Rosaceae food allergy: a review

This review provides a global overview on Rosaceae allergy and details the particularities of each fruit allergy induced by ten Rosaceae species: almond/peach/cherry/apricot/plum (Amygdaleae), apple/pear (Maleae), and raspberry/blackberry/strawberry (Rosoideae). Data on clinical symptoms, prevalence, diagnosis, and immunotherapies for the treatment of Rosaceae allergy are herein stated. Allergen molecular characterization, cross-reactivity/co-sensitization phenomena, the impact of food processing and digestibility, and the methods currently available for the Rosaceae detection/quantification in foods are also described. Rosaceae allergy has a major impact in context to pollen-food allergy syndrome (PFAS) and lipid transfer protein (LTP) allergies, being greatly influenced by geography, environment, and presence of cofactors. Peach, apple, and almond allergies are probably the ones most affecting the quality of life of the allergic-patients, although allergies to other Rosaceae fruits cannot be overlooked. From patients' perspective, self-allergy management and an efficient avoidance of multiple fruits are often difficult to achieve, which might raise the risk for cross-reactivity and co-sensitization phenomena and increase the severity of the induced allergic responses with time. At this point, the absence of effective allergy diagnosis (lack of specific molecular markers) and studies advancing potential immunotherapies are some gaps that certainly will prompt the progress on novel strategies to manage Rosaceae food allergies.

Automated summary

This review provides a comprehensive overview of Rosaceae allergy, focusing on the specificities of each fruit allergy and discussing topics such as clinical symptoms, prevalence, diagnosis, and immunotherapies. The molecular characterization of allergens, cross-reactivity/co-sensitization phenomena, food processing and digestibility, and detection/quantification methods are also covered. The impact of Rosaceae allergy on pollen-food allergy syndrome (PFAS) and lipid transfer protein (LTP) allergies is emphasized, as well as the challenges faced by patients in managing multiple fruit allergies and achieving effective avoidance. The lack of specific molecular markers for diagnosis and advances in immunotherapies are identified as gaps in current research.