Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome

Abstract

PurposeMany studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis.Materials and MethodsData were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130).ResultsThe most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (p<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25–10.23; p=0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79–15.53; p=0.003), timothy (OR, 11.8; 95% CI, 2.70–51.64; p=0.001), or ragweed (OR, 3.18; 95% CI, 1.03–9.87; p=0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15–1.37; p<0.001) were related to the development of anaphylaxis in PFAS.ConclusionThe most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.

Heterogeneity of pollen food allergy syndrome in seven Southern European countries: The @IT.2020 multicenter study

“…[7][8][9] Rarely, patients suffered from lifethreatening anaphylaxis. [10][11][12][13] Regional differences in pollen sensitization patterns influence the prevalence, elicitors, and typical symptoms of PFAS. 14 While much is known about the typical sensitization pattern for PFAS in Northern Europe, 15,16 less information is available for Southern Europe.…”

Sensitization profile to sawtooth oak component allergens and their clinical implications

“… 23 Furthermore, peanut and apple are described as the most common culprit foods causing anaphylaxis in PFAS in Korea, indicating the possible role of Que ac 1, a primary sensitizer, which is homologous to Bet v 1. 24 Molecular characterization of PR‐10 molecules from commonly consumed Korean fruits, such as Korean melon, ginseng, sesame leaf, deodeok, and lotus root, 25 should be done to understand PFAS in more detail. PFAS in Korea should be dependent on the cross‐reaction of Que ac 1 with homologous allergens from commonly consumed fruits.…”

Validation of a Multiplex Assay for Measuring Specific IgG4

“…Lee, et al 24 reported that adult patients with food allergy are allergic to more than two culprit food allergen, and Wang 25 reported that pediatric patients are allergic to three to four culprit food allergens. In addition, because pollen-food allergy syndrome is often associated with pollinosis patients, 26,27 gens might need to be tested during pollen immunotherapy. Therefore, there is a limit in measuring sIgG4 with a singleplex assay.…”