The clinical relevance of sensitization to pollen‐related fruits and vegetables in unselected pollen‐sensitized adults

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Abstract
Background: Previous studies have described cross‐reactivity between fresh fruits, vegetables and pollen. However, no data demonstrates the clinical relevance of sensitization to pollen‐related fruits and vegetables in unselected pollen‐sensitized adults with and without symptoms in the pollen season. Objective: The aim of this study was to estimate the clinical relevance of sensitization to pollen‐related fruits and vegetables in unselected pollen‐sensitized adults and to examine the diagnostic value of skin‐prick test (SPT), histamine release and specific IgE compared with the outcome of oral challenge. Methods: In total, 936 unselected adults (female : male 479 : 457, median age 33.7 years) were examined for pollen sensitization and clinical cross‐reactivity with pollen‐related fruits and vegetables by questionnaire, SPT, histamine release, specific IgE and oral challenge. Results: The prevalence of pollen sensitization was 23.8% (n = 223). The probability of a clinical reaction to pollen‐related foods in the respective pollen‐sensitized groups was: 24% (birch), 4% (grass), 10% (mugwort), 35% (birch + grass), 8% (grass + mugwort) and 52% (birch + grass + mugwort). The odds ratio of a clinical reaction to pollen‐related fruits and vegetables in symptomatic pollen‐sensitized adults was as high as four times (birch + grass) the odds ratio of a clinical reaction in asymptomatic pollen‐sensitized adults. Conclusion: This study not only demonstrates a high prevalence of clinical reactions to fruits and vegetables in pollen‐sensitized adults, but also a discrepancy between the prevalence of sensitization to fruits and vegetables and the clinical relevance in different pollen‐sensitized groups with symptoms in the pollen season as a significant factor.