Mazal tov! We are now members of the Food Allergy Club. Not the greatest club to be a member of, mind you, but it seems that nowadays we have a lot of company, unfortunately. It all started several months ago. My daughter informed me one day that when she ate a certain fruit her mouth itched. Soon it seemed that there were more and more fruits--and now some vegetables--that had the same effect. To be honest, I didn't quite believe her at first. Especially the itching part. I had never heard of this and frankly, I thought it was all in her head.
Fast forward a few months and we are at her yearly wellness exam. My daughter told the nurse practitioner that certain foods made her mouth itch. The nurse practitioner right away answered, "yes, that is actually a condition called Oral Allergy Syndrome." She showed us information online--basically, certain fruits and vegetables can cause one's mouth to itch if he/she is allergic. "There, mom, you see!" My daughter was vindicated as I shame-facedly acknowledged the existence of this condition.
Soon after, my daughter was complaining of some adverse reactions to dairy and soy. I started to feel doubtful and overwhelmed. "You can't be allergic to everything!" I thought....and said. It was time to go the the allergist and get some answers. Answers, we got...and I am still traumatized. Here's what happened:
The doctor asked my daughter specifics about which foods she reacted to and what the reactions looked like. The allergest then ordered a scratch test to be performed. Basically, allergens are lightly pricked onto the patient's back. Whichever areas become red and swell indicate an allergy. Tested were common allergens, such as pollens, some foods and plants. After about 2 minutes I could see my daughter's back forming some significant hives. By the time the 15 minutes were up, the top of my daughter's back had exploded into the biggest, reddest welts I had ever seen. It was terribly uncomfortable for her because she wasn't allowed to scratch the area. On my end, it was a horrible sight to behold. The nurse measured and recorded the hives, then gave the results to the doctor. The doctor rushed in, excitedly. She had never seen someone so highly allergic to so many grasses and pollens. Without going into all the details, my daughter is not only allergic to all but one of the grasses and pollens tested, but also to several fruits, vegetables (VERY allergic to carrots), dairy and soy. In fact, because my daughter's allergies are so pronounced, the doctor prescribed an Epipen for my daughter to carry just in case, a rarity.
Oral Allergy Syndrome: What is it?
Oral Allergy Syndrome (OAS), also known as pollen-food syndrome, occurs in people who are allergic to to grass, birch and ragweed pollens. It is caused by a cross-reaction in the body between the proteins found in these pollens and certain fruits and vegetables. The body detects the pollen and similar proteins in the food, which then triggers an allergic reaction. Symptoms include: itching, tingling, swelling or redness in and around the mouth or throat. The allergy usually manifests in older teens, young adults and adults who have eaten the foods in question for years but have become reactive.
What foods trigger Oral Allergy Syndrome?
Typically, the foods that carry the same protein make up of certain pollens are the triggers. Interestingly, most with OAS only experience allergic reactions when eating the food raw. That's because when heated, the proteins break down and change form. Below, each pollen is listed with corresponding fruit or vegetable that may cause an OAS reaction:
Fruits and Tree Nuts: apples, apricots, cherries, peaches, almonds, nectarines, pears, plums, kiwi, hazelnuts
Vegetables: carrots, potatoes, celery
Spices and Herbs: caraway, parsley, fennel, coriander, aniseed
Legumes: soy, peanuts
Celery, oranges, peaches, tomatoes
Bananas, cantaloupe, melons, watermelon, honeydew, cucumber, squash, zucchini
Celery, fennel, coriander, sunflower seeds, peppers
Daunting as the list is, not everyone allergic to a certain pollen is allergic to every food mentioned. For example, my daughter is highly allergic to birch pollen and to most of the foods in that category. However, she is not allergic to peanuts, thank G-d!
How is OAS diagnosed?
First of all, you can probably self-diagnose by simple observation. If you or your child experiences any of these symptoms, chances are pretty good he or she has OAS. The next step is going to an allergist to get tested. In my daughter's case, they did the skin prick test, which is a common form of allergy testing. Be warned: it is REALLY uncomfortable if your kid reacts to the allergens, as it causes lots of itching. The patient must not scratch the area for an extended period of time in order to ensure test accuracy. Make sure you bring lots of distracting activities, especially if you are bringing in little kids!
What are the risks of OAS?
In most cases, the risk is minimal. As our allergist explained, when you are eating an apple and your mouth starts itching, you generally stop eating the apple. Thus, you do not ingest a large amount and this minimizes exposure. However, there is always the risk of anaphylaxis, a condition in which the throat starts to close up, potentially fatal. This is rather rare, shown to occur in 1.7% of all patients. Our doctor said before the skin prick test that she usually did not prescribe an epipen (the emergency treatment for anaphylaxis) because it is not necessary for most patients. However, in my daughter's case, because she is so highly allergic to certain foods and it's not always possible to know how all food is prepared, she did prescribe an epipen just in case. The risk to my daughter is still pretty low and G-dwilling she will never have to use it. But better safe than sorry!
What is the treatment of OAS?
Obviously, abstaining from the offending foods. In addition, according to Allergy and Asthma Specialists, a practice recognized as one of the top in the Philadelphia area:
"There is evidence that undergoing immunotherapy, allergy injections or sublingual immunotherapy to treat the underlying allergic rhinitis can help lessen the symptoms of oral allergy syndrome. You should discuss this with your allergist."
For now we are just avoiding the trigger foods. My daughter does suffer terribly during allergy season, though, so there may be a time that injections are suggested.
A Word to Parents
As a parent, it's not always easy to decide what to pay attention to and what to wave off as hypochondria. How many times do we take our kids to the doctor to find out nothing is wrong? We are not perfect. I catch myself getting into the "what ifs." What if I never took her to the doctor? What if I made her eat carrots, which she is the most allergic to, and she went into anaphylactic shock, G-d forbid? What if, what if ? Seeing your child swollen like a balloon is shocking. Thinking about the what ifs is unbearable. I am saying to you parents, as well as to myself, that we are human. We make mistakes. Thank G-d, Hashem (God) watches over our children and opens our eyes when they need to be open. It is most important that we keep davening (praying) for that knowledge from Hashem and that He always protect our children.
Allergy and Asthma Specialists: "Oral Allergy Syndrome" www.86cough.com
American College of Allergy, Asthma and Immunology: "Oral Allergy Syndrome"