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Expert consensus on the diagnosis and management of pollen

花匠小妙招
2024-11-10 19:55

DOI： 10.3760/cma.j.cn112150-20231109-00324

Expert consensus on the diagnosis and management of pollen-food allergy syndrome

Allergen Specific Diagnostics Group, Chinese Society of Allergology,Chinese Medical Association

The Group of Standardized Construction for Allergic Diseases, Futang Research Center of Pediatric Development

Committee on Allergy, Beijing Research Association for Chronic Diseases Control and Health Education

Committee on Allergy, Chinese Aging Well Association

Allergen Specific Diagnostics Group, Chinese Society of Allergology,Chinese Medical Association

The Group of Standardized Construction for Allergic Diseases, Futang Research Center of Pediatric Development

Committee on Allergy, Beijing Research Association for Chronic Diseases Control and Health Education

Committee on Allergy, Chinese Aging Well Association

Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, China

Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing 100045, China

DOI： 10.3760/cma.j.cn112150-20231109-00324

摘要

花粉-食物过敏综合征（pollen-food allergy syndrome，PFAS）是发生在花粉过敏个体的食物过敏反应。近年来，花粉过敏发病率逐年升高且呈现低龄化趋势，PFAS在国内也逐渐受到关注。PFAS的临床特征具有明显的地域差异及异质性。目前，国内对PFAS诊断手段有限，认识不足，尚无可供临床使用的诊断标准。与原发性食物过敏的管理有所不同，PFAS管理需要同时兼顾花粉过敏和食物过敏，管理具有特殊性和复杂性，医生在临床实践中管理存在差异。本共识基于目前国内外现有的指南和我国相关研究证据，制定了诊断标准和管理流程图，旨在规范我国PFAS诊治流程，提高诊疗水平，指导变态反应科医师、相关专业医师和全科医师正确认识、诊断及规范管理PFAS。

关键词：食物过敏;花粉过敏;专家共识;花粉-食物过敏综合征;口腔过敏综合征

ABSTRACT

Pollen-food allergy syndrome (PFAS) is a unique type of food allergy that specifically affects individuals with pollen allergy. In recent years, pollen allergy is increasingly and shows younger tendency. PFAS has also become a topic of interest in China. The characteristics of PFAS vary across regions and show obviously heterogeneity due to different pollen sensitization profile. Currently, diagnostic methods for PFAS in China are limited, which may lead to underdiagnosed and underrecognized of this syndrome, there are currently no accessible diagnostic criteria and procedures for clinical use. Unlike primary food allergy, the management of PFAS need a combined strategy which involves managing both pollen allergy and food allergy. Therefore, its management is particularly complex and varies among doctors in clinical practice. This consensus has developed a diagnosis and management flow chart based on current domestic and foreign guidelines, as well as relevant research evidence in China. The aim is to improve the standard diagnosis and treatment of PFAS and provide guidance to allergists, healthcare professionals, and general practitioners for accurate understanding, diagnosis, and standardized management of PFAS.

KEYWORDS： Food allergy;Pollen allergy;Expert consensus;Pollen-food allergy syndrome;Oral allergy syndrome

Corresponding author: Guan Kai, Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, China, Email: mocdef.6ab21iaknaug_rd

Corresponding author:Xiang Li, Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing 100045, China, Email: mocdef.3ab61ilgnaixrd

FUNDING:

Respiratory Research Project of National Clinical Research Center for Respiratory Diseases（HXZX-20210203, HXZX-20210204, HXZX-202107）

Natural Science Foundation of China（82370041, 82070033）

Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences（2021-I2M-1-107）

The Project for Development of Beijing Municipal Research Ward（BCRW202101）

National High Level Hospital Clinical Research Funding（2022-PUMCH-B-088, 2022-PUMCH-B-089）

2023 Beijing Collaborative Research Project of Integrated Traditional Chinese and Western Medicine on Major and Refractory Diseases (Children's Pulmonary Allergic Diseases-Collaborative Research Demonstration Project of Integrated Traditional Chinese and Western Medicine)（2023BJSZDYNJBXTGG-005）

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

中华医学会变态反应学分会过敏原特异性诊断学组,福棠儿童医学发展研究中心过敏（变态）反应学科规范化建设研究组,北京慢性病防治与健康教育研究会变态反应学专业委员会,等. 花粉-食物过敏综合征诊断及管理专家共识[J]. 中华预防医学杂志,2024,58(06)：719-734.

DOI:10.3760/cma.j.cn112150-20231109-00324

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花粉-食物过敏综合征（pollen-food allergy syndrome，PFAS）是花粉过敏/致敏个体食入与花粉有交叉致敏组分的植物源性食物时引发IgE介导的过敏反应，是一种特殊的食物过敏类型。因PFAS症状通常出现在口唇、口腔黏膜和咽喉部，也曾被称为口腔过敏综合征（oral allergy syndrome，OAS）。除口腔局部症状外，胃肠道、呼吸道亦可受累，也可发生严重过敏反应［ 1 , 2 , 3 ］。严重过敏反应表现为速发、危及生命、可累及多系统的超敏反应。OAS的概念容易与仅表现为口咽部症状的过敏反应症状相混淆，且不能充分体现花粉食物交叉过敏反应的发病机制，故现在更多使用PFAS。目前在不同研究、指南/共识中OAS、PFAS均有使用［ 4 , 5 , 6 ］。在本共识中，统一使用PFAS。

PFAS通常发生在成人、青少年及学龄期儿童，婴幼儿亦有报道［ 7 ］。PFAS最初在欧洲国家报道，约50%花粉过敏患者发生PFAS，在桦树花粉过敏人群中PFAS比例可高达70% ［ 8 , 9 ］，近10年来，PFAS在国内也逐渐被关注并报道，约30%花粉过敏成人合并PFAS ［ 6 ， 10 ］，与欧洲国家不同，我国PFAS多发生在蒿属花粉过敏患者［ 6 ］，蒿属花粉过敏患者PFAS的比例可高达72% ［ 11 ］。此外，临床工作中发现儿童尤其是婴幼儿发生PFAS已不少见，我国一项纳入0~14岁由家长自报儿童PFAS研究提示约30% PFAS发生在0~3岁［ 7 ］，韩国一项研究提示桦树花粉过敏儿童PFAS比例高达43.5% ［ 12 ］，因此，PFAS在儿童也需要引起重视。

PFAS患者同时存在花粉过敏和食物过敏的临床表现，个体花粉致敏模式及相关食物致敏模式存在广泛异质性，在临床实践中，PFAS临床特征异质性明显，花粉过敏临床表型多样（如季节性过敏性鼻结膜炎、过敏性哮喘），个体可能存在多种植物源性食物共致敏，而且个体对不同食物诱发过敏的临床表现轻重不一。因此，不同于单一疾病诊疗管理模式，PFAS的诊疗管理需要同时兼顾花粉过敏和食物过敏，需根据花粉-食物共致敏模式和临床症状进行分层及个体化管理。由于PFAS临床特征及食物诱因具有明显地域性，国外的指南/共识在我国或不能完全适用，不同的临床实践存在差异［ 13 ］，我国目前尚无PFAS诊断标准及管理流程，本共识主要是基于目前国内外的指南和相关研究证据，制定诊疗管理流程图，目的在于提高我国PFAS的诊治水平，指导变态反应科医师、相关专业及全科医师正确认识、诊断及规范管理PFAS。

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