food allergy called food
pollen syndrome or oral allergy syndrome (OAS). OAS is seen in 30% to 40% of children who
have allergic rhinitis. Certain foods contain proteins that are similar to airborne allergens, and
patients who are allergic to an aeroallergen are at risk of developing reactions to the crossreacting
food protein .
In most cases, symptoms are isolated to the oropharynx, where food comes in contact with
a mucosal surface, and include lip, tongue, and oral mucosal pruritus; tingling; and occasionally
angioedema. Interestingly, because these food proteins are heat-labile, cooking the food (eg,
apple pie) negates its antigenic properties. Although symptoms typically are mild, there are
reports of severe reactions. In one recent review involving 1,361 patients who had OAS, 8.7%
experienced systemic symptoms outside the gastrointestinal tract, 3% experienced symptoms
other than oral symptoms, and 1.7% experienced anaphylactic shock.
Because OAS is relatively specific to particular cross-reacting food(s), patients do not need
to avoid other fruits or vegetables to which they have not experienced reactions. Avoidance of
unrelated foods (eg, milk, eggs) is not recommended unless the history suggests a previous
reaction. The decision to avoid causative foods can be based on the severity of reaction.
Referral to an allergist typically is reserved for situations when skin testing is desired or if the
child has experienced systemic symptoms. Skin testing is performed using a commercial extract
or the fresh fruit or vegetable. When using fresh food, the sensitivity of skin testing with a
history of reproducible reactions is close to 90%, while the negative predictive value is more
than 90%. The skin prick device is pressed into the food and then pressed in the skin (so-called
"prick-prick" skin test).
Other immunoglobulin (Ig) E food reactions include atopic dermatitis, eosinophilic esophagitis,
and specific food allergy. In the United States, 85% of specific food allergies are due to egg,
milk, wheat, soy, peanuts, tree nuts, fish, and shellfish. Most children who have IgE food
allergies react to only one or two causative foods, although children who have tree nut allergy,
atopic dermatitis, and eosinophilic esophagitis often have IgE-mediated reactions to multiple
foods
pollen syndrome or oral allergy syndrome (OAS). OAS is seen in 30% to 40% of children who
have allergic rhinitis. Certain foods contain proteins that are similar to airborne allergens, and
patients who are allergic to an aeroallergen are at risk of developing reactions to the crossreacting
food protein .
In most cases, symptoms are isolated to the oropharynx, where food comes in contact with
a mucosal surface, and include lip, tongue, and oral mucosal pruritus; tingling; and occasionally
angioedema. Interestingly, because these food proteins are heat-labile, cooking the food (eg,
apple pie) negates its antigenic properties. Although symptoms typically are mild, there are
reports of severe reactions. In one recent review involving 1,361 patients who had OAS, 8.7%
experienced systemic symptoms outside the gastrointestinal tract, 3% experienced symptoms
other than oral symptoms, and 1.7% experienced anaphylactic shock.
Because OAS is relatively specific to particular cross-reacting food(s), patients do not need
to avoid other fruits or vegetables to which they have not experienced reactions. Avoidance of
unrelated foods (eg, milk, eggs) is not recommended unless the history suggests a previous
reaction. The decision to avoid causative foods can be based on the severity of reaction.
Referral to an allergist typically is reserved for situations when skin testing is desired or if the
child has experienced systemic symptoms. Skin testing is performed using a commercial extract
or the fresh fruit or vegetable. When using fresh food, the sensitivity of skin testing with a
history of reproducible reactions is close to 90%, while the negative predictive value is more
than 90%. The skin prick device is pressed into the food and then pressed in the skin (so-called
"prick-prick" skin test).
Other immunoglobulin (Ig) E food reactions include atopic dermatitis, eosinophilic esophagitis,
and specific food allergy. In the United States, 85% of specific food allergies are due to egg,
milk, wheat, soy, peanuts, tree nuts, fish, and shellfish. Most children who have IgE food
allergies react to only one or two causative foods, although children who have tree nut allergy,
atopic dermatitis, and eosinophilic esophagitis often have IgE-mediated reactions to multiple
foods
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