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Pollen food syndrome: learning from a case series Marianne Louise Dobson Cathal Laurence Steele Elizabeth Diana Theaker Dental Update 2024 51:2, 707-709.
Authors
Marianne LouiseDobson
BMSc(Hons), BDS(Hons), MFDS RCPS(Glasg)
Specialty Registrar in Oral Medicine, Oral Medicine Department, Dundee Dental Hospital and School
Pollen food syndrome (PFS) is an IgE-mediated food hypersensitivity reaction that typically results in immediate-onset oral and oropharyngeal symptoms in individuals who are sensitized to pollen. Symptoms are often mild, but systemic allergic reactions, including anaphylaxis, occur rarely. Using a cases series of six patients who were referred to our oral medicine department and for whom a diagnosis of PFS was made, we illustrate the clinical features of PFS and discuss the possibility that oral mucosal lesions may be a feature. Patients with PFS (or indeed other food hypersensitivities) may present to dental professionals in the first instance, therefore, it is important to be able to recognize key signs/symptoms, to give advice and to investigate/refer appropriately.
CPD/Clinical Relevance: Awareness of the clinical features of PFS, including oral mucosal lesions, is of value to dental clinicians
Article
Pollen food syndrome (PFS) is an IgE-mediated food hypersensitivity reaction that results in oral and oropharyngeal symptoms within minutes of exposure in individuals who are sensitized to pollen. The term oral allergy syndrome (OAS) is often used interchangeably with PFS, but PFS is a more specific term1 that better characterizes the pathogenesis.2 PFS symptoms only occur with plant-based foods (fruit/vegetables/nuts/cereals/spices)3,4,5,6 that have similar allergenic epitopes to the sensitizing pollen(s). Symptoms of PFS typically occur within minutes of exposure to the food(s) and can vary in severity.5 The most common symptom is pruritus (itching) of the oral and oropharyngeal regions.6 Other signs and symptoms include lip, oral and oropharyngeal angioedema (mild, without compromise to airway), tingling, burning and mucosal vesicles/ulcers/blisters.6,7,8,9 Although PFS is generally thought to produce mild symptoms, more serious systemic symptoms (e.g. gastrointestinal symptoms, respiratory symptoms) can occur, and anaphylaxis is reported in 1.7% of patients.2,10 The prevalence of PFS varies with geographical location, but is thought to affect 2% of the UK population,3 and is seen particularly in individuals with atopy.11 The allergens involved in PFS are typically heat and acid labile; therefore, symptoms tend to only occur upon direct mucosal contact with the uncooked food(s) in question.3 The prevalence of PFS is thought to be increasing. This may be a consequence of rising levels of pollen and pollution.12
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