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    Oral Allergies 101

    by Dr. Santhosh Kumar, Division of Allergy and Immunology

    Original article from spring 2014 issue of Tid*Bits.

    2014 TidBits Spring

    What is oral allergy syndrome?

    Oral allergy syndrome (OAS) is a local allergic reaction where the immune system gets confused with
    a protein in certain fruits and vegetables and over-responds to it the same way it does with a pollen
    allergy. This condition is typically seen in people who have seasonal pollen allergies (hay fever). OAS
    is also referred to as "pollen-food allergy syndrome."

    What are symptoms of oral allergy syndrome?

    OAS typically causes itching and/or swelling of the mouth, tongue and throat after eating certain fresh fruits and vegetables. Symptoms usually occur within minutes of eating the food. A child experiencing OAS symptoms may say something like: "My mouth feels funny." While not typical with OAS, some types of food allergies can cause serious, life-threatening reactions. See the Serious Allergic Reactions chart below for more on this.

    What are common triggers of oral allergy syndrome?

    The food(s) that may trigger OAS usually depend on the type of pollen an individual is allergic to. The following foods are associated with the specific pollen allergies listed:

    Birch (tree) 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*

    People with OAS do not always experience the same reaction if the foods are cooked as cooking changes the food enough that the immune system does not react to it in the same way. Also, not everyone who has pollen allergies experiences OAS.

    At what age does oral allergy syndrome occur in children?

    Typically, seasonal allergies occur after a child turns 2 and OAS symptoms are also likely to occur after age 2. Symptoms can also start later in life. In some cases, older children and teens who have been eating fruits and vegetables for years with no issues begin to experience symptoms.

    What should I do if I have a concern?

    If your child experiences the symptoms noted above after eating fresh fruits and vegetables, but is able to tolerate processed or baked products made of the same fruits and vegetables, then your child may have OAS. Sometimes it might be difficult to tell the difference between other types of food allergies and OAS so it is important to see an allergist once the symptoms appear. Treatment usually involves avoiding fresh fruits and vegetables that cause the symptoms or finding ways to eat these items
    (cooked, peeled, etc.) that do not cause reactions. Sometimes in severe cases allergy shots may also help. (See immunotherapy section below for additional information on allergy shots.)

    Serious Allergic Reactions: What to Look for and How to Help

    The following are signs of a serious allergic reaction:

    • Wheezing
    • Voice change
    • Coughing
    • Dizziness
    • Swelling of the lips and mouth
    • Fainting
    • Trouble breathing

    If you see a child experience one or more signs of a serious allergic reaction:

    • Lay child flat on the ground with legs elevated.
    • If child has an EpiPen? for emergency treatment of allergic reactions, use it as instructed.
    • Call 911 immediately.
    • If child is able to swallow Benadryl?, administer an age-appropriate dose.

    SPECIAL FOCUS: Immunotherpay

    Immunotherapy is a treatment option for moderate to severe seasonal allergies (hay fever). It involves a series of shots to administer small quantities of the protein an individual is allergic to until a certain concentration of the protein is reached. Immunotherapy is very effective for people who have failed to respond to oral medications for their treatment of seasonal allergies. The shots are administered every week for 4 to 6 months then monthly for 3 to 5 years.

    Symptom improvement is typically noticeable in a few weeks, but full benefit is usually noticeable around 4 to 6 months. Many children with asthma might also see improvement in their asthma symptoms with allergy shots. There are risks involved in allergy shots, which will be discussed by your child's allergist.

    CHoR offers allergy shots as a treatment option for eligible patients and provides extended weekday clinic hours so that children who come regularly for this do not need to continually miss school.

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