What is Oral Allergy Syndrome/ Food Pollen Allergy Syndrome?

Oral allergy syndrome (OAS) is an allergy to one or more usually fresh fruits or vegetables. It is a common food-related allergy in adults and is increasingly diagnosed in older children. Symptoms are often confined to the mouth and develop within a few minutes of eating the food. The allergy is to proteins in the fruit that are similar to those found in tree (especially birch tree), grass or weed pollens causing hay fever.

What are the symptoms?

Itchiness or tingling in the lips and mouth. Sometimes local swelling of lips and tongue “angioedema”. Less common are urticaria (nettle rash), or abdominal pain. Anaphylaxis (wheeze or breathing problems) is uncommon, occurring in 1 in 50 patients.

Why are symptoms typically confined to the mouth?

Unlike other food allergies, symptoms in OAS are usually limited to the mouth, lips, tongue, and throat because the proteins causing the allergic reaction are broken down by saliva and digestive juices in the stomach.  Cooking the food also destroys the proteins. People with OAS may therefore be able to eat cooked fruit such as apple pie but react to raw apples.  Processed foods e.g. jam, and canned fruits are also often tolerated.

Which foods are involved?

Most people with OAS react to only 1 – 2 foods, although some may develop allergy symptoms to a number of foods. There is presently no way to predict who will develop a problem to a particular food.

Pollen-induced hay fever and associated food allergies

children can continue to eat these foods if they do not cause symptoms

PollensFruit and VegetablesNutsOther foods
Tree pollens (Alder & Birch)Apple Cherry Carrot Peach Peas & Beans Pear Plum Potato Strawberry TomatoAlmonds Hazelnuts WalnutsCoriander Fennel Parsley Peanut Soyabean Sunflower
Grass pollenKiwi Melon Peas Potato TomatoPeanut
MugwoodApples Carrot Celery Melon Onion Peach Pepper TomatoBasel Dill Fennel Mustard Oregano Parsley Pepper Thyme

Are allergy tests useful?

Skin tests to pollens may be considered if there are hay fever symptoms (sneezing, itchy / runny nose, and eyes). There is often no reaction to standard skin testing solutions as the proteins (allergens) are destroyed in the process of producing the test solutions, just as they are in cooking. Skin testing using the fresh food and blood allergy tests to specific protein components of the food may support the diagnosis.

Foods can be safely tested at home by touching a little of the fresh food to the lip. If there is no tingling, itchiness or swelling then a bite may be taken, the food chewed and spat out. If the patient is allergic symptoms should occur within 15 minutes. If symptoms included swelling, wheeze or abdominal pain then test foods only after seeking medical advice.

What can be done?

Raw foods causing troublesome symptoms should be avoided.  Lightly cooked foods, e.g. dishes which include stir fried vegetables or steamed / poached fruits or vegetables are usually tolerated, but if they also cause a reaction, they should also be avoided. If symptoms are more extensive and not confined to the mouth, specialist advice should be sought.

Symptoms usually respond to rinsing the mouth and then taking a dose of antihistamine. As anaphylaxis (severe allergic reaction) is unlikely, injectable adrenaline devices are not usually necessary.

If hay fever symptoms are particularly troublesome and not controlled with standard medication, further medical advice should be sought as other treatments might be considered.