Friday, November 27, 2015

Does your child have oral allergy syndrome?

That tingling and itchy feeling in the throat and mouth your child may be describing after eating certain fruits and vegetables could be oral allergy syndrome. Learn more about it and what to do if your child has this type of allergic reaction.

Does your child have oral allergy syndrome?


Has your child ever told you that certain foods cause tingling and itching in and around the mouth and the back of the throat? Does this occur within minutes of eating the food?

If your child also has seasonal allergies, it’s likely that this reaction is oral allergy syndrome. These symptoms occur because the proteins in some fruits and vegetables are similar to proteins in some pollens. These proteins can confuse the immune system and cause an allergic reaction or make existing symptoms worse.

People who are allergic to any type of pollen have a 50 percent chance of developing oral allergy syndrome. One of the most common types of cross-reactivity involves birch tree pollen and apple. Other food triggers associated with this pollen include peach, pear, kiwi, plum, coriander, fennel, parsley, celery, cherry and carrot. When one makes antibodies to the pollen, they also become sensitized to these fruits and vegetables. The Philadelphia area has an abundance of birch pollen and oral allergy syndrome is quite common here.

Most children and adults with oral allergy syndrome will experience symptoms only when eating fresh fruits and vegetables and, sometimes, nuts. In most cases, these foods are tolerated when cooked because cooking changes the shape of the food’s molecules so that the antibody doesn’t bind to the allergenic protein. So a person might be able to enjoy apple pie and applesauce without the symptoms that are caused by biting into a raw apple.  However, a minority of patients cannot tolerate either the raw or cooked version of the food, and cooking may even increase the allergic potential of a protein, as in the case of peanuts.

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The good news is that it is rare for oral allergy syndrome to be associated with anaphylaxis, a life threatening, whole-body allergic reaction. However, if a person is experiencing oral allergy symptoms, it is very important that they see their allergist to make sure that it is indeed oral allergy syndrome and not a different type of reaction that may require carrying an epinephrine auto-injector (Epi-pen). One should not assume that these symptoms are not dangerous, and we may in fact still prescribe an Epi-pen in some cases of oral allergy syndrome.

For most children, the reaction caused by oral allergy syndrome is short-lived and usually limited to itchy or tingly sensations in the mouth. Oral allergy syndrome can happen in childhood, but its onset can also occur seemingly “out of the blue” in adulthood.  Antihistamines such as Benedryl may provide temporary relief, but the only real treatment is avoidance of the offending foods.  

Parents who suspect foods are causing oral allergy syndrome may want to have children skin tested for the foods, for pollens associated with foods, and seasonal allergies if there are accompanying nasal symptoms. It’s always good to know your children’s allergic triggers to appropriately plan, avoid and treat them. It’ll keep them as comfortable and symptom-free as possible.

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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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