When is an allergic reaction to raw plant food due to tree pollen?

When is an allergic reaction to raw plant food due to tree pollen?

new Guideline It aims to help primary care physicians differentiate pollen food syndrome (PFS) – an allergic reaction to some raw, but uncooked plant foods – from others. food allergy.

The guidelines issued by the British Society of Allergy and Clinical Immunology (BSACI) focus on birch Tree pollen, a major allergen causing PFS allergy in Northern Europe. Providers may be able to diagnose PFS associated with birch pollen from the clinical history alone, including the foods involved and the speed of symptom onset, said lead author Isabel J.

New BSACI Guideline To diagnose and manage PFS was published in Clinical and experimental sensitivity.

PFS is increasingly common and widespread

PFS – also called allergic oral syndrome and pollen allergy syndrome – is common and increasingly common. PFS can begin at any age but usually begins in school-aged children sensitive to pollen and adults Seasonal allergic rhinitis.

Symptoms of similar proteins in food

Mild to moderate allergy symptoms develop quickly when people allergic to birch pollen eat raw plant foods that contain proteins similar to those in pollen, such as pathogen-related protein PR-10. Allergens are broken down by cooking or processing.

Symptoms usually occur immediately or within 15 minutes of eating. Patients may experience tingling. Itching or soreness in the mouth, throat or ears. Temperate lip and oral mucosa angioedema; itchy hands, sneezing, or eye symptoms; Angioedema of the tongue or pharynx. a rash around the mouth; cough; Stomach ache; nausea; Eczema is exacerbated. In children, itching and rashes may predominate.

Triggers depend on the type of pollen

PFS triggers vary depending on a person’s pollen allergy, which is influenced by geographic area and local dietary habits. In the UK, approximately 70% of adults with a birch allergy and more than 40% of children with a birch allergy have PFS, the authors wrote.

Typical triggers include eating apples, core fruits, kiwis, carrots, celery, hazelnuts, almonds, walnuts, soy milk, and peanuts, as well as peeling potatoes or other root vegetables. Fresh fruit or vegetable juices or juices, celery, soy milk, raw nuts, large amounts of roasted nuts, and concentrated nut products can cause more severe reactions.

Diagnostic clinical history

If the patient answers yes to these questions, he or she almost certainly has PFS, the authors write:

  1. Are symptoms caused by raw fruits, nuts, carrots, or celery?

  2. Are the same trigger foods tolerated when thoroughly cooked or roasted?

  3. Do symptoms appear immediately or within a few minutes of eating?

  4. Do symptoms occur in the oropharynx and include tingling, itching, or swelling?

  5. Does the patient suffer from seasonal allergic rhinitis or allergy to pollen?

For some cases, testing is required

Allergy tests may be needed for people who report atypical or severe reactions or who also react to cooked or processed plant foods, such as roasted nuts, nuts in foods, and fruits or vegetables in juices, smoothies, and soy products other than milk. Tests may also be necessary for people who react to foods not associated with PFS, such as cashews, pistachios, macadamia nuts, sesame seeds, beans, lentils, and chickpeas.

It is unclear whether PFS reactions also occur with roasted hazelnuts, almonds, walnuts, Brazil nuts, or peanuts, either alone or in combination foods such as chocolate, spreads, sweets, and snacks.

Oral food challenge is not required to confirm PFS unless the history and diagnostic tests are inconclusive or if the patient is avoiding multiple foods.

Diet management

PFS is managed by excluding known causative foods. This becomes a challenge for patients with pre-existing food allergies and for vegetarians and vegans.

Personalized nutritional advice is needed to avoid nutritional imbalances, reduce anxiety and unnecessary dietary restrictions, and improve quality of life. Reactions after accidental exposure often resolve without medication and, if antihistamines are needed, rarely require self-injectable devices.

Useful advice outside the UK and birch pollen

Allyson S. Larkin, MD, associate professor of pediatrics at the University of Pittsburgh School of Medicine, said Medscape Medical News In an email, the guideline summarizes in great detail the pathophysiology behind PFS and highlights how component testing can aid in patient diagnosis and management of the condition.



Dr. Alison S. Larkin

“Patients are very concerned about the development and severity of allergic reactions,” said Larkin, who was not involved in developing the guidelines.

“As the authors note, learning about the nutritional consequences of dietary restrictions is important, and nutrition counseling and appropriate alternative suggestions are very helpful for these patients, especially for those with food allergies, vegetarians or vegans.”

Jill A. Ball, MD, professor of medicine and chair of the department of allergy and immunology at the University of Nebraska School of Medicine in Omaha, notes that PFS, while common, is not recognized by the public and health care providers.



Dr. Jill A. Paul

“People are not allergic to a specific type of food, but they are allergic to seasonal allergens, such as birch, which react to a food protein, which typically changes during cooking,” she explained in an email.

“This is different from reactions by those who have moderate to severe food-specific allergic reactions which may include systemic reactions such as Squeamishness from eating certain foods.

“Importantly, the number of foods interacting with seasonal pollen is increasing, and testing has expanded in recent years,” advised Paul, who was also not involved in developing the guidelines.

The authors recommend more relevant research into food immunotherapy and new PFS treatments. They also want to raise awareness of the factors influencing the prevalence of PFS, such as the increased prevalence of pollen and allergies due to climate change, pollution, global consumption of formerly local traditional foods, and an increase in vegetarian and vegan diets.

The authors, Larkin, and Poole reported no relevant financial relationships incorporating this guideline. The guideline was not funded.

Clinical and experimental sensitivity. Posted online August 17, 2022. full text

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