# Pollen Food Allergy Syndrome in Southern European Adults: Patterns and Insights
## 6 Discussion
P7 AS was diagnosed in (2.3\%) out of the screened population & The type-2 food allergy allegers were not specified & Recruitment was performed in women & [PERSON]; et al., 2009 [55] \\ \hline Italy & 854 adults/Birch-allegericts & Frequency of OAS in Birch alergies patients is 33.5\% in Cerna, P6.9\% in Northern, 2.5\% in Central, and 60.7\% in Southern regions of Italy & Apple, apricot, cherry, peach & Retrospective study restricted in Birch-alergic patients in 2016 [46] \\ \hline Greece & 3673 adults/general population & 259, supported from all cavity, suggestive of OAS & Foods causing symptoms suggestive of OAS were not specified & Data based on online study: Self-reported symptoms, not confirmed by in vivo or in vitro allergy testing & [PERSON]; et al., 2013 [47] \\ \hline Greece & 244 adults/atopics patients & 79,264 (29.3\%) atopic patients reported OAS after consuming trials, vegetables, or or more units of the atopic patients & Peak, washout, kivel, banana, haxmeut, peanut, & Plants were recorded among the costs using allergy clinic, 2018 [48] \\ \hline Turkey & 250d adults/patients with pollen sensitization & 49/256 (19.3\%) self-reported P7 AS assimilations & 49,256 (19.3\%) self-reported P7 AS assimilations & 49,256 (19.3\%), non-warmed, watermemene, peanut, and, wamper, & Diagnosis based on SFT, not confirmed with its true primary vascularSouthern Europe's unique aeroallergen exposure--dominated by _Oleacae_, _Cupressaceae_, _Paceae_, _Uricaceae_, _Chenopodiaceae_, _Plantaginaceae_, and _Asteraceae_--plays a crucial role in the pathogenesis of PFAS [84]. The prevalence and clinical manifestations of PFAS are shaped by both local airborne allergens, which act as primary sensitizers, and the dietary habits of the population [10; 20]. The pattern of sensitization varies across different regions in Southern Europe. For example, in Rome, patients tend to be highly polysensitized, whereas, in Marseille, monosensitization to specific allergens like Cup a 1 is more common [85]. This interaction between environmental and dietary allergens is central to the distinct manifestation of PFAS in Mediterranean populations. Sensitization to specific allergens in Southern Europe leads to unique cross-reactions between aeroallergens and common foods. For instance, the profilin of _Phleum pratense_ Phl p12 is implicated in PFAS reactions to peach, melon, and kiwi, while the profilin Cyn d 12 from Bermuda Grass is cross-reactive with tomato [24; 57]. Climate change is emerging as a contributing factor to the rising prevalence of PFAS. Extended pollen seasons, shifts in vegetation patterns (notably the spread of Ragweed), and increased aeroallergen exposure may exacerbate both the incidence and severity of PFAS in Southern Europe, highlighting the need for ongoing surveillance and adaptive healthcare strategies [86; 87]. Rising temperatures and other environmental changes are key characteristics of climate change, with various effects on public health. One of the consequences of climate change is the prolonged pollen season for some allergens, leading to an extended period of pollinosis [88]. Environmental factors, such as air pollutants, can enhance the allergenicity of specific pollen species. For example, long-term exposure to high levels of NO\({}_{2}\) in urban areas is associated with the increased allergenicity of Birch pollen, though a similar effect has not been observed for Olive or Grass pollen [86; 89; 90]  
The combined exposure to air pollutants and allergens can have a synergistic effect on respiratory allergies and may also contribute to the prevalence of PFAS. A study focusing on Ragweed has predicted that, under a moderate greenhouse gas emissions scenario, sensitization to this allergen is projected to increase significantly by 2041 in European countries, including the Mediterranean basin, where it is now uncommon [86]. This projected increase in Ragweed sensitization is expected to further raise the prevalence of PFAS.