title: Pollen food syndrome amongst children with seasonal allergic rhinitis attending allergy clinic.
abstract: BACKGROUND
  There is limited information regarding the onset and sensitization patterns of pollen food syndrome (PFS) in children. The aim was to explore this within children referred to a specialist allergy clinic at a London Tertiary Hospital.
  
  
  METHODS
  A total of 54 patients with seasonal allergic rhinitis (SAR) were enrolled in equal numbers in three age groups; 0-5, 6-10, 11-15 years. Families completed a questionnaire on rhinitis, food symptoms and quality of life. Children underwent skin prick testing (SPT) to fresh fruits, nuts and a blood test for microarray analysis.
  
  
  RESULTS
  Clinical diagnosis of PFS was made in 26/54 (48%), increasing with age (group 1 = 3 (17%), group 2 = 9 (50%), group 3 = 14 (78%) (p = 0.03)). Microarray demonstrates children aged 2.8 years sensitized to pan-allergens and 4.5 years symptomatic to pan-allergens. Peach, cherry, carrot and strawberry SPT had the highest sensitivity and NPV at 100%. The sensitivity of PR10 molecules on microarray was 92%, PPV 62% and NPV 87%. Microarray confirmed 69% of allergens on clinical history compared to 61% by SPT. Microarray and SPT had a 19% false-negative rate. The quality-of-life data showed moderate impact across all domains, and patients with PFS were significantly more likely to have increased anxiety over time spent preparing food (p = 0.029).
  
  
  CONCLUSIONS
  We demonstrate that SAR occurs in children from 1.4 years and PFS from 4.5 years with a changing pattern of pan-allergen sensitization. Microarray and SPT have moderate concordance in confirming allergens. PFS impacts negatively on quality of life and should be assessed in all paediatric allergy patients.
authors.affiliation: Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Sian
authors.initials: S
authors.lastname: Ludman
authors.affiliation: Immunodiagnostics Division, Thermo Fisher Scientific, Uppsala, Sweden.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Jafari-Mamaghani
authors.affiliation: Division of Asthma, Allergy and Lung Biology, Diagnostic Immunology, King's College London, Viapath, London, UK.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Ebling
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Fox
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Gideon
authors.initials: G
authors.lastname: Lack
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: George
authors.initials: G
authors.lastname: Du Toit
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011788:Quality of Life; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D006113:United Kingdom
keywords: children; hay fever; oral allergy syndrome; pollen food syndrome; quality of life