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I had written to The Allergy and Anaphylaxis Network to congratulate them on their success putting the new food labeling law through for the big 8 food allergies. It’s important for me as a person that has many allergies and has friends with at least one of those big 8. The law will apparently not help me with my rare cinnamon allergy, but Debbie sent me this article which explains a lot of my weird “temporary” fruit allergies every spring. This may be helpful to those of you who suffer hayfever and have problems with certain fruits. It explains why I can’t eat some fruit in spring when my allergies flare up and why they have only a partial allergic reaction that doesn’t do all the horrible things to me that cinnamon does. I hope this is helpful.
This article appeared in the June/July 1994 issue of Food Allergy News
Copyright 1994 The Food Allergy Network
Do Fruits and Vegetables Cause Allergic Reactions?
by John W. Yunginger, M.D.
John W. Yunginger, M.D., is a member of the medical advisory board of The Food Allergy Network. He is also a professor of medicine at the Mayo Medical School and a consultant in pediatrics at the Mayo Clinic and foundation in Rochester, Minnesota.
Individuals who develop hay fever symptoms after exposure to certain tree (birch, alder, or hazel), grass, or weed (such as ragweed or mugwort) pollen may also experience symptoms of an allergic reaction after eating certain raw vegetables, nuts, seeds, or fresh fruits. This type of allergic reaction is called Oral Allergy Syndrome.
Oral Allergy Syndrome
OAS is caused by cross-reacting or identical allergens that are present in both the pollen and fresh food. The foods most commonly associated with OAS are listed in the accompanying table. Symptoms of OAS may include itching or swelling of the lips, tongue, throat, or roof of the mouth. They are less severe if the individual is receiving regular doses of antihistamines.
Because the allergens responsible for these reactions are usually destroyed by heating or digestion, affected individuals can usually eat fruits or vegetables that have been cooked, baked, or canned. For example, a person may experience itching of the mouth and tongue after eating a fresh apple, but may be able to eat apple sauce or an apple pie without trouble.
Oral Allergy Syndrome and Anaphylaxis
It is important to know the difference between Oral Allergy Syndrome and food-induced anaphylaxis. Although both types of reactions are caused by specific IgE antibodies, anaphylaxis is a much more severe form of food allergy. Anaphylactic reactions may include generalized hives, swelling of the lips, eyelids, face, or hands; breathing trouble, with coughing or wheezing; or loss of consciousness. Most food-induced anaphylactic reactions are due to foods such as peanuts, tree nuts, fish, milk, eggs, or shellfish. However, several foods, particularly celery, seeds, or nuts, can cause either anaphylaxis or Oral Allergy Syndrome.
It may be difficult for people to distinguish these two conditions during the first few reactions. The key difference is that OAS symptoms are always limited to the lips, mouth, or throat and usually go away without treatment. The proper treatment for OAS may be identical to that for anaphylaxis. However, if there is any doubt about whether a person's symptoms are due to OAS or anaphylaxis, it is safer to administer epinephrine.
Diagnosis
Allergists can make the diagnosis of OAS most frequently from a person's clinical history. Skin testing with commercial extracts of the incriminated fruits and vegetables or blood testing for food-specific IgE antibodies may produce negative results in many cases; however, skin tests will be positive if fresh fruits or raw vegetables are used for testing.
Treatment
Not much is known about the natural history of OAS. Some researchers report that both hay fever symptoms and OAS symptoms go away if the affected person receives immunotherapy injections with extracts of these cross-reacting pollens. As with all forms of food allergy, identification of the responsible food and strict avoidance of that food is the key to successful long-term management.
The following raw vegetables, nuts, seeds, or fresh fruits can produce oral allergy syndrome:
Vegetables
Carrot, Celery, Parsley, Potato, Tomato
Seeds and Nuts
Fennel seed, Hazelnut (filbert), Sunflower seeds
Fruits
Apple, Apricot, Banana, Cantaloupe, Cherry, Honeydew, Orange, Peach, Pear, Watermelon
This article appeared in August/September 2003 issue of Food Allergy News
Copyright 2003 The Food Allergy & Anaphylaxis Network
A Member Asks...
"How can you determine if symptoms are the result of oral allergy syndrome or the beginning of an anaphylactic reaction?"
Anna Nowak-Wegrzyn, M.D., an Assistant Professor of Pediatrics, Pediatric Allergy and Immunology, at the Mount Sinai School of Medicine in New York City, answers.
"The term oral allergy syndrome (oral allergy) is typically used to describe mild symptoms of an itchy mouth or scratchy throat caused by raw fruits or vegetables, in individuals with hay fever. It is unusual for these symptoms to go beyond the mouth.
"Allergic reactions to peanuts or other foods may sometimes begin with similar symptoms but may, or may not, progress to anaphylaxis and involve the gut (vomiting, diarrhea), skin (hives, itching, flushing, redness), airways (cough, wheezing, shortness of breath), or circulation (low blood pressure, fainting, shock).
"Oral allergy syndrome is caused by an allergic response initially directed to the pollen that crosses over to similar proteins in the foods. These proteins concentrate under the peel of some fruits and are sensitive to heating; therefore, most persons affected can tolerate cooked fruits or vegetables.
"The 'oral' nature of the symptoms presumably is due to the fact that these proteins are digested by stomach juices and do not enter the bloodstream.
"To distinguish between oral allergy syndrome and symptoms that may indicate the beginning of anaphylaxis, remember that raw fruits or vegetables are typical culprits for oral allergy syndrome, whereas milk, eggs, soy, wheat, peanuts, and tree nuts are typical triggers for anaphylaxis.
"However, if you or your child ever had a reaction caused by a raw fruit or vegetable that progressed beyond the mouth, you should consider that food a risk for anaphylaxis.
"Recognizing the confusion of the terminology, some experts propose to replace the term oral allergy syndrome with a new name, pollen-plant food allergy, to describe reactions to fruits and vegetables cross-reactive with pollens.
"If your child reacts to fruits or vegetables, alert his or her doctor. The following table provides additional helpful information."
Oral Allergy Syndrome
Onset:
Older children, teens, or young adults; typically patients have been eating the implicated foods without problems for many years.
Relation to hay fever (seasonal allergy to pollens):
Hay fever is usually present before oral symptoms to foods begin.
Symptoms:
Limited to itchy mouth and throat with occasional itchy ears and swelling of the lips; never generalized!
Difference between raw and cooked foods:
Symptoms are caused by raw fruits or vegetables; cooked or canned foods and juices are tolerated.
Treatment:
Symptoms resolve usually within minutes after the food is swallowed or removed from mouth, and treatment typically is not necessary.
Common pollen-food associations*
Birch: apple, carrot, peach, plum, cherry, pear, almond, hazelnut
Grasses: tomato
Ragweed: melons, zucchini, cucumber, kiwi, banana
* These are potential associations. Not every patient allergic to pollen develops symptoms with cross-reacting fruits or vegetables. Patients may react to a few but not all of the above.
This article appeared in the June/July 1994 issue of Food Allergy News
Copyright 1994 The Food Allergy Network
Do Fruits and Vegetables Cause Allergic Reactions?
by John W. Yunginger, M.D.
John W. Yunginger, M.D., is a member of the medical advisory board of The Food Allergy Network. He is also a professor of medicine at the Mayo Medical School and a consultant in pediatrics at the Mayo Clinic and foundation in Rochester, Minnesota.
Individuals who develop hay fever symptoms after exposure to certain tree (birch, alder, or hazel), grass, or weed (such as ragweed or mugwort) pollen may also experience symptoms of an allergic reaction after eating certain raw vegetables, nuts, seeds, or fresh fruits. This type of allergic reaction is called Oral Allergy Syndrome.
Oral Allergy Syndrome
OAS is caused by cross-reacting or identical allergens that are present in both the pollen and fresh food. The foods most commonly associated with OAS are listed in the accompanying table. Symptoms of OAS may include itching or swelling of the lips, tongue, throat, or roof of the mouth. They are less severe if the individual is receiving regular doses of antihistamines.
Because the allergens responsible for these reactions are usually destroyed by heating or digestion, affected individuals can usually eat fruits or vegetables that have been cooked, baked, or canned. For example, a person may experience itching of the mouth and tongue after eating a fresh apple, but may be able to eat apple sauce or an apple pie without trouble.
Oral Allergy Syndrome and Anaphylaxis
It is important to know the difference between Oral Allergy Syndrome and food-induced anaphylaxis. Although both types of reactions are caused by specific IgE antibodies, anaphylaxis is a much more severe form of food allergy. Anaphylactic reactions may include generalized hives, swelling of the lips, eyelids, face, or hands; breathing trouble, with coughing or wheezing; or loss of consciousness. Most food-induced anaphylactic reactions are due to foods such as peanuts, tree nuts, fish, milk, eggs, or shellfish. However, several foods, particularly celery, seeds, or nuts, can cause either anaphylaxis or Oral Allergy Syndrome.
It may be difficult for people to distinguish these two conditions during the first few reactions. The key difference is that OAS symptoms are always limited to the lips, mouth, or throat and usually go away without treatment. The proper treatment for OAS may be identical to that for anaphylaxis. However, if there is any doubt about whether a person's symptoms are due to OAS or anaphylaxis, it is safer to administer epinephrine.
Diagnosis
Allergists can make the diagnosis of OAS most frequently from a person's clinical history. Skin testing with commercial extracts of the incriminated fruits and vegetables or blood testing for food-specific IgE antibodies may produce negative results in many cases; however, skin tests will be positive if fresh fruits or raw vegetables are used for testing.
Treatment
Not much is known about the natural history of OAS. Some researchers report that both hay fever symptoms and OAS symptoms go away if the affected person receives immunotherapy injections with extracts of these cross-reacting pollens. As with all forms of food allergy, identification of the responsible food and strict avoidance of that food is the key to successful long-term management.
The following raw vegetables, nuts, seeds, or fresh fruits can produce oral allergy syndrome:
Vegetables
Carrot, Celery, Parsley, Potato, Tomato
Seeds and Nuts
Fennel seed, Hazelnut (filbert), Sunflower seeds
Fruits
Apple, Apricot, Banana, Cantaloupe, Cherry, Honeydew, Orange, Peach, Pear, Watermelon
This article appeared in August/September 2003 issue of Food Allergy News
Copyright 2003 The Food Allergy & Anaphylaxis Network
A Member Asks...
"How can you determine if symptoms are the result of oral allergy syndrome or the beginning of an anaphylactic reaction?"
Anna Nowak-Wegrzyn, M.D., an Assistant Professor of Pediatrics, Pediatric Allergy and Immunology, at the Mount Sinai School of Medicine in New York City, answers.
"The term oral allergy syndrome (oral allergy) is typically used to describe mild symptoms of an itchy mouth or scratchy throat caused by raw fruits or vegetables, in individuals with hay fever. It is unusual for these symptoms to go beyond the mouth.
"Allergic reactions to peanuts or other foods may sometimes begin with similar symptoms but may, or may not, progress to anaphylaxis and involve the gut (vomiting, diarrhea), skin (hives, itching, flushing, redness), airways (cough, wheezing, shortness of breath), or circulation (low blood pressure, fainting, shock).
"Oral allergy syndrome is caused by an allergic response initially directed to the pollen that crosses over to similar proteins in the foods. These proteins concentrate under the peel of some fruits and are sensitive to heating; therefore, most persons affected can tolerate cooked fruits or vegetables.
"The 'oral' nature of the symptoms presumably is due to the fact that these proteins are digested by stomach juices and do not enter the bloodstream.
"To distinguish between oral allergy syndrome and symptoms that may indicate the beginning of anaphylaxis, remember that raw fruits or vegetables are typical culprits for oral allergy syndrome, whereas milk, eggs, soy, wheat, peanuts, and tree nuts are typical triggers for anaphylaxis.
"However, if you or your child ever had a reaction caused by a raw fruit or vegetable that progressed beyond the mouth, you should consider that food a risk for anaphylaxis.
"Recognizing the confusion of the terminology, some experts propose to replace the term oral allergy syndrome with a new name, pollen-plant food allergy, to describe reactions to fruits and vegetables cross-reactive with pollens.
"If your child reacts to fruits or vegetables, alert his or her doctor. The following table provides additional helpful information."
Oral Allergy Syndrome
Onset:
Older children, teens, or young adults; typically patients have been eating the implicated foods without problems for many years.
Relation to hay fever (seasonal allergy to pollens):
Hay fever is usually present before oral symptoms to foods begin.
Symptoms:
Limited to itchy mouth and throat with occasional itchy ears and swelling of the lips; never generalized!
Difference between raw and cooked foods:
Symptoms are caused by raw fruits or vegetables; cooked or canned foods and juices are tolerated.
Treatment:
Symptoms resolve usually within minutes after the food is swallowed or removed from mouth, and treatment typically is not necessary.
Common pollen-food associations*
Birch: apple, carrot, peach, plum, cherry, pear, almond, hazelnut
Grasses: tomato
Ragweed: melons, zucchini, cucumber, kiwi, banana
* These are potential associations. Not every patient allergic to pollen develops symptoms with cross-reacting fruits or vegetables. Patients may react to a few but not all of the above.
