Antonella Cianferoni, MD, PhD

How Pollen Food Allergy Syndrome Contributes to EoE, with Antonella Cianferoni, MD, PhD

Antonella Cianferoni, MD, PhD, from Children’s Hospital of Philadelphia, told 

 that ≥ 90% of cases of eosinophilic esophagitis (EoE) are linked to allergic rhinitis, often triggered by pollen

 As a result, patients with EoE face a high risk of developing pollen food allergy syndrome.

“If you have any eosinophilic esophagitis that is not controlled…foods that cause the pollen Food Allergy syndrome can cause an acute reaction in your esophagitis,” Cianferoni said.

Along with an itchy mouth and swollen lips, patients may experience reflux symptoms or a constriction in their chest. This chest restriction symptom appears to be more frequent in adults but rarer in children.

“What is not completely clear is if these food[s] related with the pollen syndrome can really cause the eosinophilic esophagitis [alone],” Cianferoni said.

Cianferoni presented “Pollen Food Allergy Syndrome (PFAS) in Immunoglobulin E (IgE) and Non-IgE Mediated Food Allergies” at the 

2025 American Academy of Allergy, Asthma, & Immunology (AAAAI)

 annual meeting in San Diego on Friday, February 28. Her presentation covered the 

molecular diagnosis of pollen food allergy syndrome

, the management of pollen food allergy syndrome in IgE-mediated food allergies, and the role of pollen food allergy syndrome in EoE. 

 sat down with Cianferoni at the meeting to discuss these subject matters.

Pollen food allergy syndrome cases have increased in the past 10 – 20 years. Although this is a mild form of food allergy, Cianferoni said the syndrome can sometimes, although rarely, lead to a more severe reaction. Patients may need to carry epinephrine and strictly avoid foods.

For the management of pollen food allergy syndrome, Cianferoni said the options are either avoiding or cooking vegetables or fruits. Pollen immunotherapy, either injectable or sublingual, could be another treatment option but needs further exploration.

Some studies have shown pollen immunotherapy could be effective for pollen food allergy syndrome, but some studies showed the opposite. Cianferoni said it is recommended to give a patient pollen immunotherapy only if it targets the allergic rhinitis. By treating the allergic rhinitis, it may, in the long run, treat the pollen-associated food allergy.

“But [with] pollen allergy in the respiratory tract, it's more debatable if doing immunotherapy with the pollen can really treat the pollen allergy syndrome,” Cianferoni said.

Nowak-Wegrzyn A and Cianferoni A. 1502 - Pollen Food Allergy Syndrome (PFAS) in Immunoglobulin E (IgE) and Non-IgE Mediated Food Allergies. Presented at AAAI 2025 in San Diego on February 28 at 11:30 am.

Derman, C. Pollen Food Allergy Syndrome vs Other Allergies, with Antonella Cianferoni, MD, PhD. HCPLive. March 10, 2025. 

https://www.hcplive.com/view/pollen-food-allergy-syndrome-vs-other-allergies-with-antonella-cianferoni-md-phd

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Cianferoni discusses how pollen food allergy syndrome contributes to eosinophilic esophagitis (EoE) and potential management strategies.

Pollen Food Allergy Syndrome vs Other Allergies, with Antonella Cianferoni, MD, PhD

 spoke with expert Antonella Cianferoni, MD, PhD, from the Children’s Hospital of Philadelphia, on all-things-

 related: the syndrome’s molecular mechanisms, diagnostic tools or markers, and challenges in managing this condition. Early on during the meeting on February 28, Cianferoni presented her session, “Pollen Food Allergy Syndrome (PFAS) in Immunoglobin (IgE) and Non-IgE Mediated Food Allergies.”

The main element that separates pollen food allergy syndrome from other food allergies is the primary sensitization—pollen. First, patients become allergic to pollen and then begin reacting to fruits, vegetables, and nuts that may be similar in structure to pollen.

“In [a] regular food allergy, you get sensitized directly to the food,” Cianferoni said. “What makes this different from regular food allergies [is] that the symptoms are often mild.”

The part of the fruit or vegetable these patients may react to is unstable. The allergen may disappear as soon as the food processes in the stomach.

“That’s true if the food is processed as well,” she said. “If it's cooked, if it's transforming [into] a juice, you don't react to the food because it's very labile—not stable. Most of the time, patients really experience just mild itchiness, sometimes a little lip swelling when they eat raw vegetable[s] and fruit[s], but not when they eat the same fruit[s] and vegetables processed or cooked.”

To diagnose a pollen food allergy syndrome, allergists will often perform skin tests to assess the presence of a food sensitization with the pollen allergy. A blood test can be performed to identify the specific part of a plant that a patient reacts to.

Research has shown pollen food allergy syndrome plays a role in IGE-mediated reactions, such as a tingling or itching of the mouth.

“Although it's not yet clear if the same fruit and vegetables or the same antigen that cause pollen allergy syndrome really cause non-IgE mediated food allergies, there are some report[s] that pollen food allergy syndrome [is] more frequent in patients with non-IgE mediated food allergies such as eosinophilic esophagitis.”’

Relevant disclosures for Cianferoni include Genzyme Corporation, Regeneron Pharmaceuticals, and Optinose US.

Waserman, S., Bégin, P. & Watson, W. IgE-mediated food allergy. 

 (Suppl 2), 55 (2018). https://doi.org/10.1186/s13223-018-0284-3

At AAAAI 2025, Cianferoni described molecular mechanisms of pollen food allergy syndrome.

Antonella Cianferoni, MD, PhD

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