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BSACI guideline for the diagnosis and management of pollen food syndrome in the UK

Research output: Contribution to journalArticlepeer-review

Isabel J. Skypala, Hannah Hunter, Mamidipudi Thirumala Krishna, Helena Rey-Garcia, Stephen J. Till, George du Toit, Elizabeth Angier, Sarah Baker, Kostadin V. Stoenchev, David K. Luyt

Original languageEnglish
Pages (from-to)1018-1034
Number of pages17
JournalClinical and Experimental Allergy
Issue number9
Accepted/In press2022
PublishedSep 2022

Bibliographical note

Funding Information: The authors do not have any conflicts of interest to declare in relation to this guideline. All authors have completed an ICMJE disclosure form. In the last three years, Isabel J Skypala has received funding from ThermoFisher, the Royal College of General Practitioners (RCGP) and TouchIME. Stephen J. Till has received funding from Revolo Biotherapeutics, Astra Zeneca and National Institute of Health Research (NIHR). Mamidipudi Thirumala Krishna has received funding from NIHR, University of Birmingham, Medical Research Council, Global Challenges Research Fund and the Food Standards Agency, Hannah Hunter has received funding from ASIT Biotech. George du Toit has received funding from the Immune Tolerance Network and the National Institute of Allergy and Infectious Diseases. Elizabeth Angier has received funding from the Natasha Allergy Research Foundation, Local Medical Committee and the RCGP. The following authors have no disclosures to declare; David Luyt, Helena Rey Garcia, Kostadin Stoenchev, Funding Information: The writing group would like to acknowledge the huge help and support for this guideline from Dr Maryam Shayeghi, the BSACI Chief Scientific Officer until May 2021 and also her successor Erinn Gallagher. The final version of this document has been shaped by extensive discussions within SOCC, with many members providing valuable feedback. In particular, the writing group would like to acknowledge the support of Pam Ewan, Liz Powell, Helen Fisher, Deb Marriage, Prathap Pillai, Jose Maia Costa, Rita Mirakian, Nasreen Khan, Susana Marinho, Andy Clark, Chris Corrigan and Lavanya Diwakar. Their comments on successive documents were timely and most helpful. The authors would also like to thank Margaret Kelman from Allergy UK, who provided comments on various drafts of the document. These guidelines inform the management of pollen food syndrome. Adherence to these guidelines does not constitute an automatic defence for negligence and conversely, non-adherence is not indicative of negligence. It is anticipated that these guidelines will be reviewed every 5–7 years. There have been no funding sources for this guideline. The commercial companies or institutions BSACI have been in partnership with from 2020 to 2022 include, Sanofi Genzyme, Thermo Fisher Scientific, Novartis, Mylan, Allergy Therapeutics, Diagenics ALK Abello, Takeda, Aimmune Therapeutics, Viatris, Bio Cryst Pharmaceuticals, Indoor Biotechnologies, Captium, Scope, InBio, Reckitt Benckiser, DBV Technologies, Glenmark, Food Standards Agency and Stallergenes. The commercial companies or institutions that Anaphylaxis Campaign have been in partnership for the same period are Aimmune, ALK, Bausch & Lomb, Aston University, DBV, Co-op, Kantar Health, Viatris, Food Standards, Agency, York Health, Eton College, Manchester University. Publisher Copyright: © 2022 John Wiley & Sons Ltd.

King's Authors


Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location. The British Society of Allergy and Clinical Immunology (BSACI) Standards of Care Committee (SOCC) identified a need to develop a guideline for the diagnosis and management of PFS in the United Kingdom (UK). Guidelines produced by the BSACI use either the GRADE or SIGN methodology; due to a lack of high-quality evidence these recommendations were formulated using the SIGN guidelines, which is acknowledged to be less robust than the GRADE approach. The correct diagnosis of PFS ensures the avoidance of a misdiagnosis of a primary peanut or tree nut allergy or confusion with another plant food allergy to non-specific lipid transfer proteins. The characteristic foods involved, and rapid-onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk or severe/atypical reactions to fruits and vegetables may require additional diagnostic tests. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre-existing food allergy or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual immunotherapy to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life.

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