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Pollen Food Allergy Syndrome-Two Decades Apart: A Follow-up AAAAI Survey
Lydia Su Yin Wong1, Amanda Cox2, Antonella Cianferoni3
1Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, NY; Khoo Teck Puat University Children's Medical Institute, National University Hospital, Singapore.
The Journal of Allergy and Clinical Immunology. in Practice
|January 23, 2026
Summary
Pollen food allergy syndrome (PFAS) prevalence has increased in children and adults. Allergists report more systemic reactions, especially from nuts, but fewer epinephrine auto-injector prescriptions, highlighting evolving management needs.
Area of Science:
- Allergy and Immunology
- Epidemiology
- Clinical Practice
Background:
- Pollen food allergy syndrome (PFAS), or oral allergy syndrome, involves cross-reactivity between pollen and foods.
- While often mild, PFAS can lead to systemic reactions.
- This study revisits a 2003 survey to assess changes in PFAS epidemiology and management over two decades.
Purpose of the Study:
- To evaluate changes in the prevalence, clinical presentation, diagnosis, and management of PFAS among U.S. allergists.
- To compare current practices with data from 2003.
Main Methods:
- An electronic survey was sent to 737 U.S. allergists in 2023, with 67 responses.
- The survey included original questions from 2003 and new questions to assess changes.
- Responses were compared to the 2003 survey data.
Main Results:
- Reported PFAS prevalence increased significantly in both children (5% to 10%) and adults (8% to 20%).
- The incidence of systemic PFAS rose (20% to 67% of allergists reporting), with nut-induced PFAS increasingly recognized as a trigger.
- Epinephrine auto-injector prescribing decreased, and component-resolved diagnostics showed limited adoption.
Conclusions:
- Allergists observe higher PFAS prevalence and increased recognition of nut-induced and systemic reactions.
- Diagnostic and management practices for PFAS are evolving.
- Updated guidelines are needed for PFAS diagnosis and management.
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