Clinical and Laboratory Characteristics of Fruit and Vegetable Allergy in Childhood: A Five-Year Retrospective Evaluation.

INTRODUCTION: Fruit and vegetable allergies in childhood present with heterogeneous clinical features and are often influenced by cross-reactivity with aeroallergens. Despite their growing clinical importance, data on diagnostic accuracy and clinical phenotypes remain limited, particularly in regions where component-resolved diagnostic tests are not available. METHODS: This five-year retrospective cohort study evaluated children aged 0-18 years who presented to a tertiary pediatric allergy clinic between 2020 and 2025 with suspected fruit or vegetable allergy. Clinical history, skin prick test (SPT), specific IgE (sIgE), prick-by-prick test results, aeroallergen sensitization profiles, laboratory parameters, and oral food challenge (OFC) outcomes were reviewed. Only patients whose diagnoses were confirmed by OFC were included in the study. RESULTS: A total of 19 OFC-confirmed cases were included. The median age at symptom onset was 41.5 months. Based on the total number of triggering foods (n = 23), the most common allergens were kiwi (17.4%) and strawberry (17.4%), while urticaria was the most frequent clinical manifestation at initial presentation (52.2%). Reaction types did not significantly differ across different allergen subgroups; however, patients with oral allergy syndrome had a significantly higher age of symptom onset (p=0.002). Sensitization tests demonstrated limited diagnostic performance for predicting OFC-confirmed fruit and vegetable allergy, with a sensitivity of 47.4%, specificity of 80.0%, positive predictive value of 52.9%, negative predictive value of 76.2%, and an overall diagnostic accuracy of 69.5%. CONCLUSIONS: Fruit and vegetable allergies in childhood are generally mild but may exhibit considerable clinical variability. Skin prick test and serum specific IgE tests alone are insufficient for diagnosis, and OFC remains the gold standard for diagnostic confirmation. Larger, multi-center studies are needed to better characterize sensitization patterns and to establish reliable diagnostic cut-off values.