Allergens. Int. J. Mol. Sci., 23. source

In the paper

“as this geographic correlation reflects the widespread sensitization to Bet v 1, which primes the immune system to recognize structurally similar proteins in fruits, vegetables, and nuts [43,57].”

What the sources say

• Check pendingcites [43] Jeon, 2020, Pollen-Food Allergy Syndrome in Children, Clin. Exp. Pediatr. source
• Check pendingcites [57] Mastrorilli, C., Cardinale, F., Giannetti, A., and Caffarelli, C. (2019). Pollen-Food Allergy Syndrome: A Not so Rare Disease in Childhood. Medicina, 55. source

In the paper

“Due to their heat and digestion stability, LTPs can trigger systemic reactions, including anaphylaxis, even after ingestion of cooked or processed foods [141].”

What the sources say

• ?Not checked — no full text of the sourcecites [141] Mota, 2018, Anaphylaxis Caused by Lipid Transfer Proteins: An Unpredictable Clinical Syndrome, Allergol. Immunopathol. source

In the paper

“This structural similarity across different plant species accounts for the high degree of crossreactivity between PR-10 proteins in pollen and homologous proteins in plant-based foods.”

In the paper

“The emotional toll of constant dietary vigilance and the fear of missing hidden allergens in foods can contribute to stress and, over time, impact mental health.”

In the paper

“Their stability and ubiquitous presence make them central to the pathophysiology of PFAS, as they form the molecular link between pollinosis (pollen allergy) and food allergy [33].”

What the sources say

• Check pendingcites [33] Carlson, 2019, Pollen Food Allergy Syndrome (PFAS): A Review of Current Available Literature, Ann. Allergy Asthma Immunol. source

In the paper

“As mentioned before, PFAS is a result of immunological cross-reactivity between airborne pollen allergens and structurally similar proteins present in various plant-based foods.”

What the sources say

• Check pendingcites [33] Carlson, 2019, Pollen Food Allergy Syndrome (PFAS): A Review of Current Available Literature, Ann. Allergy Asthma Immunol. source

In the paper

“These manifestations suggest a broader systemic immune activation rather than localized reactivity [96].”

What the sources say

• Not checked yetcites [96] Lloyd, 2022, Pollen-Food Allergy Syndrome (PFAS), Curr. Allergy Clin. Immunol.

In the paper

“Profilin-related PFAS is particularly common in areas with high exposure to pollen from birch, grass, or ragweed, such as Northern and Central Europe or North America, where it can affect up to 30% of profilin-sensitized patients [55,134].”

What the sources say

• Check pendingcites [55] Krikeerati, T., Rodsaward, P., Nawiboonwong, J., Pinyopornpanish, K., Phusawang, S., and Sompornrattanaphan, M. (2023). Revisiting Fruit Allergy: Prevalence across the Globe, Diagnosis, and Current Management. Foods, 12. source
• Check pendingcites [134] Lyons, 2020, Prevalence of Food Sensitization and Food Allergy in Children Across Europe, J. Allergy Clin. Immunol. Pract. source

In the paper

“Cross-reactivity between pollen allergens and plant-derived foods is a key mechanism driving PFAS, as this phenomenon occurs due to structural similarities between proteins found in pollens and those present in certain fruits, vegetables, nuts, and seeds [31].”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Kato, Y., Morikawa, T., and Fujieda, S. (2024). Comprehensive Review of Pollen-Food Allergy Syndrome: Pathogenesis, Epidemiology, and Treatment Approaches. Allergol. Int. source

In the paper

“Alvarado et al. noted severe reactions even after small quantities of food in patients previously exposed to high levels of grass pollen [140].”

What the sources say

• ?Not checked — no full text of the sourcecites [140] Alvarado, 2014, Profilin as a Severe Food Allergen in Allergic Patients Overexposed to Grass Pollen, Allergy source

In the paper

“Systemic reactions are estimated to occur in approximately 2-10% of PFAS cases, with severe outcomes such as hypotension and respiratory distress being extremely rare (1-2%) [54,57,62,63].”

What the sources say

• Check pendingcites [54] Barni, S., Caimmi, D., Chiera, F., Comberiati, P., Mastrorilli, C., Pelosi, U., Paravati, F., Marseglia, G.L., and Arasi, S. (2022). Phenotypes and Endotypes of Peach Allergy: What Is New?. Nutrients, 14. source
• Check pendingcites [57] Mastrorilli, C., Cardinale, F., Giannetti, A., and Caffarelli, C. (2019). Pollen-Food Allergy Syndrome: A Not so Rare Disease in Childhood. Medicina, 55. source
• ?Not checked — no full text of the sourcecites [62] Skypala, 2020, Can Patients with Oral Allergy Syndrome Be at Risk of Anaphylaxis?, Curr. Opin. Allergy Clin. Immunol. source
• Check pendingcites [63] Kim, 2019, Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome, Yonsei Med. J. source

In the paper

“Pollens such as Ole e 7 from olive trees, Pla a 3 from plane trees, Art v 3 from mugwort, and Par j 1 from pellitory-of-the-wall are well-documented sources of LTP sensitization.”

In the paper

“In humans, however, these proteins act as allergens, triggering immune responses in individuals sensitized to pollen.”

In the paper

“Among fruits, peach (Pru p 3) stands out as the most significant allergen, often serving as the prototype for LTP-mediated allergic reactions [141].”

What the sources say

• ?Not checked — no full text of the sourcecites [141] Mota, 2018, Anaphylaxis Caused by Lipid Transfer Proteins: An Unpredictable Clinical Syndrome, Allergol. Immunopathol. source

In the paper

“For individuals managing PFAS, this unpredictability can also erode their confidence in food choices and nutritional balance, particularly when their reactions involve staple foods or culturally significant dishes [112].”

What the sources say

• ?Not checked — no full text of the sourcecites [112] Cook, 2023, Anthropological and Sociological Perspectives on Food Allergy, Clin. Exp. Allergy source

In the paper

“For instance, individuals allergic to birch pollen (Bet v 1) often experience symptoms after consuming raw apples (Mal d 1), apricots (Pru ar 1f), cherries (Pru av 1), peaches (Pru p 1), celery (Api g 1), soy (Gly m 4), peanuts (Ara h 8), hazelnuts (Cor a 1), chestnuts (Cas s 1), or tomatoes (Sola l 4), because of shared epitopes recognized by IgE antibodies [57,100].”

What the sources say

• Check pendingcites [57] Mastrorilli, C., Cardinale, F., Giannetti, A., and Caffarelli, C. (2019). Pollen-Food Allergy Syndrome: A Not so Rare Disease in Childhood. Medicina, 55. source
• ?Not checked — no full text of the sourcecites [100] Andersen, 2011, Identification of European Allergy Patterns to the Allergen Families PR-10, LTP, and Profilin from Rosaceae Fruits, Clin. Rev. Allergy Immunol. source

In the paper

“This structural feature makes them resistant to heat and enzymatic digestion, enabling them to retain their allergenic potential even after cooking or processing.”

In the paper

“One defining feature of PR-10 proteins is their heat-and digestion-labile nature.”

In the paper

“Fungus-food allergy syndrome (FFAS) is a condition characterized by sensitization to airborne fungal spores, which subsequently leads to allergic reactions to foods containing structurally similar fungal proteins.”

What the sources say

• Check pendingcites [87] Abel-Fernández, E., Martínez, M.J., Galán, T., and Pineda, F. (2023). Going over Fungal Allergy: Alternaria Alternata and Its Allergens. J. Fungi, 9. source
• Check pendingcites [88] Xing, 2022, Recent Advances in the Allergic Cross-Reactivity between Fungi and Foods, J. Immunol. Res. source

In the paper

“The structural conservation of profilins across plant species forms the basis of their allergenic potential, enabling them to act as panallergens in sensitized individuals by triggering immune responses through their shared molecular similarities.”

In the paper

“A study from Japan observed that 65% of patients allergic to fruits were sensitized to GRPs [158].”

What the sources say

• Check pendingcites [158] Inomata, 2020, Gibberellin-Regulated Protein Allergy: Clinical Features and Cross-Reactivity, Allergol. Int. source

In the paper

“Profilins from pollens such as Bet v 2 from birch, Phl p 12 from grass pollen, and Amb a 8 from ragweed pollen play a crucial role as primary sensitizers in individuals who develop PFAS [136].”

What the sources say

• Check pendingcites [136] Zbîrcea, L.-E., Buzan, M.-R., Grijincu, M., Babaev, E., Stolz, F., Valenta, R., Păunescu, V., Panaitescu, C., and Chen, K.-W. (2023). Relationship between IgE Levels Specific for Ragweed Pollen Extract, Amb a 1 and Cross-Reactive Allergen Molecules. Int. J. Mol. Sci., 24. source

In the paper

“The gradient highlights the continuum of allergenic risk, with more stable proteins generally associated with a higher likelihood of systemic reactions, including anaphylaxis [119].”

What the sources say

• ?Not checked — no full text of the sourcecites [119] Panaitescu, 2022, Precision Medicine in the Allergy Clinic: The Application of Component Resolved Diagnosis, Expert Rev. Clin. Immunol. source

In the paper

“Their ubiquity and high degree of conservation make them key contributors to PFAS [133].”

What the sources say

• Check pendingcites [133] Hauser, 2010, Panallergens and Their Impact on the Allergic Patient, Allergy Asthma Clin. Immunol. source

In the paper

“The hallmark of PFAS is its localized manifestation in the oropharyngeal region (OAS).”

In the paper

“Gibberellin-Regulated Proteins (GRPs) are an emerging family of plant allergens that play a role in PFAS.”

In the paper

“Allergens from the PR-10 and profilin families are heat-and digestion-labile, often leading to mild, localized reactions that resolve with cooking or processing of the food.”

In the paper

“Unlike other allergen families, LTPs, such as Tri a 14 in wheat, are implicated not only in PFAS but also in wheat-dependent exercise-induced anaphylaxis (WDEIA) [153].”

What the sources say

• Check pendingcites [153] Jiang, 2024, Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) Suspected Triggered by Lipid Transfer Protein in a Chinese Child: A Case Report, Asia Pac. Allergy source

In the paper

“However, OAS can occur as the initial symptom of both class I and class II food allergies [31].”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Kato, Y., Morikawa, T., and Fujieda, S. (2024). Comprehensive Review of Pollen-Food Allergy Syndrome: Pathogenesis, Epidemiology, and Treatment Approaches. Allergol. Int. source

In the paper

“However, severe reactions, including anaphylaxis, have been reported after consuming large amounts of profilins, which may overwhelm gastric digestion capacity and lead to significant absorption [139].”

What the sources say

• Check pendingcites [139] 2021, Profilins and Food-Dependent Exercise-Induced Anaphylaxis, J. Investig. Allergol. Clin. Immunol. source

In the paper

“Additionally, the potential for severe, life-threatening reactions such as anaphylaxis-though rare-further heightens the psychological burden, as patients may feel unprepared or anxious about the availability of emergency medical care [109][110][111].”

What the sources say

• ?Not checked — no full text of the sourcecites [109] Dupuis, 2020, Food Allergy Management at School, J. Sch. Health source
• ?Not checked — no full text of the sourcecites [110] Caner, 2023, Managing Food Allergies at School: A Qualitative Study, J. Pediatr. Nurs. source
• Check pendingcites [111] Santos, A.F., Worm, M., Kurita, S., Wong, T., Contato, D., Pirillo, E., Esteban, A.E., Tassinari, P., Perna, F., and Chinthrajah, R.S. (2023). Living with Food Allergies: The Experiences of Adult Patients and Caregivers. Front. Allergy, 4. source

In the paper

“Systemic reactions are estimated to occur in approximately 2-10% of PFAS cases, with severe outcomes such as hypotension and respiratory distress being extremely rare (1-2%) [54,57,62,63].”

What the sources say

• Check pendingcites [54] Barni, S., Caimmi, D., Chiera, F., Comberiati, P., Mastrorilli, C., Pelosi, U., Paravati, F., Marseglia, G.L., and Arasi, S. (2022). Phenotypes and Endotypes of Peach Allergy: What Is New?. Nutrients, 14. source
• Check pendingcites [57] Mastrorilli, C., Cardinale, F., Giannetti, A., and Caffarelli, C. (2019). Pollen-Food Allergy Syndrome: A Not so Rare Disease in Childhood. Medicina, 55. source
• ?Not checked — no full text of the sourcecites [62] Skypala, 2020, Can Patients with Oral Allergy Syndrome Be at Risk of Anaphylaxis?, Curr. Opin. Allergy Clin. Immunol. source
• Check pendingcites [63] Kim, 2019, Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome, Yonsei Med. J. source

In the paper

“GRPs are small proteins (7-8 kDa) with a high degree of stability, owing to their conserved cysteine residues that form multiple disulfide bridges [118].”

What the sources say

• Check pendingcites [118] Iizuka, T., Barre, A., Rougé, P., Charpin, D., Scala, E., Baudin, B., Aizawa, T., Sénéchal, H., and Poncet, P. (2022). Gibberellin-Regulated Proteins: Emergent Allergens. Front. Allergy, 3. source

In the paper

“Although uncommon, systemic manifestations of PFAS can occur, with symptoms ranging from urticaria (hives) and widespread angioedema to potentially life-threatening anaphylaxis [97].”

What the sources say

• ?Not checked — no full text of the sourcecites [97] Giovannini, 2024, Diagnosis and Management of Pollen Food Allergy Syndrome to Nuts, J. Allergy Clin. Immunol. Pract. source

In the paper

“Respiratory symptoms, though rare, may include nasal congestion, sneezing, or mild wheezing.”

What the sources say

• Not checked yetcites [96] Lloyd, 2022, Pollen-Food Allergy Syndrome (PFAS), Curr. Allergy Clin. Immunol.

In the paper

“Unlike many other LTP-related allergies, baker's asthma does not require prior sensitization to pollens containing LTPs, as sensitization occurs directly through inhalation of wheat flour particles [154].”

What the sources say

• ?Not checked — no full text of the sourcecites [154] Rius, 2022, Detection of Wheat Lipid Transfer Protein (Tri a 14) Sensitization: Comparison between Currently Available Diagnostic Tools, Int. Arch. Allergy Immunol. source

In the paper

“Among the many allergenic protein families, six have been identified as significant contributors to PFAS due to their ability to induce IgE cross-reactivity between pollens and foods.”

In the paper

“Families, in turn, may experience heightened stress as they navigate the complexities of managing their child's condition, from planning safe meals to ensuring that schools and caregivers understand the potential risks [103,107,108].”

What the sources say

• Check pendingcites [103] Protudjer, 2021, High Anxiety and Health-Related Quality of Life in Families with Children with Food Allergy during Coronavirus Disease 2019, Ann. Allergy Asthma Immunol. source
• ?Not checked — no full text of the sourcecites [107] Abrams, 2020, Qualitative Analysis of Perceived Impacts on Childhood Food Allergy on Caregiver Mental Health and Lifestyle, Ann. Allergy Asthma Immunol. source
• ?Not checked — no full text of the sourcecites [108] Chooniedass, 2020, Parents of Children with Food Allergy: A Qualitative Study Describing Needs and Identifying Solutions, Ann. Allergy Asthma Immunol. source

In the paper

“However, the prevalence of profilin-related PFAS is lower in Mediterranean regions, where other allergens, such as LTPs, dominate the clinical spectrum of food-pollen cross-reactivity [135].”

What the sources say

• Check pendingcites [135] Lipp, 2021, Heterogeneity of Pollen Food Allergy Syndrome in Seven Southern European Countries: The@ IT. 2020 Multicenter Study, Allergy source

In the paper

“The prevalence of PR-10-mediated PFAS is particularly high in regions where birch pollen allergy is common, where it may affect more than 75% of birch-allergic patients [57,127]”

What the sources say

• Check pendingcites [57] Mastrorilli, C., Cardinale, F., Giannetti, A., and Caffarelli, C. (2019). Pollen-Food Allergy Syndrome: A Not so Rare Disease in Childhood. Medicina, 55. source
• Check pendingcites [127] Wang, 2023, Profiles of Birch Allergen Component Sensitization and Its Association with Pollen Food Allergy Syndrome in Northern China, J. Asthma Allergy source

In the paper

“This localized response is attributed to the heat-and digestion-labile nature of profilins, which rapidly denature during cooking or enzymatic digestion in the gastrointestinal tract [119,138].”

What the sources say

• ?Not checked — no full text of the sourcecites [119] Panaitescu, 2022, Precision Medicine in the Allergy Clinic: The Application of Component Resolved Diagnosis, Expert Rev. Clin. Immunol. source
• Check pendingcites [138] Ansotegui, 2020, A WAO—ARIA—GA2LEN Consensus Document on Molecular-Based Allergy Diagnosis (PAMD@): Update 2020, World Allergy Organ. J. source

In the paper

“In the Mediterranean region, where cypress trees are widespread and fruits such as peaches and oranges are dietary staples, GRP sensitization is relatively common [162].”

What the sources say

• Check pendingcites [162] Cecchi, 2024, Optimization of the Diagnosis and Characterization of Gibberellin-Regulated Protein Sensitization: An Italian Cohort Study, Ann. Allergy Asthma Immunol. source

In the paper

“Of these, three families are particularly well-characterized: PR-10 proteins, profilins, and LTPs [44].”

What the sources say

• ?Not checked — no full text of the sourcecites [44] Poncet, 2020, Update on Pollen-Food Allergy Syndrome, Expert Rev. Clin. Immunol. source

In the paper

“Peanut (Ara h 9) also contributes significantly to LTP-related allergies (LTP syndrome), particularly in individuals who experience severe reactions [100,141,143].”

What the sources say

• ?Not checked — no full text of the sourcecites [100] Andersen, 2011, Identification of European Allergy Patterns to the Allergen Families PR-10, LTP, and Profilin from Rosaceae Fruits, Clin. Rev. Allergy Immunol. source
• ?Not checked — no full text of the sourcecites [141] Mota, 2018, Anaphylaxis Caused by Lipid Transfer Proteins: An Unpredictable Clinical Syndrome, Allergol. Immunopathol. source
• Check pendingcites [143] D’Aiuto, V., Mormile, I., Granata, F., Napolitano, F., Lamagna, L., Della Casa, F., de Paulis, A., and Rossi, F.W. (2024). Worldwide Heterogeneity of Food Allergy: Focus on Peach Allergy in Southern Italy. J. Clin. Med., 13. source

In the paper

“These symptoms are often accompanied by mild swelling (angioedema) of the oral mucosa, lips, or tongue [31].”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Kato, Y., Morikawa, T., and Fujieda, S. (2024). Comprehensive Review of Pollen-Food Allergy Syndrome: Pathogenesis, Epidemiology, and Treatment Approaches. Allergol. Int. source

In the paper

“As a result, PR-10-mediated PFAS typically manifests with mild oral symptoms, such as itching, tingling, and swelling of the lips, tongue, throat, and palate.”

In the paper

“Emerging research highlights other promising candidates, such as gibberellin-regulated proteins (GRPs), which are beginning to be recognized as cross-reactive allergens [118].”

What the sources say

• Check pendingcites [118] Iizuka, T., Barre, A., Rougé, P., Charpin, D., Scala, E., Baudin, B., Aizawa, T., Sénéchal, H., and Poncet, P. (2022). Gibberellin-Regulated Proteins: Emergent Allergens. Front. Allergy, 3. source

In the paper

“The PR-10 protein family, with Bet v 1 (17.5 kDa) from birch pollen as its prototype, is one of the most extensively studied allergen families implicated in PFAS [48].”

What the sources say

• Check pendingcites [48] Breiteneder, H., and Kraft, D. (2023). The History and Science of the Major Birch Pollen Allergen Bet v 1. Biomolecules, 13. source

In the paper

“LTP-mediated PFAS often presents with more severe symptoms compared to other allergenic families such as PR-10 proteins or profilins.”

In the paper

“Furthermore, Tri a 14 plays a distinct role in baker's asthma, an occupational allergy caused by inhaling wheat flour allergens.”

In the paper

“This unpredictability can lead to constant vigilance and worry, particularly during social events or dining out, where control over food preparation and exposure to potential triggers may be limited.”

In the paper

“Moreover, the unpredictability of symptoms, particularly in the presence of cofactors, can contribute to anxiety and a reduced sense of well-being [101].”

What the sources say

• ?Not checked — no full text of the sourcecites [101] To, 2022, Food-allergy-specific Anxiety and Distress in Parents of Children with Food Allergy: A Systematic Review, Pediatr. Allergy Immunol. source

In the paper

“Their cross-reactivity with profilins in plant-derived foods is responsible for allergic reactions to foods like peaches (Pru p 12), apples (Mal d 4), and cherries (Pru av 4).”

In the paper

“Most patients experience pruritus and paresthesia in the mouth, lips, tongue, and throat shortly after ingesting raw fruits, vegetables, nuts, seeds, or legumes.”

What the sources say

• ?Not checked — no full text of the sourcecites [31] Kato, Y., Morikawa, T., and Fujieda, S. (2024). Comprehensive Review of Pollen-Food Allergy Syndrome: Pathogenesis, Epidemiology, and Treatment Approaches. Allergol. Int. source

In the paper

“Sensitization to Cup s 7 has been shown to cross-react with GRPs in foods, such as Pru p 7 in peaches and similar GRPs in oranges and other fruits [158].”

What the sources say

• Check pendingcites [158] Inomata, 2020, Gibberellin-Regulated Protein Allergy: Clinical Features and Cross-Reactivity, Allergol. Int. source