Pollen–food allergy syndrome is increasingly recognized as an emerging allergic health challenge, yet information on allergists' perceptions and management of pollen–food allergy syndrome in France is limited. This study aimed to characterize allergists’ perceptions of pollen–food allergy syndrome 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 pollen–food allergy syndrome consultation frequency, perceived trends on incidence and symptom severity, suspected pollens, use of biological markers (PR-10, lipid transfer protein, gibberellin, profilin), therapeutic recommendations, and patterns of allergen immunotherapy use.

A total of 126 physicians responded (9.5 %). Most reported prioritizing pollen–food allergy syndrome consultations (74.0 %), typically up to two per week. Nearly threequarters (73.8 %) perceived an increase in pollen–food allergy syndrome cases, mainly over the past 3 to 5 years. Pollen–food allergy 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 lipid transfer protein (86.9 %), profilin (75.7 %), and gibberellin (44.9 %). Management strategies varied, including avoidance or nonavoidance of culprit foods and induction of food tolerance. Pollen–food allergy syndrome influenced AIT prescription choices for 49.6 % of allergists; however, 70.5 % never increased treatment doses, 23.8 % considered doing so in certain cases, and, if symptoms appeared during treatment, it was generally continued without dose escalation.

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