New Findings, Pathophysiology, and Antigen Analysis in Pollen-Food Allergy Syndrome

Akiko Yagami; Motohiro Ebisawa


Curr Opin Allergy Clin Immunol. 2019;19(3):218-223. 

In This Article

Pollen-food Allergy Syndrome

PFAS is a type of contact allergic reaction that mainly occurs on oral contact with plant-based foods, such as raw fruit, vegetables, or nuts.[1,2]

The pathogenesis of PFAS is related to cross-allergenicity between pollens and foods.[3,4] PFAS requires prior sensitization to a cross-reacting inhalant allergen rather than direct sensitization to a specific food protein.

In a typical example of PFAS, oral mucosal symptoms appear when a patient with birch pollen allergy eats a food from the Rosaceae family.[5] The prevalence of PFAS in pollinosis patients is around 40–50% in Europe,[6–8] 20% in Mediterranean region (a birch-free and ragweed-free area),[9] and 41.7% in Korea.[10] In children with PFAS, Kim et al. described that the prevalence of OAS in children with atopic dermatitis and birch sensitization was 43.5%. On the basis of their results, they recommended that clinicians should be vigilant for OAS in patients with a high degree of sensitization to birch pollen and even young children if they have birch sensitization.[11] Olcese et al. also investigated Mal d 1 and Bet v 1 sensitization patterns in children with PFAS. They described that high-serum IgE to Bet v1 and to Mal d 1 levels may be reasonably predictive of true apple allergy in clinical situations.[12]