Pollen–food allergy syndrome (PFAS) is increasingly recognized as an emerging allergic health challenge, yet information on allergists' perceptions and management of PFAS in France is limited. This study aimed to characterize allergists’ perceptions of PFAS frequency and severity, as well as diagnosis and management strategies in France.

A 16-item online questionnaire was distributed to 1,329 physicians in the allergy group of the AdviceMedica platform in France (1 September–1 November 2025). Questions covered PFAS consultation frequency, perceived trends on incidence and symptom severity, suspected pollens, use of biological markers (PR-10, lipid transfer protein [LTP], gibberellin, profilin), therapeutic recommendations, and patterns of allergen immunotherapy (AIT) use.

A total of 126 physicians responded (9.5%). Most reported prioritizing PFAS consultations (74.0%), typically up to two per week. Nearly three-quarters (73.8%) perceived an increase in PFAS cases, mainly over the past 3–5 years. PFAS symptoms were considered predominant in the overall clinical picture by 93.5% of respondents; 47.9% perceived increasing severity, although symptoms were usually mild and confined to the oropharyngeal cavity. Birch pollen was most frequently implicated, followed by grasses. Biomarker testing was requested in about one-quarter of cases (26.8%); when performed, PR-10 was used by 100% of respondents, with frequent use of LTP (86.9%), profilin (75.7%), and gibberellin (44.9%). Management strategies varied, including avoidance or non-avoidance of culprit foods and induction of food tolerance. PFAS influenced AIT prescription choices for 49.6% of allergists; however, 70.5% never increased AIT doses, 23.8% considered doing so in certain cases, and, if PFAS appeared during AIT, treatment was generally continued without dose escalation.

The respondents perceived PFAS as increasingly common and, in many cases, more severe, yet biomarker-based diagnosis is still used in only a minority of cases. PFAS may influence AIT selection, but dose adjustment is rarely performed once AIT has been initiated in this context. These findings highlight the need for clearer care pathways and prospective studies to define the role of AIT in PFAS.