Food-induced anaphylaxis to plant allergens in adolescents and adults: Data from the allergy Vigilance Network (2002–2024)

BACKGROUND: There is a growing interest in plant-based diets (PBDs) owing to their health benefits and environmental sustainability. However, plant proteins commonly consumed in PBDs are recognized allergens and are known triggers of food-induced anaphylaxis (FIA).

AIM: To characterize the clinical phenotypes of FIA due to plant allergens relevant to PBDs ("PAs") reported to the Allergy-Vigilance Network in adolescents and adults.

METHODS: Anaphylaxis cases attributed to plant allergens in individuals ≥13 years of age were retrospectively analyzed (2002-2024). Cases were identified by culprit allergen, irrespective of dietary patterns, and assessed for time trends, eliciting dose, cofactors, and component-resolved diagnostics. Age-specific phenotypes were compared between adolescents and adults.

RESULTS: 753 plant allergen-related FIA cases were recorded, 237 (31.5%) occurred in adolescents and 516 (68.5%) in adults. Eleven allergens (wheat, peanut, buckwheat, soy, hazelnut, sesame, lupin, cashew, pine nut, walnut and almond) accounted for 85% of all PBD-related FIA. Wheat was the main elicitor in adults (26.9% adults vs 7.6% adolescents; P < 0.001). Peanut predominated in adolescents (34.2% adolescents vs 8.1% adults; P < 0.001), and was associated with pre-existing peanut-allergy (71.8% adolescents vs 46.2% adults; P = 0.012). Soy cases in adults were frequently associated with birch pollen allergy (18.8% adolescents vs 64.5% adults; P = 0.005), whereas soy-related FIA cases in adolescents occurred in the context of a prior legume-allergy diagnosis (50% adolescents vs 5.6% adults; P < 0.001). In adolescents, physical exercise was the main cofactor reported, whereas adults showed a wider range including physical exercise, alcohol, and medications.

CONCLUSION: Several plant allergens displayed distinct age-specific clinical phenotypes, which may be relevant for dietary counseling in food-allergic or atopic individuals considering adoption of PBDs.