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

Antonella Cianferoni, MD, PhD, from Children’s Hospital of Philadelphia, told HCPLive that ≥ 90% of cases of eosinophilic esophagitis (EoE) are linked to allergic rhinitis, often triggered by pollen allergies.1 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. 2 HCPLive 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.

References

1. 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.

2. 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. Accessed March 10, 2025.