Evaluation of Allergic Reactions and Tolerance With Fruit and Vegetable Allergy in Children

To examine the demographic characteristics, tolerance rate, and resolution time of fruit and vegetable allergies in children.The population examined was in a retrospective, descriptive, cross-sectional study that included 78 children with a median age of 61.5 months at an Allergy and Immunology Clinic in Ankara, Turkey, from 2020 to 2022 with suspected allergic reactions to fruits and vegetables (F&V).Patient records were used to identify demographic date, skin prick test (SPT), prick-to-prick (PTP) test with fresh F&V, and oral food challenge (OFC) test results and laboratory findings. The OFC test was performed 3 months after the diagnosis of F&V allergy, which was based on clinical history, SPT, or blood screening. Of the diagnosed patients, 34 tested positive on the first OFC whereas 44 were excluded for various reasons including 1 with anaphylaxis that did not have OFC. Detailed analysis was performed on the 34 patients to assess tolerance progression with clinic follow-up every 3 months. Patients in the whole cohort were defined as class 1 food allergy (gastrointestinal tract sensitization; n = 65) or class 2 (result of cross-reactivity with structurally homologous inhalant allergens; n = 13).Fifty-seven fruit and 21 vegetable allergies were identified. The most common allergens were potato (21.8%), banana (15.4%), peach (14.1%), and tomato (12.8%). Urticaria was the most common clinical finding (75.6%), followed by pollen-food syndrome (15.4%), angioedema (7.7%), and anaphylaxis (1.3%). Thirteen children (38.2%) achieved tolerance and 21 (61.8%) did not during the follow-up period. The median time for tolerance development was 13.5 months after diagnosis (range 9-87 months). No significant differences were noted in age, gender, F&V sensitivity type, total eosinophil count or percent eosinophils in whole blood, or the presence of additional food allergies or other allergic diseases between the 2 developed groups (tolerant vs nontolerant). However, significant differences were observed in reaction type, clinical presentation, pan-allergy to aeroallergens, and total serum immunoglobulin E levels.This study demonstrates some unique features regarding tolerance rate and resolution time of F&V allergies based on demographic and diagnostic parameters in a limited cohort of children.Although less common among food allergies, the prevalence of F&V allergies along with others appears to be increasing worldwide. Further studies are needed to understand the risk factors for the development of these allergies and for interventions that could lead to potential prevention.