Introduction
Amid growing global health, environmental, and socio-economic challenges, nutritional strategies that promote both human well-being and planetary sustainability are gaining importance. In 2010, the Food and Agriculture Organisation (FAO) defined a sustainable diet, highlighting its multidimensional nature – nutritional, environmental, social, and cultural (FAO, 2010) [1]. An updated framework, jointly developed by the FAO and the World Health Organisation (WHO) in 2019, promotes sustainable and healthy eating across all life stages. It aims to enhance human and environmental well-being while reducing the risk of undernutrition, micronutrient deficiencies, and chronic diseases (FAO & WHO, 2019) [2]. This dietary model, known as the planetary diet, contributes to the prevention of non-communicable diseases and the mitigation of greenhouse gas emissions. However, its reliance on plant-based ingredients may increase the risk of hypersensitivity reactions in individuals with food allergies.
Food allergy
Atopic disorders are commonly classified into three categories: IgE-mediated, mixed (both IgE- and non-IgE-mediated), and non-IgE-mediated types. Food allergy (FA) is an atopic disorder caused by an abnormal immune response to otherwise harmless food proteins [3]. Recent advances in microbiome research have underscored the role of gut dysbiosis in modulating immune responses, potentially leading to increased susceptibility to food allergies [4].
Non-IgE-mediated FA is believed to result from allergen-specific T-cell activation and primarily affects the gastrointestinal tract, with limited involvement of the skin and respiratory system. In contrast, IgE-mediated responses involve the activation and degranulation of mast cells and basophils, leading to the rapid onset of gastrointestinal, skin, and respiratory symptoms. Gastrointestinal symptoms may include oral allergy syndrome (OAS), itching, swelling, nausea, abdominal pain, and vomiting. Respiratory symptoms include wheezing and airway inflammation, while skin manifestations may present as flushing, urticaria, angioedema, and pruritus. Severe systemic reactions, such as anaphylaxis and anaphylactic shock, may also occur [3].
The prevalence of FA has been steadily increasing, rising in Europe from 2.6% (2000–2012) to 3.5% (2012–2021) [5]. According to the EuroPrevall study [6], the lifetime prevalence of self-reported FA among children aged 7–10 years is highest in North-Eastern Europe (26.4% in Lodz, Poland) and lowest in South-Eastern Europe (6.5% in Athens, Greece). The proportion of cases where symptoms coincide with IgE sensitisation, classified as probable FA, is lower, ranging from 1.9% to 5.6% [7]. Studies have shown that most FA cases in both children and adults in Europe are caused by plant-based allergens [6, 7].
Planetary diet as an element of sustainable nutrition
Sustainable nutrition
A sustainable diet is defined by its low environmental impact, support for biodiversity, cultural acceptability, economic accessibility, and its ability to provide sufficient essential nutrients [8]. In practical terms, this involves increasing the consumption of plant-based foods (vegetables, fruits, legumes, nuts, and whole grains) while reducing the intake of animal-derived products, particularly red and processed meats. Numerous epidemiological studies support this dietary pattern, linking excessive red meat intake to higher risks of cancer, cardiovascular disease, type 2 diabetes, and premature death [9–12]. Limiting meat consumption and replacing it with plant-based protein sources may offer substantial health and environmental benefits.
The planetary diet
To address these challenges, on 17 January 2019, the EAT-Lancet Commission, together with The Lancet, introduced the planetary diet – a model that integrates public health objectives with environmental sustainability [13]. The Planetary Health Diet calls for a global transition to healthy diets by 2050, involving approximately a twofold increase in the consumption of plant-based foods and a reduction of red meat and sugar intake by over 50% [14]. It promotes a predominantly plant-based diet, while restricting the intake of meat, added sugars, and highly processed products [13–15]. The quantitative guidelines encompass 14 food groups, with recommended daily intakes (in g/person/day) based on a 2500 kcal diet suitable for a moderately active adult. Key components include vegetables and fruits (~500 g/day), whole grains (~230 g/day), legumes (50 g/day), and nuts (50 g/day), which serve as primary sources of protein and unsaturated fats. Animal-based products such as meat, fish, dairy, and eggs are included in limited quantities, with red meat restricted to a maximum of 14 g/day and dairy to 250 g/day [13, 16].
Numerous epidemiological studies have shown that plant-based diets low in red and processed meat are linked to a lower risk of non-communicable diseases, including cardiovascular disease, cancer, and type 2 diabetes [12, 17, 18]. These dietary patterns also help reduce greenhouse gas emissions and land use related to animal-based food production [19].
The literature describes various dietary strategies aimed at improving health and preventing allergy development. Many of these strategies focus on changing eating habits. Although potentially beneficial, such approaches are typically supportive, and their effectiveness in reducing food allergy especially among sensitised individuals remains inconclusive and requires further study [20]. Given the growing popularity of the planetary diet, which emphasises vegetables, fruits, legumes, and nuts while reducing animal products, it is important to recognise not only its health and environmental benefits, but also the potential allergenic risks.
Like other plant-based dietary models, the planetary diet emphasises vegetables, fruits, grains, legumes, and nuts. As a result, replacing animal-derived products with plant-based alternatives may present nutritional and immunological challenges, especially for individuals with food allergies. Legumes and nuts (common sources of plant-based protein) are also among the leading food allergens responsible for anaphylaxis in adults [21, 22]. In addition, cross-reactivity with airborne allergens (e.g. birch pollen) may elevate the risk of allergic reactions in sensitised individuals [23].
Aim
The aim of this study is to review allergenic plant-based foods that form the foundation of the planetary diet, particularly legumes (e.g. peanuts, soy), tree nuts (e.g. hazelnuts, walnuts, cashews, pistachios), seeds (e.g. sesame), fruits, vegetables, and cereals (e.g. wheat).
Plant allergens
Plant allergens are commonly grouped into four classes: storage proteins, non-specific lipid transfer proteins (nsLTPs), PR-10 pathogenesis-related proteins (Bet v 1 homologues), and profilins. Storage proteins and nsLTPs are resistant to both heat and digestive enzymes and are strongly associated with severe allergic reactions, including food-induced anaphylaxis. In contrast, PR-10 proteins and profilins are heat- and digestion-labile. Food allergy related to PR-10 or profilin is usually secondary to primary sensitisation to tree pollen. Due to cross-reactivity between pollen and plant proteins, patients sensitised to pollen-derived PR-10 proteins or profilins may experience mild symptoms of food allergy, typically limited to the oral cavity and triggered by raw fruits or vegetables [24].
Legumes
Common legumes (Fabaceae) include alfalfa, clover, peas, beans, lentils, chickpeas, lupine, soy, and peanuts. In Europe, peanuts, soy, and lupine are classified as priority legume allergens and must be declared on food labels [25, 26]. In this region, the prevalence of peanut allergy is estimated at 2%, and soy allergy at approximately 0.5% [7, 27]. Lupine sensitisation rates in Europe range from 0.27% to 4.1%, although the true prevalence of lupine allergy in the general population remains unknown [28]. Non-priority legumes, such as peas, beans, lentils, and chickpeas, may cause allergic reactions but are not subject to mandatory labelling. The prevalence of non-priority legume allergy is estimated at ≤ 0.5% in studies on food-induced anaphylaxis and in children with food-protein-induced enterocolitis syndrome (FPIES) [29]. Cross-reactivity among legumes is relatively common due to the presence of structurally homologous proteins and shared epitopes. In most cases, patients with a legume allergy exhibit hypersensitivity to more than one legume species. For example, chickpea allergy may co-occur with lentil allergy, and bean allergy often overlaps with pea allergy. In rarer cases, peanut allergy may be accompanied by sensitisation to lentils or chickpeas [24, 30].
Peanut
Peanuts (Arachis hypogaea), classified as legumes, are nutritionally valuable owing to their high protein content, which ranges from 24% to 29% [24]. However, they are also the most frequent cause of food-induced anaphylaxis [24, 31]. Peanut allergy affects individuals across all age groups and may persist throughout life. In Europe, the self-reported prevalence of peanut allergy is approximately 2% in adults and 1.9% in children [6, 32].
To date, 18 allergenic proteins from peanuts have been identified, designated Ara h 1 through Ara h 18 [33]. The nomenclature is based on the Latin name Arachis hypogaea, followed by a number that reflects the order of discovery or characterisation. Under EU Regulation 1169/2011 on food information to consumers, peanuts, including all peanut-derived ingredients, must be clearly declared as allergens [26]. Despite mandatory labelling, peanuts may still be present in food products as undeclared allergens, for example due to cross contamination, which is common in food service environments. As a result, restaurant meals pose a significant risk for individuals with peanut allergy [31]. The main peanut allergens responsible for triggering allergic reactions in patients are storage proteins, specifically: Ara h 1, Ara h 2, Ara h 3, and Ara h 6. Due to their high resistance to heat and enzymatic digestion, sensitisation to these proteins is associated with an elevated risk of anaphylaxis. Oleosins: Ara h 10, Ara h 11, Ara h 14, and Ara h 15 are additional peanut allergens linked to anaphylaxis. Similar to storage proteins, oleosins are resistant to heat and enzymatic degradation. Their strong hydrophobicity limits their solubility in aqueous solutions, which may result in low or undetectable concentrations in skin test extracts or sIgE assays. This poses a diagnostic challenge in detecting oleosin sensitisation. However, not all peanut-specific sensitisations confer a high risk of anaphylaxis. Sensitisation to Ara h 8 (a Bet v 1 homologue) or Ara h 5 (a profilin) is typically associated with a significantly lower risk of systemic reactions than sensitisation to nsLTPs or storage proteins. Detection of sIgE to Ara h 8 or Ara h 5 usually reflects secondary peanut sensitisation due to primary sensitisation to pollen allergens [24].
Soy
Soy (Glycine max) is a widely used plant-based protein and a common alternative to meat in vegetarian diets. Soy is present in many processed and packaged foods, making its avoidance challenging for individuals adhering to plant-based diets [18]. The presence of soy in food products must be clearly declared according to food labelling regulations [26]. The overall prevalence of soy allergy is relatively low, although it may be more common in specific geographic regions [28]. For example, allergen-specific IgE to soybean extract was detected in 6.3% of participants aged 3–17 years in a large German cohort [34]. Age-related differences in soy sensitisation have also been reported. In a large Mexican cohort, the sensitisation rate was lower in children aged ≤ 5 years than in those aged 6–17 years [35]. Approximately 0.4% of children have a soy allergy, making it about half as prevalent as peanut allergy.
Eight soy allergens (Gly m 1–8) have been identified to date, all capable of eliciting allergic reactions. Gly m 5, Gly m 6, and Gly m 8 are storage proteins associated with severe systemic reactions. Similar to peanuts, soy contains oleosins and nsLTPs, which are also implicated in anaphylaxis. Gly m 4 is a Bet v 1 homologue, while Gly m 3 is a profilin. Sensitisation to these proteins usually reflects cross-reactivity with pollen allergens and is not associated with high anaphylaxis risk. However, Gly m 4 sensitisation may occasionally trigger systemic reactions to soy products (e.g. soy milk or protein powder), affecting up to 10% of individuals with birch pollen allergy. Such patients typically exhibit high levels of birch pollen-specific IgE [24].
Tree nuts and seeds
Tree nuts are recognised as a valuable component of a healthy diet owing to their high nutritional value. Accordingly, the planetary diet promotes a substantial increase in nut intake [13]. However, nuts contain multiple allergenic proteins capable of triggering IgE-mediated hypersensitivity reactions, including potentially life-threatening anaphylaxis. The global prevalence of tree nut allergy is estimated at up to 4.9%. “Tree nuts” is a collective term referring to edible seeds from various botanical families, including hazelnuts, walnuts, pecans, almonds, cashews, pistachios, and Brazil nuts [36]. Increased exposure to tree nut and seed allergens, along with the general rise in allergic diseases, may account for the growing number of reported reactions to this food group. Emerging allergenic sources with increasing dietary use include flaxseed and chia seeds. Other seeds commonly associated with allergic reactions include sesame, sunflower, poppy, mustard, and buckwheat. Cross-reactivity between tree nut and seed proteins is common due to significant molecular homology [24].
Hazelnuts and walnuts
Despite regional and age-related differences, hazelnut allergy is the most prevalent tree nut allergy in Europe. By contrast, walnut allergy, relatively uncommon in Europe (2.2%), is the most frequently reported tree nut allergy in the United States [36].
To date, 12 hazelnut and 8 walnut allergens have been recognised by the IUIS allergen database [30]. In birch-endemic regions, hazelnut allergy frequently arises from primary birch pollen sensitisation and is characterised by sIgE reactivity to cross-reactive molecules such as Bet v 1 and Bet v 2. In Mediterranean regions, sensitisation to Cor a 8 (a hazelnut nsLTP) is more common and often results from primary sensitisation to Pru p 3 (a peach nsLTP). A comparable pattern is observed in walnut allergy, involving PR-10 protein Jug r 5 and nsLTP Jug r 3 [24].
Cross-reactive hazelnut allergens Cor a 1 (a Bet v 1 homologue) and Cor a 2 (a profilin) are present in both pollen and nut kernels at high concentrations. These allergens are typically associated with mild oral symptoms in individuals primarily sensitized to birch pollen. By contrast, the storage proteins Cor a 14 and Cor a 9 are considered markers of increased risk for severe systemic reactions [24, 36]. Cross-reactivity between hazelnut and walnut storage proteins is well documented and attributed to significant sequence homology. Specifically, Cor a 14 shares 66% sequence identity with Jug r 1, and Cor a 9 shares 75% with Jug r 4. Moreover, Jug r 4 exhibits 95% sequence homology with Car i 4, an allergen present in pecan nuts [24].
Cashew and pistachio
The prevalence of cashew nut allergy appears to be rising in parallel with the increased consumption of this nut [36]. However, data on the regional prevalence of cashew and pistachio allergy in Europe remain limited. A Dutch study described self-reported cashew and pistachio allergy rates of 0.7% and 0.49%, respectively. Another study from Turkey reported a pistachio allergy prevalence of 0.8% [37]. Australian data from the 2018 SchoolNuts study reported a prevalence of 2.3% for cashew nut allergy and 1.6% for pistachio allergy [24].
Pistachios and cashews both belong to the Anacardiaceae family. Consequently, they exhibit similar protein expression profiles. Most known allergens contained in cashews and pistachios are storage proteins, with the exception of Pis v 4, a manganese superoxide dismutase. They are designated Ana o 1–3 (cashew) and Pis v 1–5 (pistachio) [33]. Sequence identity between cashew and pistachio proteins ranges from 69% to 82%, with the highest similarity observed between Pis v 3 and Ana o 1. Sensitisation to cashew often leads to clinically relevant cross-reactivity with pistachio, whereas not all individuals with pistachio allergy are cross-sensitised to cashew proteins [24].
Sesame
The prevalence of sesame allergy varies widely and is largely influenced by dietary exposure to sesame [35]. Among European children, the highest rate of self-reported sesame allergy confirmed by sensitisation was observed in Reykjavik (0.15%) [6]. Among adults, the highest prevalence was reported in Zurich (0.03%) [6]. Sesame sensitisation without clinical symptoms is more common in Europe, with rates ranging from 2.86% to 12.10% [6]. In countries with high sesame consumption, sesame allergy confirmed by oral food challenge (OFC) has been reported in over 0.4% of children [38].
Seed allergies are predominantly associated with sesame, whereas allergic reactions to other seeds are generally reported as isolated cases [24, 39, 40]. Because of the high risk of accidental exposure to sesame in foods, pharmaceuticals, and cosmetics, and its well-documented allergenicity, mandatory allergen labelling of sesame has been implemented. In 2021, sesame was officially recognised as the ninth major food allergen requiring mandatory labelling, alongside milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soy [41]. Currently, seven sesame allergens are known, designated Ses i 1–7. Of these, five are storage proteins and two are oleosins [33]. Ses i 1 is considered the major diagnostic marker for primary sesame allergy and risk assessment of systemic reactions. sIgE testing for Ses i 1 provides greater specificity and predictive value for positive oral food challenge outcomes than either skin testing or sIgE to whole sesame extract [38].
Fruits and vegetables
Fruit and vegetable allergies may arise from two main routes of sensitisation. Primary sensitisation occurs through the gastrointestinal tract, while secondary sensitisation results from cross-reactivity with pollen and/or latex allergens. Allergens involved in primary food allergy are typically resistant to heat treatment and digestion. In contrast, proteins responsible for secondary sensitisation are typically thermolabile and easily degraded during digestion. When food allergy symptoms develop as a result of primary pollen sensitisation, the condition is referred to as pollen-food allergy syndrome (PFAS) [24, 42]. The EuroPrevall study [5] found that among plant-sensitised children, 63.2% were primarily sensitised to plant-derived foods. Sensitisation due to PR-10 cross-reactivity was observed in 40.9% of cases, while 28.5% showed reactivity to profilin or cross-reactive carbohydrate determinants (CCDs).
Pru p 3, a nonspecific lipid transfer protein (nsLTP) from peach, is a key molecule involved in primary fruit allergy. Sensitisation to Pru p 3 is also considered a marker for potential cross-reactivity with other nsLTPs. Such individuals may react to other Rosaceae fruits, including apple, pear, cherry, plum, apricot, raspberry, and strawberry [24, 43]. Act d 1, the major kiwi allergen, is a cysteine protease and another important trigger of primary fruit allergy. Like Pru p 3, Act d 1 is heat-stable and resistant to digestion. Sensitisation to Act d 1 is often associated with monosensitisation [24]. Secondary sensitisation to food allergens affects up to 40–50% of European patients with pollen allergy [44]. PFAS symptoms may intensify during pollen seasons, when the syndrome occurs more frequently and with greater severity [45]. The proteins most commonly involved in PFAS are Bet v 1 homologues, profilins, and, to a lesser extent, nsLTPs. Cross-reactions within the PR-10 group can lead to fruit allergies in individuals sensitised to birch pollen (birch-fruit syndrome). Profilin cross-reactivity may result in celery or carrot allergy in patients sensitised to mugwort [46]. Although nsLTPs are typically linked to primary fruit allergy, especially in Mediterranean countries, they have also been implicated in PFAS, including syndromes such as mugwort–mustard and mugwort–peach [46, 47]. Component-resolved diagnostics are valuable tools for identifying individual sensitisation profiles, assessing the likelihood of pollen-related symptoms, estimating anaphylaxis risk, and predicting cross-reactivity with other plant foods [24].
Cereals
In the planetary diet, cereals such as wheat, rice, and corn are expected to contribute the majority of total energy intake, preferably in the form of whole rather than refined grains [13]. However, in individuals allergic to cereal proteins, consumption may trigger severe allergic reactions [24, 48]. The majority of cereal allergies are caused by wheat, although cross-reactivity with other cereal grains has also been reported. Sensitisation to nsLTPs has been associated with positive oral challenge outcomes for wheat, corn, and rice. Sensitisation to specific wheat prolamins, a type of storage protein, may also cause cross-reactivity with rye and barley [24]. Millet, previously not considered allergenic, has also been associated with sensitisation in some patients [48].
Wheat
Wheat is one of the most widely consumed cereal grains worldwide and serves as a major source of dietary energy. It is commonly used in bread, pasta, breakfast cereals, semolina, bulgur, couscous, and other processed grain-based products. The genus Triticum comprises numerous species and subspecies, with over 25,000 known cultivated varieties. However, wheat is also one of the nine most common food allergens, with reported prevalence ranging from 0.4% to 4%, depending on age and geographic region. Wheat allergy can manifest through various symptoms, including classic IgE-mediated food allergy, wheat-dependent exercise-induced anaphylaxis (WDEIA), inhalation allergy (e.g. baker’s asthma), and contact urticaria [24]. To date, 28 wheat allergens have been identified, though many lack established clinical relevance [33]. Among them, omega-5 gliadin (Tri a 19) is the best-characterised and is recognised as the major trigger in WDEIA, wheat-associated childhood eczema, and baker’s asthma. Other well described allergens include alpha-amylase inhibitors and nsLTP (Tri a 14), which are associated with both respiratory and food allergies. Sensitisation to Tri a 36 and Tri a 26 is commonly observed in childhood wheat allergy. All these allergens are thermostable and resistant to digestion. Patients allergic to wheat may also react to related cereals such as rye and barley due to cross-reactivity [24, 49, 50]. Research suggests that up to 50% of children with wheat allergy react to barley, probably due to homology between omega-5 gliadin and γ3-hordein [49]. Cross-reactivity with rye has been attributed to structural similarity between Tri a 19 and rye proteins [51]. Therefore, sensitisation to omega-5 gliadin may serve as an important marker for potential reactions to both barley and rye [49–51]. Individuals with wheat or gluten hypersensitivity often turn to alternative grains. However, these substitutes may also contain homologous proteins capable of triggering allergic reactions. Examples include Silybum marianum (milk thistle) and Eragrostis tef (teff), which are naturally gluten free. Nevertheless, they may harbour proteins homologous to those in wheat, barley, and rye, and could elicit allergic symptoms in predisposed individuals [52].
Novel allergens
Global interest in “superfoods” – foods rich in nutrients and bioactive compounds – has increased in recent years. This trend is largely driven by growing consumer awareness of health and disease prevention, particularly through a well-balanced diet [53]. Popular superfoods include chia seeds, goji berries, avocado, kale, quinoa, flaxseed, and spirulina. Although cross-reactivity between chia seed proteins and those from sesame and hazelnut has been observed, its clinical relevance is not fully established. Nonetheless, cases of allergic reactions and even anaphylaxis have been reported [54, 55]. Similarly, anaphylactic reactions to goji berries have been reported, attributed to cross-reactivity with nsLTP proteins, particularly those shared with tomatoes [56]. Subsequent LC-HR-MS/MS analysis revealed that goji berries also contain storage proteins such as vicilin and 11S globulin [57]. Other examples of superfood-related allergies include anaphylactic reactions to quinoa and a case of occupational asthma following exposure to quinoa flour [58]. Five cases of allergic reactions to spirulina of varying severity (moderate to severe) have also been reported, most frequently after tablet consumption. Potential allergens include phycocyanin (which imparts spirulina’s colour), thioredoxins, superoxide dismutase, glyceraldehyde-3-phosphate dehydrogenase, and triosephosphate isomerase. These proteins exhibit sequence homology with known allergens from pistachio, fish, shellfish, and corn [59]. Increased exposure to novel food sources including superfoods and imported plant products has raised concerns about a potential increase in allergic reactions. These dietary shifts, often motivated by health trends, have introduced previously uncommon foods into regular consumption. The allergenic potential of many superfoods remains poorly understood, and their increasing consumption may lead to a rise in reported allergic reactions [60, 61].
Evaluation of the planetary diet with respect to allergies
While both animal- and plant-based foods are common causes of anaphylaxis in children, plant-derived foods are the predominant triggers in adults. In this group, the most frequent causes of anaphylaxis include legumes and nuts, the primary protein sources in the planetary diet. A greater intake of plant-based foods is generally considered beneficial to health. However, in sensitised individuals, it may provoke symptoms ranging from mild to life-threatening [25]. Therefore, before adopting the planetary diet, or any new dietary pattern, it is essential to consider the potential for food hypersensitivity reactions. The patient’s medical history should be carefully reviewed for the presence of past food allergy symptoms. If symptoms were present, it is important to assess their severity, identify the causative foods, evaluate the possibility of pollen-related cross-reactivity, and determine the risk of reactions to other plant allergens. To confirm a food allergy, diagnostic tools such as skin prick testing (SPT), serum-specific IgE (sIgE), or basophil activation testing (BAT) may be employed. In selected cases, an oral food challenge with the suspected allergen may be necessary to confirm the diagnosis. In some cases, extract-based tests (SPT or serology) may reveal patterns suggesting sensitisation to specific cross-reactive allergenic molecules. Molecular diagnostic methods offer valuable insights into allergen-specific sensitisation profiles. Serological sIgE testing is particularly useful for detecting sensitisation to allergens of low abundance or stability, such as Gly m 4 in soy extracts. It also aids in assessing reaction severity, predicting cross-reactivity, and confirming genuine (species-specific) sensitisation [24].
Research limitations and future research directions
Despite the growing interest in the planetary diet and its impact on health and the environment, research on its potential allergological effects remains limited. Most available analyses focus on health benefits related to the reduction of non-communicable disease risk and carbon footprint [5–12], while issues concerning immunological tolerance to dietary components, especially in individuals with food allergies, remain poorly explored [13–15]. In particular, there is a lack of:
prospective studies assessing the long-term effects of increased consumption of potentially allergenic plant-based foods [19, 21],
multicentre epidemiological analyses that account for the geographic and cultural diversity of food allergies in the context of transitioning to a plant-based diet [16, 25],
clinical studies evaluating the influence of gut microbiota composition on tolerance to plant proteins within the planetary diet [2],
risk models for cross-reactive allergic responses, particularly in patients with respiratory allergies or primary pollen sensitisation [17, 21]. Future research should aim to develop:
dietary strategies that support the safe incorporation of plant-based products into the diets of individuals with food allergies [21, 36],
clinical guidelines for physicians and dietitians on allergy prevention in the context of promoting sustainable diets [15, 17],
interdisciplinary translational studies combining immunology, nutrition, public health, and environmental sciences [9, 14].
Integrating allergological data with environmental and nutritional analyses could contribute to the development of effective and safe sustainable dietary models that address the needs of sensitive population groups, such as children, the elderly, and patients with allergic diseases [2, 15, 17].
It has been shown that a healthy diet rich in plant products, such as the planetary diet, may pose an inherent risk to patients with food allergies, which highlights the importance of dietary education and proper diagnosis in preventing recurrent anaphylaxis [62]. Therefore, in the future, special attention should be paid to educating people with diagnosed or suspected food or respiratory (pollen) allergies who are planning to switch to a planetary diet. This education is crucial to ensure that the process of adapting to such a diet is safe and sustainable for people with minimizing the risk of anaphylaxis and preventing unjustified dietary eliminations.
Summary
In response to growing health and environmental challenges, the planetary diet proposed by the EAT-Lancet Commission seeks to reconcile public health goals with environmental sustainability. This dietary model promotes increased consumption of plant-based foods such as vegetables, fruits, legumes, and nuts while reducing the intake of meat and processed foods. Adherence to this pattern may contribute to the prevention of non-communicable diseases and a reduction in greenhouse gas emissions. However, for individuals with food allergies, the diet poses potential risks, as many key plant-based components are recognized allergens. Moreover, the rising popularity of “superfoods” may introduce novel allergenic exposures due to protein homology with known allergens. These factors underscore a significant challenge for healthcare professionals and individuals transitioning to a plant-based diet, highlighting the need for increased awareness, appropriate screening, and tailored dietary guidance to minimise the risk of hypersensitivity reactions.
