Pollen-Food Allergy Syndrome: Pathogenesis, Diagnosis, Management, and Implications for Athletic Populations — A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.65.73946Keywords
pollen-food allergy syndrome, oral allergy syndrome, cross-reactivity, pan-allergens, food-dependent exercise-induced anaphylaxis, allergen immunotherapy, omalizumab, athletesAbstract
Background. Pollen-food allergy syndrome (PFAS) is an IgE-mediated hypersensitivity reaction caused by cross-reactivity between airborne pollen allergens and homologous proteins in plant-derived foods. Aim. To provide a structured overview of PFAS pathogenesis, allergen components, regional epidemiology, clinical spectrum, diagnosis and management, with emphasis on its relevance for sports medicine. Material and methods. Narrative review of 25 full-text articles (1987–2025): position papers, large cohorts, randomised trials and the 2024 AAAAI Delphi consensus. Results. PFAS affects 4.7–53.8% of pollen-allergic patients; anaphylaxis is reported in 1.7–8.9%. PR-10 sensitisation drives the birch–Rosaceae pattern, profilins underlie milder polyreactive phenotypes, nsLTP and GRP are linked to severe, cofactor-dependent reactions. Sublingual immunotherapy with recombinant Mal d 1 and omalizumab are the most promising therapies; pollen immunotherapy alone is not currently endorsed for PFAS. Exercise, NSAIDs and uncontrolled rhinitis amplify severity, with direct relevance for athletes. Conclusions. PFAS is a heterogeneous, prevalent and clinically meaningful condition. Personalised diagnostics, cofactor avoidance and emerging biologicals will shape future management, especially for outdoor athletes exposed to lengthening pollen seasons under climate change.
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Copyright (c) 2026 Weronika Matera, Aleksandra Majewska, Leon Miller, Gabriela Augustynowicz, Klaudia Dziuba, Wiktoria Michalska, Karolina Gaweł, Emilia Dedio, Aleksandra Kozik, Wiktoria Podlasiewicz
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