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Episode 041

What's the Link Between Pollen and Nut Allergies? Diagnostic Insights for Clinicians

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  • Summary
  • Episode Resources
  • Transcript
  • Related Episodes

Episode summary

Did you know that up to 70% of adults with seasonal allergies may experience symptoms of pollen food allergy syndrome (PFAS)? This often-overlooked condition can mimic true nut allergies, leading to unnecessary dietary restrictions. In this episode, we tackle the challenge of differentiating PFAS from primary nut allergies. We explore the molecular basis of cross-reactivity between pollen and food proteins, discuss key diagnostic approaches using testing with allergen components, and provide insights on risk stratification. Learn about the unique presentation of pollen food allergy syndrome with tree nuts and peanuts, understand the role of labile versus storage proteins in symptom manifestation, and gain practical tips for patient management and dietary advice.

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Episode transcript

Time stamps

0:00 - Introduction

0:52 - Overview of pollen food allergy syndrome

2:37 - Immunological differences in pollen food allergy syndrome

4:49 - Protein similarities between pollens and foods

5:42 - Prevalence of pollen food allergy syndrome

8:15 - Specific proteins in tree nuts and peanuts related to pollen food allergy syndrome

11:47 - Management considerations for pollen food allergy syndrome

14:28 - Case study: 8-year-old boy with hazelnut reaction

17:58 - Case study: 32-year-old female with mixed nut reaction

23:32 - Key takeaways and importance of allergen component testing

 

 

 

 

 

References used in this episode
  • Giovannini M, Skypala IJ, Caubet JC, Du Toit G, Nowak-Wegrzyn A. Diagnosis and Management of Pollen Food Allergy Syndrome to Nuts. J Allergy Clin Immunol Pract. 2024 Mar;12(3):599-604. doi: 10.1016/j.jaip.2024.01.025. Epub 2024 Jan 25. PMID: 38280450
  • Carlson G, Coop C. Pollen food allergy syndrome (PFAS): A review of current available literature. Ann Allergy Asthma Immunol. 2019 Oct;123(4):359-365. doi: 10.1016/j.anai.2019.07.022. Epub 2019 Jul 31. PMID: 31376490.
  • Rawat, Mandeep Singh, editor. "Cashew Emerges as Leading Cause of Tree Nut-Induced Anaphylaxis in Children." Medscape, 19 June 2025, www.medscape.com/viewarticle/cashew-emerges-leading-cause-tree-nut-induced-anaphylaxis-2025a1000gd3?form=fpf. Accessed 17 Sept. 2025.