Yonsei Med J.  2019 Oct;60(10):960-968. 10.3349/ymj.2019.60.10.960.

Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome

• Kim M
• Ahn Y
• Yoo Y
• Kim DK
• Yang HJ
• Park HS
• Lee HJ
• Kim MA
• Jeong YY
• Kim BS
• Bae WY
• Jang AS
• Park Y
• Koh YI
• Lee J
• Lim DH
• Kim JH
• Lee SM
• Kim YM
• Jun YJ
• Kim HY
• Kim Y
• Choi JH
• Work Group for Rhinitis, the Korean Academy of Asthma, Allergy and Clinical Immunology

• KMID: 2459149
• DOI: http://doi.org/10.3349/ymj.2019.60.10.960

Abstract

PURPOSE
Many studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis.
MATERIALS AND METHODS
Data were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130).
RESULTS
The most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (p<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25-10.23; p=0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79-15.53; p=0.003), timothy (OR, 11.8; 95% CI, 2.70-51.64; p=0.001), or ragweed (OR, 3.18; 95% CI, 1.03-9.87; p=0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15-1.37; p<0.001) were related to the development of anaphylaxis in PFAS.
CONCLUSION
The most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.

Keyword

Pollen-food allergy syndrome; pollen; food allergy; anaphylaxis

MeSH Terms

Alnus
Ambrosia
Anaphylaxis*
Arachis
Cross-Sectional Studies
Demography
Dermatitis, Atopic
Food Hypersensitivity
Fruit
Humans
Hypersensitivity*
Juglans
Nuts
Panax
Pollen
Prunus persica
Rhinitis, Allergic, Seasonal
Risk Factors*
Salix
Vegetables

Figure

• 

  Fig. 1 Comparison of allergen sensitization profiles between anaphylaxis (n=27) and only oropharyngeal symptom patients (n=130) with pollen-food allergy syndrome (PFAS). More patients with anaphylaxis were sensitized to hazel and willow than patients with only oropharyngeal symptoms. *p<0.05. D, Dermatophagoides.

• 

  Fig. 2 Associations between the number of systemic symptoms other than oral symptoms in pollen-food allergy syndrome and the strength of sensitization to pollen by allergy skin tests. Significant association was found between anaphylaxis and strength of pollen sensitization (A, C, D, E, F, G, H, J: p<0.05 in G2 vs. G0, G1) (B, I: p<0.05 in G2 vs. G1). X-axis, number of systemic symptoms other than oropharyngeal symptoms, G0: only oropharyngeal symptoms, G1: one systemic symptom, G2: anaphylaxis, Y-axis, strength of sensitization (A/H ratio: Allergen/Histamine ratio). *p<0.05 in G2 vs. G0, G1, respectively; †p<0.05 in G2 vs. G1. Neg, negative skin prick test.

• 

  Fig. 3 Associations between the number of systemic symptoms other than oropharyngeal symptoms in pollen-food allergy syndrome (PFAS) and the number of causative pollen-related foods (A) and between the number of systemic symptoms other than oropharyngeal symptoms and the number of sensitized pollen (B). Anaphylaxis (G2) was significantly associated with a higher number of pollen-related foods (p<0.05), but was not associated with the number of sensitized pollens (p>0.05). X-axis, number of systemic symptoms other than oropharyngeal symptoms, G0: only oropharyngeal symptom, G1: one systemic symptom, G2: anaphylaxis. *p<0.05 in G2 vs. G0, G1, respectively.

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