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.

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.