Common Triggers Of Oral Allergy Syndrome
Patients with OAS can be triggered by a single food source or from many different types of food. In some cases, patients will also only react to certain varieties for example, someone might react to one type of red apple, but not to a type of green apple.
In general, a patients triggers correlate with whatever type of seasonal allergy they have.
- Those with ragweed allergies react to: Bananas, melons, zucchini, cucumber, dandelions, and chamomile
- Those with birch allergies react to: apples, peaches, pears, cherries, apricots, plums, prunes, nectarines, kiwi, carrots, celery, potatoes, peppers, coriander, hazelnuts, and more
- Those with grass allergies react to: peaches, celery, tomatoes, oranges, and melons
- Those with mugwort allergies react to: apples, celery, kiwi, peanuts, fennel, carrots, parsley, sunflower seeds, peppers, and coriander
- Those with alder allergies react to: pears, apples, celery, almonds, hazelnuts, cherries, peaches, and parsley
- Finally, those with a latex allergy may react to: avocados, kiwis, bananas, chestnuts, and papaya.
Foods That Cause Oral Allergy Syndrome
Many foods can cause OAS, but your allergist must make an accurate diagnosis. For example, nuts are a common trigger for OAS, and if this is the case, testing for a more serious tree nut allergy should be done as well. If you experience tingling around the mouth after eating fruit, this is another sign of OAS. Properly understanding the triggers ensures that you can receive the most effective treatment plan.
Almonds, hazelnuts, walnuts and peanuts are the nuts most likely to cause your immune system to react, and soy milk is another trigger to be aware of. Because many products might contain traces of peanuts, tree nuts and/or soy, the food labels for these products will list the possible traces involved.
How To Recognize Oral Allergy Syndrome
There is nothing scarier than having an allergic reaction to food, especially if you are unaware of any food allergies. But what if you are certain of other allergies, like a tree pollen allergy? This could be the allergy causing the allergic reaction while eating and is known as oral allergy syndrome. Recognizing this syndrome can be difficult if you do not know what it is.
What Is Oral Allergy Syndrome?
It is first important to understand exactly what oral allergy syndrome is. This syndrome is caused by cross reacting allergens that are found in pollens and in raw fruits, vegetables, and tree nuts. The immune system recognizes these proteins and produces an allergic response. For example, if you have an allergy to tree pollen then you can have an allergic reaction to apples because the same allergen is found in both. The allergic response creates the following symptoms: oral itching , itchy throat, and even swelling of the lips and tongue.
How Do I Recognize It?
How Do I Manage Oral Allergy Syndrome?
If you need help managing your oral allergy syndrome or other allergies, you can schedule an appointment by calling us at 212-7976 or by scheduling online.
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What Are The Symptoms
Oral allergy syndrome usually is a mild reaction but in rare cases can worsen and become a severe reaction that causes difficulty breathing or anaphylaxis. The most common symptoms are: itching and burning of the mouth, lips, tongue, and throat water, itchy eyes a runny nose and sneezing.
These symptoms will usually happen within minutes of eating the offending food and last for several minutes though it is possible to have symptoms up to an hour after eating the offending food. More serious and less common symptoms are: rash or hives lip, tongue, or throat swelling nausea and vomiting diarrhea reflux stomach ache and difficulty breathing and wheezing.
Will I Need Investigations For My Pollen Food Syndrome
Often your healthcare professional can diagnose pollen food syndrome from your consultation without any need for further testing. However, if your diagnosis is not clear your healthcare professional may recommend that you have a blood test or skin prick testing where facilities are available. In skin prick testing the skin is pricked with prepared allergen extracts, however, as fruit and vegetable allergens can be affected by processing, testing may also involve prick testing with the relevant fresh fruit or vegetable, rather than using a prepared extract. If you are allergic, an itchy bump will come up within minutes of the test. This can be very itchy in the first few minutes, but will settle down over about an hour. A blood test is not usually necessary if skin prick tests are available, but occasionally your allergy healthcare professional may request a specific blood test called component testing to confirm a diagnosis.
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How Is Oral Allergy Syndrome Prevented
People with oral allergy syndrome can minimize or even avoid symptoms altogether by:
- Avoid the food that is causing symptoms.
- Bake or microwave the food in question before eating it. This can break down the allergic protein so that you are able to tolerate it. For example, you may be able to eat cooked tomato sauce on pizza but develop an itchy mouth from a fresh tomato in a salad.
- Peel the skin off fruits that cause symptoms or try other varieties of fruits .
Oral Allergy Syndrome Diagnosis
As with any allergy diagnosis, your doctor will first ask you about the history of your symptoms, Dr. Elliott says. Then a skin prick test or a blood test can help confirm the diagnosis and determine the specific pollen youre reacting to. Skin prick tests can also test for food allergies, but in the case of oral allergy syndrome, typically pollen will be positive and food will be negative, Dr. McNairn says.
Its possible you may not even realize you have a pollen allergy, Dr. Elliott adds. Some people could have a very mild pollen allergy, and its main manifestation is pollen-food allergy syndrome. They might come to me saying they cant eat fresh fruit because of their itchy mouth. Ill say, Do you get itchy eyes and a runny nose in the spring? And theyll realize they do, every spring!
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Food Allergies And Oas
Parents need to understand that there is a very important difference between true food allergies and oral allergy syndrome, says Dr. Stukus. Many times patients can eat the offending foods when they have OAS, especially if they try different preparations.
This is not the case with a food allergy. With food allergies, the offending foodâlike milk, eggs, soy, wheat, fish, shellfish, peanuts, and tree nutsâmust be avoided at all times due to the high risk of anaphylaxis. Likewise, people with food allergies usually carry an EpiPen.
According to Dr. Stukus, there is no direct correlation between true food allergies and oral allergy syndrome. Additionally, he notes that children usually don’t develop oral allergy syndrome until they are older or even into adolescence.
“Seasonal allergies usually don’t develop until 3 or 4 years of age,” he says. So, OAS doesn’t usually show up until they have developed allergies to pollens and then typically only occurs in very allergic individuals.
Common Oral Allergy Syndrome Questions
Is OAS a life-threatening condition?
In most cases, OAS sufferers will experience mild symptoms. But the possibility of a more severe allergic reaction does exist. Speak to your allergist to determine a treatment plan and whether you require an epinephrine injector.
Is there a cure for oral allergy syndrome?
While there is no cure for OAS or other allergies, oral immunotherapy treatment is the option closest to a cure. Successful treatment of oral allergy syndrome may allow you to consume these foods without negative consequences.
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Oral Allergy Syndrome: What It Is + How To Manage It
Oral Allergy Syndrome: What It Is + How To Manage It Oral Allergy Syndrome: What It Is + How To Manage It
Do you ever get a tingling, itchy, or scratchy tongue or throat after eating certain raw fruits, vegetables, nuts, or seeds? You aren’t alone. In fact, there’s actually a term for this: oral allergy syndrome . OAS is caused by a cross-reactivity between foods and pollens, and people who experience OAS usually also have seasonal hay fever symptoms as well.
What happens is that the proteins in the foods look similar enough to the pollen proteins that your immune system causes an allergic reaction . Usually the symptoms are mild, localized, and dissipate pretty quicklybut they can cause enough discomfort to make you want to avoid that food.
The most common pollens that cause this cross-reactivity are from birch, ragweed, or grasses. Since the pollen production of these plants is seasonal, OAS symptoms can often increase or decline as the seasons change too. These are some of the most common foods that can cause OAS:
- Birch pollen: apple, almond, carrot, celery, cherry, hazelnut, kiwi, peach, pear, plum
- Grass pollen: celery, melons, oranges, peaches, tomato
- Ragweed pollen: banana, cucumber, melons, sunflower seeds, zucchini
If you experience OAS, there are two courses of action to think about. First, remove the trigger for your reactions by noticing and avoiding foods that cause discomfort. Keep a diet journal if you find that helpful for identifying problem foods.
How Oral Allergy Syndrome Is Diagnosed
As with diagnosing any condition, diagnosing oral allergy syndrome involves multiple steps. Diagnosing the condition can be challenging given the multiple factors involved. A doctor will likely begin with a physical exam and medical history.
When taking the medical history, the doctor will ask after a family history of allergies as well as if the patient has any diagnosed allergies. A doctor or allergist may also recommend testing. Testing options for oral allergy syndrome can include both skin tests and blood tests to confirm a diagnosis. The presence of a confirmed test for a pollen allergy can, of course, help in the diagnostic process.
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Signs And Symptoms Of Oral Allergy Syndrome
The signs and symptoms associated with oral allergy syndrome vary from one patient to the next. In general, the most common symptoms include:
- Itchiness in the face and in the mouth
- Swelling in the mouth, face, lips, tongue, and throat
Most oral allergy syndrome symptoms appear right after someone has consumed raw vegetables or fruits, but occasionally a patient will experience a delayed reaction and have symptoms hours later. Additional, less common symptoms can include irritation in the gums, eyes or nasal cavity. While symptoms of oral allergy syndrome can happen all year round due to the wide availability of out of season fruits and vegetables, symptoms are also worse during the spring and fall months when there is more pollen in the air.
Oral Allergy Syndrome Treatment
There is no cure for the oral allergy syndrome 70). Food allergy treatment depends on antihistamines, corticosteroids, and epinephrine . No clear evidence exists for using sodium cromoglycate 71). Specific immune therapy for food allergy is not feasible. Specific immune therapy that used peanuts was discontinued because of excessively high levels adverse effects 72). Novel encouraging immunologic investigations of mice include the utilization of recombinant allergens and the use of the allergen mixed with heat killed listeria as an adjuvant 73).
Monoclonal humanized antibodies of anti-IgE may be used to counter severe food allergy. IgE receptor antibodies of the mast cells that lack cell degranulation might obstruct the allergic response. Initial studies demonstrate that anti-IgE treatment can, in essence, enlarge the threshold amount of peanut protein necessary to incite allergic symptoms in individuals with peanut allergy 74). The utilization of anti-IgE treatment in combination with specific immune therapy might be a valuable therapy in the future 75).
Although serious responses are rarely encountered, intramuscular use of an epinephrine autoinjector may be advised 76). Food allergy-induced asthma encompassed 9.5% of individuals and asthma that occurred singly was recognized in just 2.8% of patients. Food allergy-induced asthma is potentially life threatening, which leads to prescribing epinephrine autoinjectors and bronchodilators 77).
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Eating Cooked Vs Raw Fruits And Veggies
And in another weird twist, you can eat the fruits or veggies cooked, but not raw. How is that possible? Because cooking distorts the proteins, so the immune system doesn’t see it as the same food.2 So my friend can eat cherry pie, just not fresh cherries. If you are having a picnic this summer and munching on fresh fruit and veggies and suddenly get an itchy mouth, it could be oral allergy syndrome.
How Do I Manage Pollen Food Syndrome
Avoidance of the foods that cause your reactions is most important, there is no need to avoid foods that do not cause any symptoms. Usually, you will only need to avoid the allergenic food in its raw form as cooking destroys the allergens. It is worth trying the food cooked, canned or microwaved to see if it is tolerated. Some people find that different varieties of fruits or vegetables can be tolerated, for example it is worth checking to see whether you can tolerate one type of apple, even if another type causes symptoms.
Most people with pollen food syndrome can tolerate well-cooked fruits and vegetables. It is worth noting that lightly cooked vegetables such as stir-fried vegetables, for example bean sprouts, mange tout and carrots, and nuts both raw and cooked have been known to induce symptoms.
It is really important to continue to take any medication your healthcare professional has prescribed for other allergies, including asthma and hay fever, as this will help you to maintain control of symptoms of pollen food syndrome. If you have experienced any severe reactions, such as breathing difficulties or anaphylaxis, your healthcare professional may prescribe adrenaline autoinjectors and advise you to avoid the foods that caused the allergic reaction.
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How Long Does Oral Allergy Syndrome Last
Oral allergy syndrome typically leads to a short, acute manifestation of symptoms. Generally speaking, any reactions triggered by oral allergy syndrome disappear after the triggering fruit is no longer near the patient. It is extremely rare for symptoms of OAS to last very long or cause serious harm.
What Are The Symptoms Of Oral Allergy Syndrome
The main symptoms are redness, swelling and itching in the mouth immediately after contact with certain foods. There may be a blotchy, pimply or even blistering rash on the lips, tongue, the inside of the mouth, and the soft palate.
Symptoms in the gullet or stomach occur only very occasionally. This causes discomfort, heartburn, nausea or even vomiting.
General allergy symptoms, such as urticaria, rhinitis and asthma, are relatively unusual but when they do occur, it is normally after a period of minutes or hours. These symptoms are more likely if you ignore the initial mouth symptoms and eat all of the food causing the reaction.
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How Is Oral Allergy Syndrome Treated
While most oral allergy symptoms will go away when you stop eating the food, its a good idea to see an allergist for an individual consultation any time you experience allergy symptoms related to food. Food-related symptoms can sometimes alert you to a more dangerous allergy, such as latex.
The allergist will determine whether your symptoms are a mild cross reaction or whether they could lead to a life-threatening allergic reaction such as anaphylaxis.
Anaphylaxis from oral allergy syndrome is extremely rare, but if youre at risk, you may require a prescription for epinephrine auto-injectors, the first-line treatment.
A board-certified allergist can give you an accurate diagnosis, advise you which foods to avoid and recommend treatments to relieve symptoms.
Which Foods Are Involved
Most people with OAS are sensitive to one or two foods, although some will find they may develop problems with a number of the different foods.
Foods that are more common causes of oral allergy syndrome include: apple, carrot, walnut, cherries, peach, potato, peanuts, plum, pear, fennel, wheat, honey, nectarine, spinach, hazelnuts, almonds, strawberries, brazil nuts, celery, apricots, melon, watermelon, cucumber, tomato, camomile tea, and spices .
- Birch pollen cross-reacts with almond, apple, apricot, raw carrot, raw celery, cherry, coriander, fennel, hazelnut, kiwi, nectarine, parsley, parsnip, peach, pear, peppers, plum, raw potato, prune, tomato, and walnut.
- Rye-grass pollen cross-reacts with melon, peanut, tomato, and watermelon.
- Rubber latex cross-reacts with almond, apple, apricot, avocado, banana, chestnut, cherry, dill, fig, ginger, kiwi, mango, melon, oregano, papaya, passion fruit, peach, pear, plum, raw potato, sage, and raw tomato.
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Risk Factors For Oral Allergy Syndrome
The main risk factor for oral allergy syndrome is the presence of a pre-existing pollen or latex allergy. Research has shown that patients with OAS may have some additional risk factors beyond atopy, though research in this area is ongoing. It is known that cases of OAS appear more frequently in women than in men.
Oral Allergy Syndrome Triggers
Apples might be the food most likely to spark oral allergy syndrome symptoms, Dr. McNairn says. Along with other pitted fruits like apricots, cherries, peaches, and plums, apples are associated with birch pollen allergiesas are almonds, carrots, celery, hazelnuts, kiwi, parsley, and soybeans. Bananas, cantaloupe, cucumbers, honeydew, peppers, watermelon, and zucchini can cause oral allergy syndrome symptoms in people with ragweed allergies. And people with grass allergies might react to oranges, peaches, tomatoes, and more.
What allergy you have determines what foods youre more likely to have this reaction to, says Tania Elliott, MD, an allergist in New York City and chief medical officer of preventive health company EHE.
While nuts can cause oral allergy syndrome symptoms, theyre more likely than other foods to cause severe food allergy symptoms, Dr. McNairn adds, so youll definitely want to bring up any nut-related mouth itchiness with an allergy doc. If youre not allergic to pollen, that makes a food allergy much more likely as well,she says.
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