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

Abstract

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 5-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%, a specificity of 80.0%, a positive predictive value of 52.9%, a 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.