D3.206 - Pollen-Food Allergy Syndrome (PFAS): A New Paradigm in Allergy Practice – Results of a Survey Among Allergists

Oropharyngeal reactions triggered by the ingestion of plant-based foods in pollen-allergic individuals appear to be increasing in frequency and sometimes be the first patients requirement. In recent years, many allergists have reported a strong trend toward a decline in patient quality of life. Rhinitis may be secondary, and systemic reactions—while rare—are possible. This phenomenon complicates clinical profiles and therapeutic strategies, raising the question of the need to adapt clinical practices.

To explore the perceptions of French-speaking allergists regarding the frequency, evolution, and management of Pollen-Food Allergy Syndrome, as well as the role of Allergen Immunotherapy. The goal was to collect real-world data necessary to better understand and manage the impact of PFAS on patients' respiratory health. 

Data were collected from 123 allergists who responded to a survey distributed via the AdviceMedica platform, connecting all allergists in France. The survey focused on consultation frequency, symptom progression, proposed treatments, and the biological markers utilized in practice

Consultation Frequency: 74,0% of practitioners report priority appointments for PFAS; 55.7% see 0–2 cases per week, while 37.1% observe 3–5 cases per week.

Clinical Evolution: 73.8% report an increase in isolated PFAS or cases where PFAS precedes allergic rhinitis; 47.9% note a worsening of symptoms.

Symptomatology: PFAS is the predominant symptom in 93.5% of cases, mostly mild-to-moderate and localized to the oropharyngeal cavity. 

Allergen Triggers: Birch pollen is the leading trigger, followed by grasses, then Cupressaceae/Oleaceae, and finally weeds.

Therapeutic Impact: 49.6% believe PFAS influences the choice of AIT. If PFAS emerges during AIT, over 30% adjust the dosage, while 20% sometimes suggest a dose increase and only 25% initiate fruit OIT concurrently with AIT.

Diagnostics: Systematic testing is frequent; markers include PR-10 (100%), LTP (86.9%), profilins (75.7%), and gibberellin-regulated proteins (44.9%). 

PFAS is no longer a simple secondary symptom; it has emerged as a major clinical marker influencing quality of life and therapeutic strategies for pollen-allergic patients. The increasing frequency and severity confirmed by allergists highlight the urgent need to integrate this phenomenon into clinical practice, particularly within the context of climate change and the diversification of allergens