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Nutritional Management of Patients With Pollen Food Syndrome: Is There a Need?

  • Food Allergy (M Fernández-Rivas, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Abstract

Purpose of review

Pollen food syndrome (PFS) is a highly prevalent condition causing mild oropharyngeal reactions to plant foods due to recognition by pollen-specific antibodies. It is most frequent in adults, but it can also occur in children. This review aims to establish the pitfalls of diagnosis and the nutritional consequences, and whether individuals with PFS require an individualised dietary and nutritional management strategy.

Recent findings

The diagnosis of PFS can be made through history alone but is greatly enhanced by undertaking component-resolved diagnostic (CRD) tests to individual allergens in birch pollen and relevant foods. Management of PFS requires dietary avoidance of trigger foods, but often, many foods have to be avoided, which can affect quality of life and nutritional intake. Not all symptoms are mild, especially if concentrated forms of allergen are taken, which may occur more frequently with the increased emphasis of the health benefits of fruits and vegetables. Oral food challenge (OFC) and, in the future, novel immunotherapy may minimise necessary avoidance.

Summary

Due to the high homology of the allergens involved, multiple allergy tests can result in mass exclusion of antioxidant-rich fruits and vegetables, which are important nutritional contributors to the diet. Thus, those with PFS should receive individual dietary counselling to prevent deficiency diseases, especially expectant mothers, children and those who are avoiding multiple foods.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Muluk NB, Cingi C. Oral allergy syndrome. Am J Rhinol Allergy. 2018;32:27–30.

    PubMed  Google Scholar 

  2. Skypala IJ, Bull S, Deegan K, Gruffydd-Jones K, Holmes S, Small I, et al. The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18-75 incorporating a validated PFS diagnostic questionnaire. Clin Exp Allergy. 2013;43:928–40.

    CAS  PubMed  Google Scholar 

  3. • Wassmann-Otto A, Heratizadeh A, Wichmann K, Werfel T. Birch pollen-related foods can cause late eczematous reactions in patients with atopic dermatitis. Allergy. 2018. https://doi.org/10.1111/all.13454. An important breakthrough in defining the full scale of PFS, both early and late phase reactions.

    CAS  PubMed  Google Scholar 

  4. García BE, Lizaso MT. Cross-reactivity syndromes in food allergy. J Investig Allergol Clin Immunol. 2011;21:162–70.

    PubMed  Google Scholar 

  5. Barber D, de la Torre F, Feo F, Florido F, Guardia P, Moreno C, et al. Understanding patient sensitization profiles in complex pollen areas: a molecular epidemiological study. Allergy. 2008;63:1550–8. https://doi.org/10.1111/j.1398-9995.2008.01807.x.

    Article  CAS  PubMed  Google Scholar 

  6. Brieteneder H, Kleine-Tebbe, Jorg. PR10-like allergens. Molecular allergology users guide 299–310.

  7. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69:1008–25.

    CAS  PubMed  Google Scholar 

  8. Pascal M, Muñoz-Cano R, Reina Z, Palacín A, Vilella R, Picado C, et al. Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens. Clin Exp Allergy. 2012;42:1529–39.

    CAS  PubMed  Google Scholar 

  9. Skypala IJ, Calderon MA, Leeds AR, Emery P, Till SJ, Durham SR. Development and validation of a structured questionnaire for the diagnosis of oral allergy syndrome in subjects with seasonal allergic rhinitis during the UK birch pollen season. Clin Exp Allergy. 2011;41:1001–11.

    CAS  PubMed  Google Scholar 

  10. Villalta D, Asero R. Is the detection of IgE to multiple Bet v 1-homologous food allergens by means of allergen microarray clinically useful? J Allergy Clin Immunol. 2010;125:1158–61.

    CAS  PubMed  Google Scholar 

  11. •• Flores Kim J, McCleary N, Nwaru BI, Stoddart A, Sheikh A. Diagnostic accuracy, risk assessment, and cost-effectiveness of component-resolved diagnostics for food allergy: a systematic review. Allergy. 2018. https://doi.org/10.1111/all.13399. An important systematic review of CRD, one of the most useful diagnostic tools to determine the difference between nut allergy and PFS.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, Lidholm J, Andersson K, Akkerdaas JH, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults. J Allergy Clin Immunol. 2013;132:393–9.

    CAS  PubMed  Google Scholar 

  13. Uotila R, Kukkonen AK, Blom WM, Remington B, Westerhout J, Pelkonen AS, et al. Component-resolved diagnostics demonstrates that most peanut-allergic individuals could potentially introduce tree nuts to their diet. Clin Exp Allergy. 2018;48:712–21. https://doi.org/10.1111/cea.13101.

    Article  CAS  PubMed  Google Scholar 

  14. Beck SC, Huissoon AP, Collins D, Richter AG, Krishna MT. The concordance between component tests and clinical history in British adults with suspected pollen-food syndrome to peanut and hazelnut. J Clin Pathol. 2018;71:239–45. https://doi.org/10.1136/jclinpath-2017-204573.

    Article  PubMed  Google Scholar 

  15. Wagner A, Szwed A, Buczyłko K, Wagner W. Allergy to apple cultivars among patients with birch pollinosis and oral allergy syndrome. Ann Allergy Asthma Immunol. 2016;117:399–404.

    PubMed  Google Scholar 

  16. Mothes-Luksch N, Raith M, Stingl G, Focke-Tejkl M, Razzazi-Fazeli E, Zieglmayer R, et al. Pru p 3, a marker allergen for lipid transfer protein sensitization also in Central Europe. Allergy. 2017;72:1415–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Ballmer-Weber BK, Hoffmann A, Wüthrich B, Lüttkopf D, Pompei C, Wangorsch A, et al. Influence of food processing on the allergenicity of celery: DBPCFC with celery spice and cooked celery in patients with celery allergy. Allergy. 2002;57:228–35.

    CAS  PubMed  Google Scholar 

  18. Hansen KS, Ballmer-Weber BK, Lüttkopf D, Skov PS, Wüthrich B, Bindslev-Jensen C, et al. Roasted hazelnuts—allergenic activity evaluated by double-blind, placebo-controlled food challenge. Allergy. 2003;58:132–8.

    PubMed  Google Scholar 

  19. Sampson HA, Gerth van Wijk R, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW, et al. Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology—European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012;130:1260–74.

    PubMed  Google Scholar 

  20. van Erp FC, Knulst AC, Meijer Y, Gabriele C, van der Ent CK. Standardized food challenges are subject to variability in interpretation of clinical symptoms. Clin Transl Allergy. 2014;4:1–6.

    Google Scholar 

  21. Cochrane SA, Salt LJ, Wantling E, Rogers A, Coutts J, Ballmer-Weber BK, et al. Development of a standardized low-dose double-blind placebo-controlled challenge vehicle for the EuroPrevall project. Allergy. 2012;67:107–13.

    CAS  PubMed  Google Scholar 

  22. Ortolani C, Ballmer-Weber BK, Hansen KS, Ispano M, Wüthrich B, Bindslev-Jensen C, et al. Hazelnut allergy: a double-blind, placebo-controlled food challenge multicentre study. J Allergy Clin Immunol. 2000;105:577–81.

    CAS  PubMed  Google Scholar 

  23. Skamstrup Hansen K, Vestergaard H, Stahl Skov P, Søndergaard Khinchi M, Vieths S, Poulsen LK, et al. Double-blind, placebo-controlled food challenge with apple. Allergy. 2001;56:109–17.

    CAS  PubMed  Google Scholar 

  24. Ballmer-Weber BK, Wüthrich B, Wangorsch A, Fötisch K, Altmann F, Vieths S. Carrot allergy: double-blinded, placebo-controlled food challenge and identification of allergens. J Allergy Clin Immunol. 2001;108:301–7.

    CAS  PubMed  Google Scholar 

  25. Treudler R, Franke A, Schmiedeknecht A, Ballmer-Weber BK, Worm M, Werfel T, et al. Standardization of double blind placebo controlled food challenge with soy within a multicentre trial. Clin Transl Allergy. 2016;6:39.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Mittag D, Vieths S, Vogel L, Becker WM, Rihs HP, Helbling A, et al. Soybean allergy in patients allergic to birch pollen: clinical investigation and molecular characterization of allergens. J Allergy Clin Immunol. 2004;113:148–54.

    CAS  PubMed  Google Scholar 

  27. Werfel T, Asero R, Ballmer-Weber BK, Beyer K, Enrique E, Knulst AC, et al. Position paper of the EAACI: food allergy due to immunological cross-reactions with common inhalant allergens. Allergy. 2015;70:1079–90.

    CAS  PubMed  Google Scholar 

  28. Kinaciyan T, Nagl B, Faustmann S, Kopp S, Wolkersdorfer M, Bohle B. Recombinant Mal d 1 facilitates sublingual challenge tests of birch pollen-allergic patients with apple allergy. Allergy. 2016;71:272–4.

    CAS  PubMed  Google Scholar 

  29. Venter C, Groetch M, Netting M, Meyer R. A patient-specific approach to develop an exclusion diet to manage food allergy in infants and children. Clin Exp Allergy. 2018;48:121–37.

    CAS  PubMed  Google Scholar 

  30. Ross J, Fishman J, Wang J. Internet and food allergy: what patients are seeking and what they do with the information. J Allergy Clin Immunol Pract. 2017;5:494–5.

    PubMed  Google Scholar 

  31. Berneder M, Bublin M, Hoffmann-Sommergruber K, Hawranek T, Lang R. Allergen chip diagnosis for soy-allergic patients: Gly m 4 as a marker for severe food-allergic reactions to soy. Int Arch Allergy Immunol. 2013;161:229–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. • Beyer S, Franke A, Simon JC, Treudler R. Measurement of health-related quality of life in adult patients with birch pollen-associated food allergy. J Dtsch Dermatol Ges. 2016;14:397–404. Important paper demonstrating the how multiple food exclusions in PFS affect quality of life.

    PubMed  Google Scholar 

  33. Kim J, Kwon J, Noh G, Lee SS. The effects of elimination diet on nutritional status in subjects with atopic dermatitis. Nutr Res Pract. 2013;7:488–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. des Roches A, Paradis L, Paradis J, Singer S. Food allergy as a new risk factor for scurvy. Allergy. 2006;61:1487–8.

    CAS  PubMed  Google Scholar 

  35. Henning SM, Yang J, Shao P, et al. Health benefit of vegetable/fruit juice-based diet: role of microbiome. Sci Rep. 2017;7:2167.

    PubMed  PubMed Central  Google Scholar 

  36. Hong SA, Lee E, Kwon SO, Kim KW, Shin YH, Ahn KM, et al. Effect of prenatal antioxidant intake on infants' respiratory infection is modified by a CD14 polymorphism. World J Pediatr. 2017;13:173–82.

    CAS  PubMed  Google Scholar 

  37. Surette ME. Dietary omega-3 PUFA and health: stearidonic acid-containing seed oils as effective and sustainable alternatives to traditional marine oils. Mol Nutr Food Res. 2013;57:748–59.

    CAS  PubMed  Google Scholar 

  38. Brown RC, Gray AR, Tey SL, Chisholm A, Burley V, Greenwood DC et al. Associations between nut consumption and health vary between omnivores, vegetarians, and vegans. Nutrients. 2017;6:9(11).

  39. McKenzie R, Skypala IJ. Oral allergy syndrome affects quality of life but not fruit and vegetable intake. Clin Exp Allergy. 2009;39:1948.

    Google Scholar 

  40. Zeng C. Effects of different cooking methods on the vitamin C content of selected vegetables. Nutr Food Sci. 2013;43:438–43.

    Google Scholar 

  41. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69:1008–25.

    CAS  PubMed  Google Scholar 

  42. • Uotila R, Kukkonen AK, Pelkonen AS, Mäkelä MJ. Cross-sensitization profiles of edible nuts in a birch-endemic area. Allergy. 2016;71(4):514–21. Data from very large sample size demonstrating how often sensitisation to nuts occurs without any clinical significance.

    CAS  PubMed  Google Scholar 

  43. • Deschildre A, Elegbédé CF, Just J, et al. Peanut-allergic patients in the MIRABEL survey: characteristics, allergists' dietary advice and lessons from real life. Clin Exp Allergy. 2016;46:610–20. Demonstrates the anxiety associated with the exclusion of peanuts.

    CAS  PubMed  Google Scholar 

  44. Mittag D, Akkerdass J, Ballmer-Weber B, Vogel L, Wensing M, Becker WM, et al. Ara h 8, a Bet v 1-homologous allergen from peanut, is a major allergen in patients with combined birch pollen and peanut allergy. J Allergy Clin Immunol. 2004;114:1410–7.

    CAS  PubMed  Google Scholar 

  45. Masthoff LJ, Hoff R, Verhoeckx KC, van Os-Medendorp H, Michelsen-Huisman A, Baumert JL, et al. A systematic review of the effect of thermal processing on the allergenicity of tree nuts. Allergy. 2013;68:983–93.

    CAS  PubMed  Google Scholar 

  46. Robertson ON, Hourihane JO, Remington BC, Baumert JL, Taylor SL. Survey of peanut levels in selected Irish food products bearing peanut allergen advisory labels. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2013;30:1467–72.

    CAS  PubMed  Google Scholar 

  47. McClain S, Bowman C, Fernández-Rivas M, Ladics GS, Ree RV. Allergic sensitization: food- and protein-related factors. Clin Transl Allergy. 2014;4(1):11.

    PubMed  PubMed Central  Google Scholar 

  48. Patel A, Bahna SL. Hypersensitivities to sesame and other common edible seeds. Allergy. 2016;71:1405–13.

    CAS  PubMed  Google Scholar 

  49. Berneder M, Bublin M, Hoffmann-Sommergruber K, Hawranek T, Lang R. Allergen chip diagnosis for soy-allergic patients: Gly m 4 as a marker for severe food-allergic reactions to soy. Int Arch Allergy Immunol. 2013;161:229–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Bolhaar ST, Ree R, Bruijnzeel-Koomen CA, Knulst AC, Zuidmeer L. Allergy to jackfruit: a novel example of Bet v 1-related food allergy. Allergy. 2004;59:1187–92.

    CAS  PubMed  Google Scholar 

  51. Wongrakpanich S, Klaewsongkram J, Chantaphakul H, Ruxrungtham K. Jackfruit anaphylaxis in a latex allergic patient. Asian Pac J Allergy Immunol. 2015;33:65–8.

    PubMed  Google Scholar 

  52. González-De-Olano D, González-Mancebo E, Mohedano-Vicente E, Gandolfo-Cano M, Bartolomé B. Pollen-food syndrome involving allergy to tiger nut. J Investig Allergol Clin Immunol. 2013;23:197–8.

    PubMed  Google Scholar 

  53. Vlieg-Boerstra BJ, van de Weg WE, van der Heide S, Skypala I, Bures P, Ballmer-Weber BK, et al. Additional indications for the low allergenic properties of the apple cultivars Santana and Elise. Plant Foods Hum Nutr. 2013;68:391–5.

    CAS  PubMed  Google Scholar 

  54. Bolhaar ST, van de Weg WE, van Ree R, Gonzalez-Mancebo E, Zuidmeer L, Bruijnzeel-Koomen CA, et al. In vivo assessment with prick-to-prick testing and double-blind, placebo-controlled food challenge of allergenicity of apple cultivars. J Allergy Clin Immunol. 2005;116:1080–6.

    PubMed  Google Scholar 

  55. Carnés J, Ferrer A, Fernández-Caldas E. Allergenicity of 10 different apple varieties. Ann Allergy Asthma Immunol. 2006;96:564–70.

    PubMed  Google Scholar 

  56. Veiths S, Jankiewicz A, Schoning B, Aulepp H. Apple allergy: the IgE-binding potency of apple strains is related to the occurrence of the 18-kDa allergen. Allergy. 1994;49:262–71.

    Google Scholar 

  57. Nybom H, Cervin-Hoberg C, Andersson M. Oral challenges with four apple cultivars result in significant differences in oral allergy symptoms. Int Arch Allergy Immunol. 2013;161:258–64.

    PubMed  Google Scholar 

  58. Sancho AI, van Ree R, van Leeuwen A, Meulenbroek BJ, van de Weg EW, Gilissen LJ, et al. Measurement of lipid transfer protein in 88 apple cultivars. Int Arch Allergy Immunol. 2008;146(1):19–26.

    CAS  PubMed  Google Scholar 

  59. Sancho AI, Foxall R, Browne T, Dey R, Zuidmeer L, Marzban G, et al. Effect of postharvest storage on the expression of the apple allergen Mal d 1. J Agric Food Chem. 2006;54:5917–−5923.

    CAS  PubMed  Google Scholar 

  60. Sancho AI, Foxall R, Rigby NM, Browne T, Zuidmeer L, van Ree R, et al. Maturity and storage influence on the apple (Malus domestica) allergen Mal d 3, a nonspecific lipid transfer protein. J Agric Food Chem. 2006;54(14):5098–104.

    CAS  PubMed  Google Scholar 

  61. Słowianek M, Skorupa M, Hallmann E, Rembiałkowska E, Leszczyńska J. Allergenic potential of tomatoes cultivated in organic and conventional systems. Plant Foods Hum Nutr. 2016;71:35–41.

    PubMed  Google Scholar 

  62. Fernandez-Rivas M, Cuevas M. Peels of Rosaceae fruits have a higher allergenicity than pulps. Clin Exp Allergy. 1999;29:1239–47.

    CAS  PubMed  Google Scholar 

  63. Sancho AI, Rigby NM, Zuidmeer L, Asero R, Mistrello G, Amato S, et al. The effect of thermal processing on the IgE reactivity of the non-specific lipid transfer protein from apple, Mal d 3. Allergy. 2005;60:1262–1268.45.

    CAS  PubMed  Google Scholar 

  64. •• Pekar J, Ret D, Untersmayr E. Stability of allergens. Mol Immunol. 2018;100:14–20. An excellent review of allergen stability.

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Teodorowicz M, van Neerven J, Savelkoul H. Food processing: the influence of the Maillard reaction on immunogenicity and allergenicity of food proteins. Nutrients. 2017;9(8).

    PubMed Central  Google Scholar 

  66. Gruber P, Becker WM, Hofmann T. Influence of the maillard reaction on the allergenicity of rAra h 2, a recombinant major allergen from peanut (Arachis hypogaea), its major epitopes, and peanut agglutinin. J Agric Food Chem. 2005;53:2289–96.

    CAS  PubMed  Google Scholar 

  67. Sancho AI, Wangorsch A, Jensen BM, Watson A, Alexeev Y, Johnson PE, et al. Responsiveness of the major birch allergen Bet v 1 scaffold to the gastric environment: impact on structure and allergenic activity. Mol Nutr Food Res. 2011;55:1690–9.

    CAS  PubMed  Google Scholar 

  68. Ballmer-Weber BK, Hoffmann A, Wüthrich B, Lüttkopf D, Pompei C, Wangorsch A, et al. Influence of food processing on the allergenicity of celery: DBPCFC with celery spice and cooked celery in patients with celery allergy. Allergy. 2002;57:228–35.

    CAS  PubMed  Google Scholar 

  69. Rib-Schmidt C, Riedl P, Meisinger V, Schwaben L, Schulenborg T, Reuter A, et al. pH and heat resistance of the major celery allergen Api g 1. Mol Nutr Food Res. 2018 May;25:e1700886.

    Google Scholar 

  70. Bohle B. The impact of pollen-related food allergens on pollen allergy. Allergy. 2007;62:3–10.

    CAS  PubMed  Google Scholar 

  71. Bohle B, Zwölfer B, Heratizadeh A, Jahn-Schmid B, Antonia YD, Alter M, et al. Cooking birch pollen-related food: divergent consequences for IgE- and T cell-mediated reactivity in vitro and in vivo. J Allergy Clin Immunol. 2006;118:242–9.

    CAS  PubMed  Google Scholar 

  72. Schimek EM, Zwölfer B, Briza P, Jahn-Schmid B, Vogel L, Vieths S, et al. Gastrointestinal digestion of Bet v 1-homologous food allergens destroys their mediator-releasing, but not T cell-activating, capacity. J Allergy Clin Immunol. 2005;116:1327–33.

    CAS  PubMed  Google Scholar 

  73. Bégin P, Des Roches A, Nguyen M, Masse MS, Paradis J, Paradis L. Freezing does not alter antigenic properties of fresh fruits for skin testing in patients with birch tree pollen-induced oral allergy syndrome. J Allergy Clin Immunol. 2011;127:1624–6.

    PubMed  Google Scholar 

  74. Bindslev-Jensen C, Vibits A, Skov SP, Weeke B. Oral allergy syndrome: the effect of astemizole. Allergy. 1991;46:610–3.

    CAS  PubMed  Google Scholar 

  75. de Silva D, Geromi M, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. Acute and long-term management of food allergy: systematic review. Allergy. 2014;69:159–67.

    PubMed  Google Scholar 

  76. Turner PJ, Dawson TC, Skypala IJ, Fox AT. Management of pollen food and oral allergy syndrome by health care professionals in the United Kingdom. Ann Allergy Asthma Immunol. 2015;114:427–8.e1.

    PubMed  Google Scholar 

  77. Ma S, Sicherer SH, Nowak-Wegrzyn A. A survey on the management of pollen-food allergy syndrome in allergy practices. J Allergy Clin Immunol. 2003;112:784–8.

    PubMed  Google Scholar 

  78. Bolhaar ST, Tiemessen MM, Zuidmeer L, van Leeuwen A, Hoffmann-Sommergruber K, Bruijnzeel-Koomen CA, et al. Efficacy of birch-pollen immunotherapy on cross-reactive food allergy confirmed by skin tests and double-blind food challenges. Clin Exp Allergy. 2004;34:761–9.

    CAS  PubMed  Google Scholar 

  79. Mauro M, Russello M, Incorvaia C, Gazzola G, Frati F, Moingeon P, et al. Birch-apple syndrome treated with birch pollen immunotherapy. Int Arch Allergy Immunol. 2011;156:416–22.

    PubMed  Google Scholar 

  80. Bucher X, Pichler W, Dahinden C, Helbling A. Effect of tree pollen specific, subcutaneous immunotherapy on the oral allergy syndrome to apple and hazelnut. Allergy. 2004;59:1272–6.

    CAS  PubMed  Google Scholar 

  81. van Hoffen E, Peeters KA, van Neerven RJ, van der Tas CW, Zuidmeer L, van Ieperen-van Dijk AG, et al. Effect of birch pollen-specific immunotherapy on birch pollen-related hazelnut allergy. J Allergy Clin Immunol. 2011;127:100–1.

    PubMed  Google Scholar 

  82. Kinaciyan T, Jahn-Schmid B, Radakovics A, Zwölfer B, Schreiber C, Francis JN, et al. Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1. J Allergy Clin Immunol. 2007;119:937–43.

    CAS  PubMed  Google Scholar 

  83. Treudler R, Franke A, Schmiedeknecht A, Ballmer-Weber B, Worm M, Werfel T, et al. BASALIT trial: double-blind placebo-controlled allergen immunotherapy with rBet v 1-FV in birch-related soya allergy. Allergy. 2017;72:1243–53.

    CAS  PubMed  Google Scholar 

  84. • Kinaciyan T, Nagl B, Faustmann S, Frommlet F, Kopp S, Wolkersdorfer M, et al. Efficacy and safety of 4 months of sublingual immunotherapy with recombinant Mal d 1 and Bet v 1 in patients with birch pollen-related apple allergy. J Allergy Clin Immunol. 2018;141:1002–8. This study is one of the first to demonstrate that sublingual treatment with a recombinant food allergen is safe and clinically effective for the treatment of birch pollen-related apple allergy.

    CAS  PubMed  Google Scholar 

  85. Hofer H, Asam C, Hauser M, Nagl B, Laimer J, Himly M, et al. Tackling Bet v 1 and associated food allergies with a single hybrid protein. J Allergy Clin Immunol. 2017;140:525–33.

    CAS  PubMed  Google Scholar 

  86. Kopac P, Rudin M, Gentinetta T, Gerber R, Pichler C, Hausmann O, et al. Continuous apple consumption induces oral tolerance in birch-pollen-associated apple allergy. Allergy. 2012;67:280–5.

    CAS  PubMed  Google Scholar 

  87. Pauli G, Larsen TH, Rak S, Horak F, Pastorello E, Valenta R, et al. Efficacy of recombinant birch pollen vaccine for the treatment of birch-allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2008;122:951–60.

    CAS  PubMed  Google Scholar 

  88. Bedolla-Barajas M, Kestler-Gramajo A, Alcalá-Padilla G, Morales-Romero J. Prevalence of oral allergy syndrome in children with allergic diseases. Allergol Immunopathol (Madr). 2017;45:127–33.

    CAS  Google Scholar 

  89. Mastrorilli C, Tripodi S, Caffarelli C, Perna S, Di Rienzo-Businco A, Sfika I, et al. Endotypes of pollen-food syndrome in children with seasonal allergic rhinoconjunctivitis: a molecular classification. Allergy. 2016;71:1181–91.

    CAS  PubMed  Google Scholar 

  90. Ludman S, Jafari-Mamaghani M, Ebling R, Fox AT, Lack G, Du Toit G. Pollen food syndrome amongst children with seasonal allergic rhinitis attending allergy clinic. Pediatr Allergy Immunol. 2016;27:134–40.

    PubMed  Google Scholar 

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  1. Royal Brompton & Harefield NHS Foundation Trust, London, UK

    Natasha C. Gunawardana MA, MRCP, Helena Rey-Garcia BSc & Isabel J. Skypala PhD

  2. Imperial College, London, UK

    Isabel J. Skypala PhD

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  1. Natasha C. Gunawardana MA, MRCP
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  2. Helena Rey-Garcia BSc
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Correspondence to Isabel J. Skypala PhD.

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Natasha Gunawardana declares that she has no conflict of interest. Helena Rey Garcia declares that she has no conflict of interest. Isabel Skypala declares that she has no conflict of interest.

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This article is part of the Topical Collection on Food Allergy

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Gunawardana, N.C., Rey-Garcia, H. & Skypala, I.J. Nutritional Management of Patients With Pollen Food Syndrome: Is There a Need?. Curr Treat Options Allergy 5, 500–514 (2018). https://doi.org/10.1007/s40521-018-0188-y

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