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

At the 2025 American Academy of Allergy, Asthma, & Immunology (AAAAI) annual meeting in San Diego, HCPLive spoke with expert Antonella Cianferoni, MD, PhD, from the Children’s Hospital of Philadelphia, on all-things-pollen food allergy syndrome 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.

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. Waserman, S., Bégin, P. & Watson, W. IgE-mediated food allergy. Allergy Asthma Clin Immunol 14 (Suppl 2), 55 (2018). https://doi.org/10.1186/s13223-018-0284-3