The melibiose-derived glycation product mimics a unique epitope present in human and animal tissues.

Non-enzymatic modification of proteins by carbohydrates, known as glycation, leads to generation of advanced glycation end-products (AGEs). In our study we used in vitro generated AGEs to model glycation in vivo. We discovered in vivo analogs of unusual melibiose-adducts designated MAGEs (mel-derived AGEs) synthesized in vitro under anhydrous conditions with bovine serum albumin and myoglobin. Using nuclear magnetic resonance spectroscopy we have identified MAGEs as a set of isomers, with open-chain and cyclic structures, of the fructosamine moiety. We generated a mouse anti-MAGE monoclonal antibody and show for the first time that the native and previously undescribed analogous glycation product exists in living organisms and is naturally present in tissues of both invertebrates and vertebrates, including humans. We also report MAGE cross-reactive auto-antibodies in patients with diabetes. We anticipate our approach for modeling glycation in vivo will be a foundational methodology in cell biology. Further studies relevant to the discovery of MAGE may contribute to clarifying disease mechanisms and to the development of novel therapeutic options for diabetic complications, neuropathology, and cancer.

Structural characterization and immune-enhancing activity of a novel high-molecular-weight polysaccharide from Cordyceps militaris.

A novel homogeneous polysaccharide (CMP-III) was extracted and purified from C. militaris. Structural characterization revealed that CMP-III had an average molecular weight of 4.796 × 104 kDa and consisted of glucose, mannose and galactose with the molar ratio of 8.09:1.00:0.25. The main linkage types of CMP-III consisted of 1 â†’ 4)-α-D-Glc (70.08%), 1 â†’ 4,6)-α-D-Man (9.59%), 1→)-α-D-Man (10.79%) and 1 → 2,6)-α-D-Gal (3.93%) based on methylation and NMR analysis. The immunomodulatory assay indicated that CMP-III significantly promoted macrophage phagocytosis and secretion of NO, TNF-α and IL-6. Further study suggested that macrophage activated by CMP-III involved mitogen-activated protein kinases (MAPKs) and nuclear factor kappa-B (NF-κB) signaling pathways. Overall, these results suggested that CMP-III could be developed as a potent immunomodulatory agent for use in functional foods and dietary supplements.

Intestinal IgA Regulates Expression of a Fructan Polysaccharide Utilization Locus in Colonizing Gut Commensal Bacteroides thetaiotaomicron.

Gut-derived immunoglobulin A (IgA) is the most abundant antibody secreted in the gut that shapes gut microbiota composition and functionality. However, most of the microbial antigens targeted by gut IgA remain unknown, and the functional effects of IgA targeting these antigens are currently understudied. This study provides a framework for identifying and characterizing gut microbiota antigens targeted by gut IgA. We developed a small intestinal ex vivo culture assay to harvest lamina propria IgA from gnotobiotic mice, with the aim of identifying antigenic targets in a model human gut commensal, Bacteroides thetaiotaomicron VPI-5482. Colonization by B. thetaiotaomicron induced a microbe-specific IgA response that was reactive against diverse antigens, including capsular polysaccharides, lipopolysaccharides, and proteins. IgA against microbial protein antigens targeted membrane and secreted proteins with diverse functionalities, including an IgA specific against proteins of the polysaccharide utilization locus (PUL) that are necessary for utilization of fructan, which is an important dietary polysaccharide. Further analyses demonstrated that the presence of dietary fructan increased the production of fructan PUL-specific IgA, which then downregulated the expression of fructan PUL in B. thetaiotaomicron, both in vivo and in vitro Since the expression of fructan PUL has been associated with the ability of B. thetaiotaomicron to colonize the gut in the presence of dietary fructans, our work suggests a novel role for gut IgA in regulating microbial colonization by modulating their metabolism.IMPORTANCE Given the significant impact that gut microbes have on our health, it is essential to identify key host and environmental factors that shape this diverse community. While many studies have highlighted the impact of diet on gut microbiota, little is known about how the host regulates this critical diet-microbiota interaction. In our present study, we discovered that gut IgA targeted a protein complex involved in the utilization of an important dietary polysaccharide: fructan. While the presence of dietary fructans was previously thought to allow unrestricted growth of fructan-utilizing bacteria, our work shows that gut IgA, by targeting proteins responsible for fructan utilization, provides the host with tools that can restrict the microbial utilization of such polysaccharides, thereby controlling their growth.

Performance and altitude: Ways that nutrition can help.

High altitudes are a challenge for human physiology and for sports enthusiasts. Several reasons lead to deterioration in performance at high altitudes. Hypoxia owing to high altitude causes a breakdown of homeostasis with imbalance in several physiological systems, including the immune system. The reduction in mucosal immunity and inflammation and the predominance of the humoral immune response causes a condition of immunosuppression and an increased likelihood of infection. In addition, it is known that worsening of the immune response is associated with reduced performance. On the other hand, immunonutrition plays an important role in modulating the effects of physical exercise on the immune system. However, to our knowledge, few studies have evaluated the effect of nutrition on the immune system after exercise in hypoxia. Although the association between exercise and hypoxia has been shown to be more severe for the body owing to the sum of stressful agents, supplementation with carbohydrates and glutamine seems to play a relevant role in mitigating immunosuppressive effects. These findings, although limited by the fact that they are the result of very few studies, shed light on a relevant theme for sports physiology and nutrition and suggest that both supplements may be useful for athletes, visitors, and workers in high-altitude regions. The aim of this review was to discuss the effects of high-altitude hypoxia on the human body from the point of view of exercise immunology because it is known that transient immunosuppression after strenuous exercise and competition should be followed by reduction in training overload and worse performance.

The Effect of Digestion and Digestibility on Allergenicity of Food.

Food allergy prevalence numbers are still on the rise. Apart from environmental influences, dietary habits, food availability and life-style factors, medication could also play a role. For immune tolerance of food, several contributing factors ensure that dietary compounds are immunologically ignored and serve only as source for energy and nutrient supply. Functional digestion along the gastrointestinal tract is essential for the molecular breakdown and a prerequisite for appropriate uptake in the intestine. Digestion and digestibility of carbohydrates and proteins thus critically affect the risk of food allergy development. In this review, we highlight the influence of amylases, gastric acid- and trypsin-inhibitors, as well as of food processing in the context of food allergenicity.

Consensus Statement Immunonutrition and Exercise.

In this consensus statement on immunonutrition and exercise, a panel of knowledgeable contributors from across the globe provides a consensus of updated science, including the background, the aspects for which a consensus actually exists, the controversies and, when possible, suggested directions for future research.

The impact of sleeping with reduced glycogen stores on immunity and sleep in triathletes.

PURPOSE: We investigated the effects of a 3-week dietary periodization on immunity and sleep in triathletes. METHODS: 21 triathletes were divided into two groups with different nutritional guidelines during a 3-week endurance training program including nine twice a day sessions with lowered (SL group) or maintained (CON group) glycogen availability during the overnight recovery period. In addition to performance tests, sleep was monitored every night. Systemic and mucosal immune parameters as well as the incidence of URTI were monitored every week of the training/nutrition protocol. Two-ways ANOVA and effect sizes were used to examine differences in dependent variables between groups at each time point. RESULTS: The SL group significantly improved 10 km running performance (-1 min 13 s, P < 0.01, d = 0.38), whereas no improvement was recorded in the CON group (-2 s, NS). No significant changes in white blood cells counts, plasma cortisol and IL-6 were recorded over the protocol in both groups. The vitamin D status decreased in similar proportions between groups, whereas salivary IgA decreased in the SL group only (P < 0.05, d = 0.23). The incidence of URTI was not altered in both groups. All participants in both groups went to bed earlier during the training program (SL -20 min, CON -27 min, P < 0.05, d = 0.28). In the SL group, only sleep efficiency slightly decreased by 1.1 % (P < 0.05, d = 0.25) and the fragmentation index tended to increase at the end of the protocol (P = 0.06). CONCLUSION: Sleeping and training the next morning regularly with reduced glycogen availability has minimal effects on selected markers of immunity, the incidence of URTI and sleeping patterns in trained athletes.

Seven days of high carbohydrate ingestion does not attenuate post-exercise IL-6 and hepcidin levels.

PURPOSE: This investigation examined if a high carbohydrate (CHO) diet, maintained across a seven-day training period, could attenuate post-exercise interleukin-6 (IL-6) and serum hepcidin levels. METHODS: Twelve endurance-trained male athletes completed two seven-day running training blocks whilst consuming either a high (8 g kg(-1)) versus a low (3 g kg(-1)) CHO isoenergetic diet. Each training block consisted of five running sessions performed on days 1, 2, 4, 5, and 7, with the intensity and duration of each session matched between training weeks. Serum levels of Interleukin-6 (IL-6) and hepcidin were measured pre- and either immediately (IL-6) or 3-h (hepcidin) post-exercise on days 1 and 7 of each training week. RESULTS: During each training week, the immediate post-exercise IL-6 and 3-h post-exercise serum hepcidin levels were significantly elevated (both p = 0.001) from pre-exercise on days 1 and 7. These increases were not different between trials. CONCLUSIONS: These results suggest that the ingestion of a high (compared to low) CHO diet over a seven-day training period is ineffective in attenuating post-exercise IL-6 and hepcidin responses. Such results may be due to the modest training load, the increased protein intake in the low-CHO trial, and a 48 h recovery period prior to sample collection on day 7, allowing a full recovery of muscle glycogen status between exercise sessions.

Impact of intensified training and carbohydrate supplementation on immunity and markers of overreaching in highly trained cyclists.

PURPOSE: To determine effects of intensified training (IT) and carbohydrate supplementation on overreaching and immunity. METHODS: In a randomized, double-blind, crossover design, 13 male cyclists (age 25 ± 6 years, VO2max 72 ± 5 ml/kg/min) completed two 8-day periods of IT. On one occasion, participants ingested 2 % carbohydrate (L-CHO) beverages before, during and after training sessions. On the second occasion, 6 % carbohydrate (H-CHO) solutions were ingested before, during and after training, with the addition of 20 g of protein in the post-exercise beverage. Blood samples were collected before and immediately after incremental exercise to fatigue on days 1 and 9. RESULTS: In both trials, IT resulted in decreased peak power (375 ± 37 vs. 391 ± 37 W, P < 0.001), maximal heart rate (179 ± 8 vs. 190 ± 10 bpm, P < 0.001) and haematocrit (39 ± 2 vs. 42 ± 2 %, P < 0.001), and increased plasma volume (P < 0.001). Resting plasma cortisol increased while plasma ACTH decreased following IT (P < 0.05), with no between-trial differences. Following IT, antigen-stimulated whole blood culture production of IL-1α was higher in L-CHO than H-CHO (0.70 (95 % CI 0.52-0.95) pg/ml versus 0.33 (0.24-0.45) pg/ml, P < 0.01), as was production of IL-1ß (9.3 (95 % CI 7-10.4) pg/ml versus 6.0 (5.0-7.8) pg/ml, P < 0.05). Circulating total leukocytes (P < 0.05) and neutrophils (P < 0.01) at rest increased following IT, as did neutrophil:lymphocyte ratio and percentage CD4+ lymphocytes (P < 0.05), with no between-trial differences. CONCLUSION: IT resulted in symptoms consistent with overreaching, although immunological changes were modest. Higher carbohydrate intake was not able to alleviate physiological/immunological disturbances.

The effects of dietary carbohydrate on the growth, antioxidant capacities, innate immune responses and pathogen resistance of juvenile Black carp Mylopharyngodon piceus.

The present study was focused on the growth, antioxidant capacities, innate immune responses and pathogen resistance in juvenile Black carp Mylopharyngodon piceus fed with graded levels of dietary carbohydrate (CHO) (0.6, 106.5, 194.3, 288.4, 379.1 and 473.8 g kg(-1)) for 9 weeks. Results showed that highest weight gain and special growth ratio was obtained at 288.4 g kg(-1) dietary CHO. And adequate dietary CHO content (288.4 g kg(-1)) could significantly increase the activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (Gpx), promote reduced glutathione (GSH) content and then increase the total antioxidant capacities (TAOC) in the liver of M. piceus. However, the malondialdehyde (MDA) levels in the fish liver could be significantly aggravated by excessive dietary CHO. Serum cortisol (COL) levels could be significantly increased in juvenile Black carp M. piceus fed with 379.1 g kg(-1) dietary CHO compared with CHO-deficient diets. Activities of alanine transaminase (GPT) and aspartate transaminase (GOT) were both decreased in the serum of juvenile Black carp M. piceus fed with 194.3 g kg(-1) dietary CHO compared with CHO-deficient diets (0.6 and 106.5 g kg(-1)) or CHO-excess diets (379.1 and 473.8 g kg(-1)). In addition, 288.4 g kg(-1) dietary CHO could significantly up-regulate the mRNA expression levels of hepcidin (HEPC), natural resistance-associated macrophage protein (NRAMP), tumor necrosis factor-α (TNF-α) and interferon (IFN), lysozyme (LYZ) and complement component 3 (C3) in the blood and liver samples of juvenile Black carp M. piceus compared with the CHO-deficient diets (0.6 and 106.5 g kg(-1)). Moreover, 288.4 g kg(-1) dietary CHO could also enhance the contents of C3 and plasma nitrogen monoxide (NO), and increase the activities of LYZ and total nitric oxide synthase (t-NOS) in the serum compared with the CHO-deficient or CHO-excess diets. Furthermore, the survival rates were also increased by adequate dietary CHO (194.3 and 288.4 g kg(-1)) fed to juvenile Black carp M. piceus after infection with Aeromonas hydrophila. In conclusion, these results suggest that adequate dietary CHO (288.4 g kg(-1)) could increase growth, reduce oxidative stress, enhance innate immune responses, improve the health states and then promote disease resistance in juvenile Black carp M. piceus.

Interaction of Proteasomes and Complement C3, Assay of Antisecretory Factor in Blood.

Antisecretory factor (AF) is a protein complex which inhibits inflammation and regulates fluid transport. In this article, two new immunoassays (ELISA) are developed. The first ELISA establishes a 26S proteasome concentration of 0.41±0.03 µg/mL in normal plasma; the second ELISA discloses the binding of proteasomes to complement factor C3. The latter test values increased about tenfold following intake of processed cereals, paralleling with the old AF ELISA. The proteasome/C3 complex is purified and shown to expose hidden antisecretory peptide sequence and contain the inactive C3c protein. These findings might explain the antisecretory and anti-inflammatory effect during AF complex formation.

Component-resolved diagnostics for the evaluation of peanut allergy in a low-prevalence area.

BACKGROUND: Major allergenic components of peanut from distinct geographical regions are widely dispersed. Most of the diagnostic studies are from countries with a high prevalence. There have been only few reports of allergen component sensitizations from countries with a low prevalence of peanut allergy. We aimed to investigate roles of component-resolved diagnostic (CRD) to differentiate peanut allergy and peanut tolerance in the Asian population from a country with low prevalence of peanut allergy. METHODS: Participants with peanut sensitization were enrolled. Clinical reactions were determined. Skin prick test (SPT) and specific IgE (sIgE) to peanut and related allergen components were performed. RESULTS: Forty subjects with peanut sensitization were included. The mean wheal sizes of SPT and peanut sIgE were not good predictors for differentiating peanut reactions. SIgE to rAra h 2 was more often found in patients with peanut allergy and anaphylaxis. sIgE to rAra h 9 was also more frequent in the peanut-allergic group but not related to severe reactions. In the peanut-tolerant group, despite positive SPT and/or sIgE to peanut, 90% had negative sIgE to rAha h 2 and rAra h 9. Combining rAra h 2 and rAra h 9 resulted in high performance of the test with sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 90%, 0.89, and 0.86, respectively. The ratio between rAra h 2 sIgE to peanut sIgE of 0.6 can be helpful in predicting patients who will develop severe reaction. SIgE to cross-reactive carbohydrate determinants (CCD) was exclusively found in the peanut-tolerant group (33.3% vs. 0%, p = 0.012). CONCLUSIONS: Our study identifies three allergen components: rAra h 2, rAra h 9, and CCD as important components in the diagnosis of peanut allergy in an Asian country with low prevalence. The ratio between rArah h 2 sIgE to peanut sIgE can be used for predicting patients who will develop anaphylaxis.

Effect of post-exercise protein-leucine feeding on neutrophil function, immunomodulatory plasma metabolites and cortisol during a 6-day block of intense cycling.

Whey protein and leucine ingestion following exercise increases muscle protein synthesis and could influence neutrophil function during recovery from prolonged intense exercise. We examined the effects of whey protein and leucine ingestion post-exercise on neutrophil function and immunomodulators during a period of intense cycling. In a randomized double-blind crossover, 12 male cyclists ingested protein/leucine/carbohydrate/fat (LEUPRO 20/7.5/89/22 g h(-1), respectively) or isocaloric carbohydrate/fat control (CON 119/22 g h(-1)) beverages for 1-3 h post-exercise during 6 days of high-intensity training. Blood was taken pre- and post-exercise on days 1, 2, 4 and 6 for phorbol myristate acetate (PMA)-stimulated neutrophil superoxide (O2 (-)) production, immune cell counts, amino acid and lipid metabolism via metabolomics, hormones (cortisol, testosterone) and cytokines (interleukin-6, interleukin-10). During recovery on day 1, LEUPRO ingestion increased mean concentrations of plasma amino acids (glycine, arginine, glutamine, leucine) and myristic acid metabolites (acylcarnitines C14, myristoylcarnitine; and C14:1-OH, hydroxymyristoleylcarnitine) with neutrophil priming capacity, and reduced neutrophil O2 production (15-17 mmol O2 (-) cell(-1) ± 90 % confidence limits 20 mmol O2 (-) cell(-1)). On day 2, LEUPRO increased pre-exercise plasma volume (6.6 ± 3.8 %) but haematological effects were trivial. LEUPRO supplementation did not substantially alter neutrophil elastase, testosterone, or cytokine concentrations. By day 6, however, LEUPRO reduced pre-exercise cortisol 21 % (±15 %) and acylcarnitine C16 (palmitoylcarnitine) during exercise, and increased post-exercise neutrophil O2 (-) (33 ± 20 mmol O2 (-) cell(-1)), relative to control. Altered plasma amino acid and acylcarnitine concentrations with protein-leucine feeding might partly explain the acute post-exercise reduction in neutrophil function and increased exercise-stimulated neutrophil oxidative burst on day 6, which could impact neutrophil-dependent processes during recovery from intense training.

Evidence-based benefits of specific mixtures of non-digestible oligosaccharides on the immune system.

Non-digestible carbohydrates (NDC) are natural constituents of many foods. They are mostly referred to as dietary fibre and are associated with many health benefits mostly connected to gut health. NDC have emerged as a promising nutritional concept to modulate immune function as well. In the world of immunology non-digestible carbohydrates are recognized now as key immunomodulating molecules. Both pharma and food industries realize the enormous potency of these immune active components. Although the mechanisms underlying the effects of NDC on the immune system are not totally clear yet many studies have reported beneficial effects on both mucosal and systemic immunity in humans. The aim of this review is to summarize the available evidence on the immune modulatory effects of specific mixtures of oligosaccharides. Both mechanistic in vitro and in vivo studies have been performed and will be discussed. Finally the potential use of these unique structures will be evaluated.

Dietary carbohydrate/lipid ratios affect stress, oxidative status and non-specific immune responses of fingerling blunt snout bream, Megalobrama amblycephala.

This study aimed to evaluate the effects of dietary carbohydrate/lipid (CHO:L) ratios on stress, liver oxidative status and non-specific immune responses of fingerling blunt snout bream. Fish were fed six isonitrogenous and isoenergetic diets containing various CHO:L ratios for 10 weeks. After the feeding trial, fish were challenged by Aeromonas hydrophila and survival rate was recorded for the next 10 days. The lowest plasma cortisol, lactate, aspartate aminotransferase and alanine aminotransferase were all observed in fish fed a CHO:L ratio of 5.64. They were significantly (P < 0.05) lower than those of fish offered the lowest CHO:L ratio, but showed little difference (P > 0.05) with those of fish fed the highest CHO:L ratio. This also held true for liver catalase and glutathione peroxidase activities, whereas the opposite was true for liver reduced glutathione contents, plasma lysozyme and alternative complement (ACH50) activities. Contrary to leucocyte counts, plasma glucose levels, liver malondialdehyde contents, blood haemoglobin contents and erythrocyte numbers all increased significantly (P < 0.05) with decreasing dietary CHO:L ratios. The highest plasma total protein and globulin content both observed in fish fed a CHO:L ratio of 2.45 was significantly (P < 0.01) higher than that of fish offered the lowest CHO:L ratio, but showed no statistical difference (P > 0.05) with that of the other groups. After challenge, fish fed the lowest CHO:L ratio obtained significantly (P < 0.05) low survival rate. However, survival rate showed little difference (P > 0.05) as dietary CHO:L ratios ranged from 3.67 to 24.20. The results of this study indicated that high dietary lipid may cause metabolic stress of fingerling blunt snout bream, as might consequently lead to the elevated liver oxidation rates, impaired liver function, depressed immunity and reduced resistance to A. hydrophila infection of this species, whereas the opposite was true for carbohydrate enriched diets.

Novel mechanism for the generation of human xeno-autoantibodies against the nonhuman sialic acid N-glycolylneuraminic acid.

The nonhuman sialic acid N-glycolylneuraminic acid (Neu5Gc) is metabolically incorporated into human tissues from certain mammalian-derived foods, and this occurs in the face of an anti-Neu5Gc "xeno-autoantibody" response. Given evidence that this process contributes to chronic inflammation in some diseases, it is important to understand when and how these antibodies are generated in humans. We show here that human anti-Neu5Gc antibodies appear during infancy and correlate with weaning and exposure to dietary Neu5Gc. However, dietary Neu5Gc alone cannot elicit anti-Neu5Gc antibodies in mice with a humanlike Neu5Gc deficiency. Other postnatally appearing anti-carbohydrate antibodies are likely induced by bacteria expressing these epitopes; however, no microbe is known to synthesize Neu5Gc. Here, we show that trace exogenous Neu5Gc can be incorporated into cell surface lipooligosaccharides (LOS) of nontypeable Haemophilus influenzae (NTHi), a human-specific commensal/pathogen. Indeed, infant anti-Neu5Gc antibodies appear coincident with antibodies against NTHi. Furthermore, NTHi that express Neu5Gc-containing LOS induce anti-Neu5Gc antibodies in Neu5Gc-deficient mice, without added adjuvant. Finally, Neu5Gc from baby food is taken up and expressed by NTHi. As the flora residing in the nasopharynx of infants can be in contact with ingested food, we propose a novel model for how NTHi and dietary Neu5Gc cooperate to generate anti-Neu5Gc antibodies in humans.

Effect of ingesting a honey-sweetened beverage on soccer performance and exercise-induced cytokine response.

PURPOSE: This study compared the effect of a honey-sweetened beverage with those of a commercial sports drink and a placebo on performance and inflammatory response to a 90-min soccer simulation. METHODS: Ten experienced male soccer players randomly performed 3 trials (honey [H], sports drink [S], and placebo [P]), consuming the beverage before and during halftime for a total of 1.0 g/kg carbohydrate for H and S. Performance measures included 5 sets (T1-T5) of a high-intensity run and agility and ball-shooting tests followed by a final progressive shuttle-run (PSR) test to exhaustion. Blood samples were drawn pretest, posttest (B2), and 1 hr posttest (B3) for markers of inflammation, oxygen radical absorbance capacity (ORAC), and hormone response. RESULTS: T2-T5 were significantly slower than T1 (p < .05), and a decrease in PSR time was observed from baseline (-22.9%) for all treatments. No significant effect of the interventions was observed for any performance measures. Plasma IL-1ra levels increased posttest for all treatments (65.5% S, 63.9% P, and 25.8% H), but H was significantly less than S at posttest and P at B3. Other cytokines and ORAC increased at B2 (548% IL-6, 514% IL-10, 15% ORAC) with no difference by treatment. CONCLUSION: Acute ingestion of honey and a carbohydrate sports drink before and during a soccer-simulation test did not improve performance, although honey attenuated a rise in IL-1ra. Ingestion of carbohydrate and/ or antioxidant-containing beverages at frequencies typical of a regulation match may not be beneficial for trained soccer players.

Pollen food syndrome: update on the allergens.

Pollen food syndrome results from cross-reactivity between pollen-specific IgE and homologous proteins found in fruits and vegetables. These proteins can be grouped into several categories based on structure and include profilins, pathogenesis-related proteins, and cross-reactive carbohydrate determinants. Although cooking the reactive fruits and vegetables has been shown to destroy IgE-binding epitopes, evidence suggests that the remaining linear epitopes can bind cross-reactive T cells and enhance T-cell activation in vitro. Several methods of diagnosing food allergies exist, including skin prick tests and double-blind food challenges; however, diagnosing pollen food syndrome depends almost exclusively on clinical history. Immunotherapy has been studied as a treatment for pollen food syndrome, with highly variable results.