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Dietary Interventions in Pollen-Related Food Allergy

1
Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
2
Laboratory for Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
3
Department of Dietetics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Nutrients 2018, 10(10), 1520; https://doi.org/10.3390/nu10101520
Received: 20 September 2018 / Revised: 10 October 2018 / Accepted: 12 October 2018 / Published: 16 October 2018
(This article belongs to the Special Issue Contributions of Diet and Gastrointestinal Digestion to Food Allergy)
In practice, it remains unclear what the best dietary approach is in subjects with pollen-related food allergy (PRFA). Our objective was to evaluate the effect of (1) dietary avoidance advice, (2) oral immunotherapy (OIT), (3) (heat) processing, and (4) consumption of hypoallergenic cultivars on frequency, severity, and eliciting dose of pollen-related food allergic reactions. A systematic search was conducted in PubMed, Embase, and Cochrane. All studies performing an in vivo investigation of one of the four interventions in adults with PRFA were included. Each study was assessed for quality and validity. Available data on frequency, severity, and eliciting dose of allergic reactions were extracted. Ten studies matched the eligibility criteria. No studies were retrieved on dietary avoidance advice. Two studies (N = 92) on apple OIT reported that tolerance was induced in 63% and 81% of subjects. Four studies (total N = 116) focused on heat processing. Heating was found to completely eradicate symptoms in 15–71% of hazelnut allergic and 46% of celery allergic individuals. Four studies (N = 60) comparing low to high allergenic apple cultivars revealed that Santana (and possibly Elise) apples seemed to cause milder reactions than Golden Delicious. In the awareness that overall level of evidence was low, we conclude that OIT, heat processing, and hypoallergenic cultivars may diminish or completely prevent allergic reactions in some but not all subjects with PRFA. View Full-Text
Keywords: pollen-related food allergy; food allergy; pollen; diet; avoidance; immunotherapy; heating; processing; hypoallergenic pollen-related food allergy; food allergy; pollen; diet; avoidance; immunotherapy; heating; processing; hypoallergenic
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Lyons, S.A.; Dijk, A.M.; Knulst, A.C.; Alquati, E.; Le, T.-M.; Os-Medendorp, H.V. Dietary Interventions in Pollen-Related Food Allergy. Nutrients 2018, 10, 1520.

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