Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK.
Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK.
Clin Exp Allergy. 2022 Sep;52(9):1018-1034. doi: 10.1111/cea.14208. Epub 2022 Aug 17.
Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location. The British Society of Allergy and Clinical Immunology (BSACI) Standards of Care Committee (SOCC) identified a need to develop a guideline for the diagnosis and management of PFS in the United Kingdom (UK). Guidelines produced by the BSACI use either the GRADE or SIGN methodology; due to a lack of high-quality evidence these recommendations were formulated using the SIGN guidelines, which is acknowledged to be less robust than the GRADE approach. The correct diagnosis of PFS ensures the avoidance of a misdiagnosis of a primary peanut or tree nut allergy or confusion with another plant food allergy to non-specific lipid transfer proteins. The characteristic foods involved, and rapid-onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk or severe/atypical reactions to fruits and vegetables may require additional diagnostic tests. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre-existing food allergy or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual immunotherapy to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life.
花粉食物过敏症（PFS）是一种高发的食物过敏症，影响花粉敏感的儿童和成人。当食用生植物食物时，由于花粉过敏原与这些食物中的不稳定蛋白质之间的同源性，患者会出现过敏症状。涉及的触发因素可能因花粉致敏而有所不同，而花粉致敏又受地理位置的影响。英国过敏与临床免疫学学会（BSACI）标准护理委员会（SOCC）确定需要制定英国（UK）花粉食物过敏症的诊断和管理指南。BSACI 制定的指南使用 GRADE 或 SIGN 方法；由于缺乏高质量的证据，这些建议是根据 SIGN 指南制定的，该指南被认为不如 GRADE 方法稳健。正确诊断 PFS 可确保避免误诊为原发性花生或树坚果过敏，或与其他植物性食物过敏相混淆。涉及的特征性食物和快速发作的口咽症状意味着 PFS 通常可以仅根据临床病史进行诊断。然而，涉及树坚果、花生和豆浆或对水果和蔬菜的严重/非典型反应可能需要额外的诊断测试。管理方法是通过排除已知的触发食物，这看似简单，但如果与先前存在的食物过敏或对素食/纯素饮食的个体结合使用，就会出现问题。花粉免疫疗法不是 PFS 的有效治疗方法，尽管针对食物的口服或舌下免疫疗法似乎更有前途，但仍需要进行大型对照研究。PFS 的典型轻度症状可能导致错误的认知，即这种情况总是很容易管理，但严重的反应可能会发生，并且对新食物症状发作的焦虑会对生活质量产生深远影响。
