New guidelines to help patients with Pollen Food Syndrome

New guidelines to help patients with Pollen Food Syndrome

  • 17 August 2022
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The British Society for Allergy and Clinical Immunology (BSACI) has announced the publication of the BSACI Guideline for the diagnosis and management of Pollen Food Syndrome/Oral Allergy Syndrome.

Pollen Food Syndrome (PFS), also known as Oral Allergy Syndrome, is a highly prevalent food allergy which affects 2% of the adult population in the UK and is linked to hay fever. Up to 40% of children and 70% of adults with birch tree pollen allergy, report mild itching or swelling of the mouth/throat when eating raw or uncooked fruits, vegetables or nuts, because their pollen antibodies mistakenly recognise and react to proteins in these foods. A need was identified for guidelines outlining the correct diagnosis and management of this common condition and ensure the avoidance of a misdiagnosis of a peanut or tree nut allergy, or confusion with another plant food allergy to non-specific Lipid Transfer Proteins.

PFS can usually be diagnosed without allergy tests; people reporting mild oral tingling or itching with raw fruits or raw nuts probably have PFS. Those with more severe symptoms to raw food triggers, or who react to cooked fruits and vegetables or roasted nuts should be referred to an allergy specialist. Diagnostic tests should include allergy tests to tree and grass pollen, because a positive test to tree pollen makes a diagnosis of PFS more likely.

Standard skin prick and blood allergy tests for peanuts, almond and hazelnut are usually positive in those allergic to tree pollen, so testing to individual tree nut or peanut allergens can help to distinguish PFS from a tree nut or peanut allergy. People with PFS only need to avoid their specific food triggers; reactions are usually mild and symptoms generally disappear after a short time, often without the need for antihistamines, and self-injectable adrenaline devices are rarely required.

Current evidence suggests that pollen immunotherapy is not an effective treatment for PFS, and there is currently insufficient evidence for immunotherapy or desensitisation with fresh foods to make a recommendation.

Patient Jane McCloskey explains:

“For almost forty years I have been aware of reactions to certain foods when eaten raw including apples, celery, carrots and peaches yet the cooked versions of these fruits and vegetables posed no problem. After experiencing hay-fever symptoms in reaction to birch tree pollen and two disturbing reactions to almond and carrot, I was finally diagnosed with Food Pollen Allergy. The ability to finally manage my condition with antihistamine and more care in the pollen season has been both a revelation and a relief and I hope these guidelines will help other sufferers.”

The guideline is a key resource, not only for allergists, but also for GP’s. It contains a separate leaflet and diagnostic algorithm to help GPs make decisions about who needs to be referred to an allergist. Professor Graham Roberts, President of BSACI explains:

“We are delighted to announce the publication of the guideline for the diagnosis and management of Pollen Food Syndrome. It will provide healthcare professionals with advice about the management of this common condition and improve outcomes for patients.”

Sarah Baker, Head of Health Policy and Developments at Anaphylaxis UK, says: “We are very pleased to have been involved in the development of these BSACI guidelines. As a patient organisation, Anaphylaxis UK contributes by giving a patient perspective and ensuring that people with allergies are fully represented. We will work with healthcare professionals to support patient knowledge and understanding of Pollen Food Syndrome.”

Margaret Kelman, Head of Clinical Services at Allergy UK says, “This guideline will be a valuable and much-needed resource for healthcare professionals, that will bring a great deal of benefit and clarity for patients affected by Pollen Food Syndrome in the UK.”  

Access the BSACI guideline for the diagnosis and management of Pollen Food Syndrome/Oral Allergy Syndrome at


Additional information:

  1. The British Society for Allergy & Clinical Immunology (BSACI) is the national, professional, and academic society which represents the specialty of allergy at all levels. Its aim is to improve the management of allergies and related diseases of the immune system in the United Kingdom, through education, training, and research

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