Oral allergy syndrome (OAS) is a well-recognized but poorly understood condition. It is characterized by a burning sensation or pain and swelling in the mouth when you eat specific foods that cross-react with the pollens to which you are allergic. Interestingly, the specific foods that cause this reaction are well established to cross-react with certain tree, grass or weed pollens, house dust mites, or latex. There are common groups of foods that are grouped with certain nasal allergies. For example, ragweed allergy commonly causes an oral or intestinal reaction after eating melons or bananas, but usually not other foods. Birch pollen is commonly associated with reactions to numerous foods, including latex allergy. The explanation for these reactions includes similarities in protein structures as well as some chemicals in food.

Although this reaction is well documented in the allergy literature, it is not commonly recognized or diagnosed by most physicians, including some allergists and many stomach specialists. Various allergy websites include lists of common foods associated with certain pollens, dust mites, or latex. However, a complete list that is easy to read or interpret can be difficult to find. Also, the names of some pollens or the common links between a pollen group and a food group can be confusing.

In its classic form, the OEA should be easy to recognize. After eating a food associated with a pollen to which you are allergic, you experience an almost immediate burning sensation in your mouth or throat with or without swelling. However, it is commonly recognized that often in medicine, symptoms do not occur in the “classical” or typical way in a specific person. Put another way, doctors are taught that “patients don’t read textbooks.” So you may experience variations of the reaction, such as swelling or tightness in your throat, burning when you swallow, a lump in your throat, or a feeling of difficulty swallowing, but you don’t make the connection to what you ate or what’s wrong with you. happening.

You or your doctor may misread your symptoms. Often people just assume it happened because they had a choking spell from food they chewed poorly, swallowed too quickly, or ate or drank while it was too hot or too cold. The cause is commonly assumed to be an esophageal (swallowing tube) disorder, especially acid reflux with a hiatal hernia. Acid reflux can cause an esophageal constriction called a stricture or ring which can lead to a feeling of food sticking, but this is usually associated with symptoms of heartburn or food sticking, which then prompts an upper endoscopy or endoscope examination. Other times, especially if it occurs in an older person, a neurological condition such as a stroke or Parkinson’s disease is blamed. Sometimes doctors decide that your symptoms are due to a nervous reaction or neurosis that was historically called globus hystericus. The hysterical portion of the term is generally dropped these days into the shorter term globus or globus sensation, especially since it is not proven to be due to a psychiatric problem. However, globus may be the diagnosis of choice if your complaint is a lump in your throat and an ‘assessment’ seems to turn up nothing, even if OAS was not considered or excluded.

An unusual condition that has been recognized more recently in the field of gastroenterology (diseases of the stomach and intestines) that may be related to a variant of OAS is called eosinophilic esophagitis (EE) or allergic esophagitis. It was first described in the pediatric population but is now known to occur in adults. Classically described in adolescents and young men who presented episodes of adherence to food without symptoms of heartburn or acid reflux, it is associated with an unusual appearance of the esophagus at endoscopy (light microscopic examination of the upper gastrointestinal tract). What the doctor who does the endoscope sees is that the esophagus looks like a cat’s esophagus. That is, it looks like it has rings (cats have rings of cartilage in their esophagus, we don’t) and this is known as “ringed esophagus” or felinization of the esophagus. Microscopic signs of allergy are seen on biopsy of a ring-shaped or feline-like esophagus (which is also often narrowed and causes food to stick). The lining shows numerous eosinophils, a reddish-pink white blood cell, characteristic of allergic conditions. These eosinophils release chemicals like histamine that cause inflammation, pain, and tissue damage.

Food allergies are commonly found in EE, although sometimes a search for a food allergy using traditional skin tests or IgE blood tests is negative. Treatment consists of avoiding known food allergens and ingested nasal steroid sprays that are designed to be used in the nose for nasal allergies. Although not yet specifically tested, eosinophilic esophagitis (EE) may be a variant of OAE.

Eosinophilic gastroenteritis and eosinophilic or allergic colitis also exist and can be diagnosed by biopsies of the stomach, small intestine, and colon, respectively. Allergic colitis is typically seen in infants who have an allergy to cow’s milk protein. It presents as crampy abdominal pain, diarrhea, weight loss, and bloody diarrhea in an infant who drinks cow’s milk formula or, sometimes, in infants whose mother drinks a lot of cow’s milk.

Allergic gastroenteritis occurs in any age group and typically presents as abdominal pain, with or without intestinal blockage or perforation; Diarrhea; anemia; weightloss; and microscopic bleeding in the intestinal tract also known as fecal occult blood. Such bleeding is detectable only by special chemical tests on stool known as fecal occult blood tests (FOBT) or fecal guaiac test.

At least some people with food intolerances that do not make sense of the limited information in the diet diary, blood tests, biopsies, or allergy tests, may have a form of ODS. In other words, the presence of known pollen or latex allergies may predispose to reactions to foods known to cross-react with allergies noted in OAS. However, instead of the classic symptoms of oral allergy syndrome, other stomach and intestinal symptoms or even non-gastrointestinal symptoms may occur.

Support for this concept can be found in the detailed screening of people with food intolerance. People with known pollen or latex allergies, any known food allergies or intolerances, including gluten intolerance (celiac disease) and casein intolerance, are asked to complete a series of symptom assessments and rating scales followed by a strict elimination diet. This is followed by a reassessment of symptom response while reintroducing foods one at a time while monitoring for recurrence.

This type of analysis is the basis of the Neopaleo Specific Diet. In the near future, online symptom assessments and food intolerance screening, along with individual dietary recommendations, will be available at www.thefooddoc.com. An online diet symptoms diary will also be available. A simplified table illustrating common foods that can cross-react with the broad categories of pollen and latex allergy allergens is available. Food intolerances are increasingly recognized as a common cause of illness and symptoms. Specific individualized diet recommendations and elimination diet trials may be more helpful in uncovering possible links to what you’re eating and how you’re feeling.

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