Update on pollen-food allergy syndrome

ABSTRACT

Introduction

Allergies affect 20-30% of the population and respiratory allergies are mostly due to pollen grains from anemophilous plants. One to 5% of people suffer from food allergies and clinicians report increasing numbers of pollen-food allergy syndrome (PFAS), such that the symptoms have broadened from respiratory to gastrointestinal, and even to anaphylactic shock in the presence of cofactors. Thirty to 60% of food allergies are associated with pollen allergy while the percentage of pollen allergies associated to food allergy varies according to local environment and dietary habits

Areas covered

Articles published in peer-reviewed journals, covered by PubMed databank, clinical data are discussed including symptoms, diagnosis, and management. A chapter emphasizes the role of six well-known allergen families involved in PFAS: PR10 proteins, profilins, lipid transfer proteins, thaumatin-like proteins, isoflavone reductases, and β-1,3 glucanases. The relevance in PFAS of three supplementary allergen families is presented: oleosins, polygalacturonases, and gibberellin-regulated proteins. To support the discussion a few original relevant results were added.

Expert opinion

Both allergenic sources, pollen and food, are submitted to the same stressful environmental changes resulting in an increase of pathogenesis-related proteins in which numerous allergens are found. This might be responsible for the potential increase of PFAS.

KEYWORDS:

• Pollen-food allergy syndrome
• PR-10
• profilin
• lipid transfer protein
• thaumatin-like protein
• isoflavone reductase
• β-1,3 glucanase
• oleosin
• polygalacturonase
• gibberellin-regulated proteins

Article highlights

• Symptoms of PFAS are not limited to Oral Allergy Syndrome but can be more severe

• PR10, LTP, and profilin are the top three cross-reactive allergens

• Emergence of new cross-reactive allergen families: Gibberellin-regulated proteins

• Pathogenesis-Related proteins include numerous allergens and are produced upon stressful environmental changes

• Will pollen-food allergy syndrome increase?

Acknowledgments

The authors thank the students who participated in the study of the cross-reactivity of cypress pollen - Y Shahali, O Riveira, A Brazdova, C Longé, O Naas, M Alter, K Dinard, N Girard, M Dubail, A Gomes, M Mossalaei, S Keykhosravi, and J Legendre - and M-A Selva for enthusiastic help. The authors want to acknowledge also the fruitful collaboration with the teams from Japan, Pr Tomoyasu Aizawa and his students and from Czech Republic, late Dr Jarmila Zidkova, Magdalena Melcova and Petr Svoboda.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was financially supported by a joint program between France and Japan “The Hubert Curien Sakura” program (project number: 40956WJ), implemented by the French Ministry for Europe and Foreign Affairs, the French Ministry of Higher Education, Research and Innovation and the Japan Society for the Promotion of Science and from the “Société Française d’Allergologie” (Jan2018)