From Pollen to Plate: A Botanical Classification-Based Narrative Review of Fresh Fruit Allergy

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.