From Pollen to Plate: A Botanical Classification-Based Narrative Review of Fresh Fruit Allergy
11 affiliations
- 1Department of Experimental Medicine, Pediatric Section, University of Salento, Hospital “Vito Fazzi”, 73100 Lecce, Italy
- 2Pediatric Hospital Giovanni XXIII, Pediatric and Emergency Department, AOU Policlinic of Bari, 70100 Bari, Italy
- 3Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- 4Allergy Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
- 5Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
- 6Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80100 Naples, Italy
- 7Pediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy
- 8Pediatric Allergy Unit, Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
- 9Department of Health Sciences, University of Florence, 50139 Florence, Italy
- 10Department of Human Pathology in Adult and Development Age “Gaetano Barresi”, Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98100 Messina, Italy
- 11Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
Abstract
Fruit consumption is a cornerstone of a healthy diet, providing essential micronutrients and bioactive compounds; however, fresh fruits may also trigger IgE-mediated allergic reactions, ranging from mild oral symptoms to potentially life-threatening anaphylaxis. Fruit allergy is a heterogeneous field characterized by diverse clinical phenotypes, botanical relationships, molecular sensitization profiles, and patterns of cross-reactivity. This narrative review organizes the available evidence according to 18 botanical families, adapting and extending an established botanical classification framework to the specific context of fresh fruit allergy. Botanical classification serves as a structured organizational framework rather than as a predictor of allergenic cross-reactivity, which is primarily determined by shared or homologous allergenic proteins and may occur both within and across botanical families. The review integrates botanical relationships with clinical manifestations, molecular allergen families, cross-reactivity, cofactors, diagnosis, and management. Clinical assessment should be individualized and based on the clinical history and appropriate in vivo and in vitro testing, including skin prick or prick-to-prick testing with fresh fruit and measurement of specific IgE, with oral food challenges reserved for selected cases. Molecular allergology may provide additional information for risk assessment in selected patients, although the availability and strength of evidence for individual molecular components vary considerably. Management should likewise be individualized according to the confirmed trigger, clinical phenotype, and risk of systemic reactions, with appropriate dietary counselling and patient education. The available epidemiological and clinical evidence is heterogeneous, particularly for uncommon fruits and in pediatric populations. It should therefore be interpreted in the context of study design, geographic setting, and diagnostic approach. Integrating botanical classification with molecular allergology and clinical phenotyping may provide a useful framework for organizing the fragmented evidence on fresh fruit allergy and informing individualized diagnostic and management approaches.
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BibTeX
@article{pecoraro2026from,
title = {{From Pollen to Plate: A Botanical Classification-Based Narrative Review of Fresh Fruit Allergy}},
author = {Luca Pecoraro and Carla Mastrorilli and Riccardo Castagnoli and Francesca Mori and Stefania Arasi and Angela Klain and Lucia Liotti and Simona Barni and Mariannita Gelsomino and Mattia Giovannini and Lucia Caminiti and Cristiana Indolfi and Francesca Saretta and Gian Luigi Marseglia and Elio Novembre},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18203377},
url = {https://www.mdpi.com/2072-6643/18/20/3377},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From Pollen to Plate: A Botanical Classification-Based Narrative Review of Fresh Fruit Allergy
AU - Luca Pecoraro
AU - Carla Mastrorilli
AU - Riccardo Castagnoli
AU - Francesca Mori
AU - Stefania Arasi
AU - Angela Klain
AU - Lucia Liotti
AU - Simona Barni
AU - Mariannita Gelsomino
AU - Mattia Giovannini
AU - Lucia Caminiti
AU - Cristiana Indolfi
AU - Francesca Saretta
AU - Gian Luigi Marseglia
AU - Elio Novembre
PY - 2026
DA - 2026/10/01
JO - Nutrients
DO - 10.3390/nu18203377
UR - https://www.mdpi.com/2072-6643/18/20/3377
AB - Fruit consumption is a cornerstone of a healthy diet, providing essential micronutrients and bioactive compounds; however, fresh fruits may also trigger IgE-mediated allergic reactions, ranging from mild oral symptoms to potentially life-threatening anaphylaxis. Fruit allergy is a heterogeneous field characterized by diverse clinical phenotypes, botanical relationships, molecular sensitization profiles, and patterns of cross-reactivity. This narrative review organizes the available evidence according to 18 botanical families, adapting and extending an established botanical classification framework to the specific context of fresh fruit allergy. Botanical classification serves as a structured organizational framework rather than as a predictor of allergenic cross-reactivity, which is primarily determined by shared or homologous allergenic proteins and may occur both within and across botanical families. The review integrates botanical relationships with clinical manifestations, molecular allergen families, cross-reactivity, cofactors, diagnosis, and management. Clinical assessment should be individualized and based on the clinical history and appropriate in vivo and in vitro testing, including skin prick or prick-to-prick testing with fresh fruit and measurement of specific IgE, with oral food challenges reserved for selected cases. Molecular allergology may provide additional information for risk assessment in selected patients, although the availability and strength of evidence for individual molecular components vary considerably. Management should likewise be individualized according to the confirmed trigger, clinical phenotype, and risk of systemic reactions, with appropriate dietary counselling and patient education. The available epidemiological and clinical evidence is heterogeneous, particularly for uncommon fruits and in pediatric populations. It should therefore be interpreted in the context of study design, geographic setting, and diagnostic approach. Integrating botanical classification with molecular allergology and clinical phenotyping may provide a useful framework for organizing the fragmented evidence on fresh fruit allergy and informing individualized diagnostic and management approaches.
SN - 2072-6643
ER -