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Pollen Allergy and Food Sensitivity: The Oral Allergy Syndrome and Food Intolerance
Oral allergy syndrome (OAS) is a well recognized but little known condition. It is characterized by a burning sensation or mouth pain and swelling when you eat specific foods that cross-react to 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 mite or latex. There are common groups of foods that cluster with certain nasal allergies. For example, ragweed allergy usually causes an oral or intestinal reaction after eating melons or bananas, but usually not other foods. Birch tree pollen is often associated with reactions to numerous foods such as latex allergy. The explanation for these reactions include similarities in protein structures as well as some chemicals in the food.
Although this reaction is well documented in the allergy literature, it is not commonly recognized or diagnosed by most doctors, including some allergy specialists and many gastroenterologists. Several allergy websites include lists of the common foods associated with certain pollens, dust mites or latex. However, a comprehensive list that is easy to read or interpret can be difficult to find. Also the names of some pollens or the common connections between a group of pollens and a group of foods can be confusing.
In its classic form, OAS should be easy to recognize. After eating a food associated with a pollen to which you are allergic, you experience near-instant burning sensations in your mouth or throat with or without swelling. However, it is generally recognized that symptoms in medicine often do not occur in the “classic” or typical way in a specific person. Put another way, doctors are taught “patients don’t read the textbooks”. Therefore, you may experience variations of the reaction, such as swelling or tightening of the throat, burning when swallowing, a lump in the throat or a feeling of difficulty swallowing, but do not make the connection with what you ate or what you happen
You or your doctor may misinterpret your symptoms. Often people just assume it happened because they had a piece of food that was poorly chewed, swallowed too hard, or eaten or drunk while they were too hot or cold. It is usually assumed that an esophageal (swallowing) disorder, especially acid reflux with a hiatal hernia, is the cause. Acid reflux can cause an esophageal constriction called a stricture or ring that can result in a food sticking sensation, but this is usually associated with heartburn symptoms or food sticking which then requires an upper endoscopy or scope exam. Other times, especially when it occurs in an elderly person, a neurological condition such as stroke or Parkinson’s disease is to blame. Sometimes doctors decide that your symptoms are due to a nervous reaction or neurosis that was historically called globus hystericus. The hystericus part of the term is usually dropped these days to the shorter term globus or globus sensation, mainly because it has not been proven to be due to a psychiatric problem. However, globus may be the diagnosis if your complaint is that you feel a lump in your throat and an ‘evaluation’ doesn’t seem to turn up anything, even if OAS was not considered or ruled out.
An unusual condition more recently recognized in the field of gastroenterology (diseases of the stomach and intestines) that may be related to or 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 teenage boys and young men who present with food sticking episodes without heartburn or acid reflux symptoms, it is associated with a strange appearance of the esophagus on endoscopy (illuminated scope examination of the upper gastrointestinal tract). What the doctor sees the scope of is that the esophagus looks like a cat’s esophagus. That is, it looks like it has rings (cats have cartilage rings in their esophagus, we don’t) and this is referred to as “ringed esophagus” or felinization of the esophagus. On biopsy of such a ringed or felinized esophagus (which is also often narrowed as a result of the food sticking) microscopic signs of allergy are noticed. The lining shows numerous eosinophils, a reddish pink appearing white blood cells, characteristic of allergic conditions. These eosinophils release chemicals such as histamine that trigger swelling, pain and tissue damage.
Food allergies are often found in EE, although sometimes the search for a food allergy by traditional skin tests or IgE blood tests is negative. Treatment is avoidance of known food allergens and inhaled steroid nasal sprays designed for use in the nose for nasal allergies. Although not yet specifically proven, eosinophilic esophagitis (EE) may be a variant of OAS.
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 a cow’s milk protein allergy. It presents as colic-type abdominal pain, diarrhea, weight loss and bloody diarrhea in a baby on cow’s milk formula or sometimes in breastfed children whose mother drinks a lot of cow’s milk.
Allergic gastroenteritis occurs in any age group that typically presents as abdominal pain, with or without intestinal blockage or perforation; diarrhea; anemia; weight loss; and microscopic bleeding in the intestinal tract also known as occult blood in the stool. Such bleeding can only be detected by special chemical tests for stool known as fecal occult blood tests (FOBT) or stool guaiac tests.
At least some people with food intolerances who don’t respond to limited diet diary information, blood tests, biopsies, or allergy testing may have some form of OAS. In other words, the presence of known pollen or latex allergies may predispose to reactions to foods known to react with allergies noted in OAS. However, instead of classic oral allergy syndrome symptoms, other stomach and intestinal symptoms or even non-gastrointestinal symptoms may result.
Support for this concept can be found in detailed screening of individuals for food intolerance. Those with known pollen or latex allergies, any known food allergy or intolerance, including gluten intolerance (celiac disease) and casein intolerance, are asked to complete a series of symptom assessments and severity rating scales, followed by a strict elimination diet. This is followed by reassessment of response of symptoms, while foods are reintroduced one at a time while checking for recurrence.
This type of analysis is the basis for the Neopaleo-specific diet. In the near future, online symptom assessments and food intolerance screening along with dietary recommendations specific to individuals will be available at www.thefooddoc.com. An online diet symptom diary will also be available. A simplified table illustrating the common foods that may cross-react with the broad categories of pollen allergen and latex allergy is available. Food intolerances are increasingly being recognized as a common cause of illness and symptoms. Individualized specific dietary recommendations and elimination diet trials can be helpful in discovering any possible links to what you eat and how you feel.
copyright 2006 The Food Doc, LLC. All rights reserved.
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