Fruit allergy epidemiology, clinical diagnosis and preventive management

Fruit allergy is a significant and increasingly recognized global health concern: once reported as a problem in Europe, it is now relevant in many countries, especially China, as consumption in both variety and quantity has increased dramatically. It is often associated with pollen allergy, with clinical manifestations ranging from localized oral allergy syndrome (OAS) to severe systemic reactions such as anaphylaxis. The majority of fruit allergens belong to a limited number of protein families each exhibiting distinct biochemical properties and clinical relevance. Allergy diagnosis relies on a detailed clinical history supported by in vivo and/or in vitro measurements. Component-resolved diagnosis (CRD) with purified allergen molecules provides insight into the primary sensitizing molecules and a more precise and standardized identification of sensitization patterns than possible with extract-based tests. Allergy management focuses on strict avoidance of trigger fruits, while prevention involves breeding hypoallergenic cultivars with lower allergen content and food processing technologies to reduce allergenicity. Allergen immunotherapy (AIT) has been explored as a treatment for fruit allergy with indications of improved tolerance. Emerging approaches combining AIT with biologic agents may further enhance treatment outcomes, although these novel strategies require additional research.