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Pollen Allergy and Food Sensitivity: The Oral Allergy Syndrome and Food Intolerance
Oral allergy syndrome (OAS) is a well-known but little-known condition. It is characterized by a burning sensation or mouth pain and swelling when eating specific foods that cross-react to the pollens to which you are allergic. Interestingly, the specific foods that cause this reaction are well established to cross-react with certain trees, grasses or weed pollens, house dust mites, or latex. There are common food groups that cluster with certain nasal allergies. For example, ragweed allergy often causes an oral or intestinal reaction after eating melons or bananas, but usually not other foods. Birch pollen is often associated with reactions to numerous foods, such as latex allergy. The explanation for these reactions includes similarities in protein structures as well as some food chemicals.
Although this reaction is well documented in the allergy literature, it is not routinely recognized or diagnosed by most physicians, including some allergists and many gastroenterologists. Several allergy websites include lists of 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 links between a pollen group and a food group can be confusing.
In its classic form 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 often recognized that often in medicine, symptoms do not occur in a “classic” or typical way in a specific person. In other words it teaches doctors “patients don’t read textbooks”. Therefore, you may experience variations of the reaction, such as swelling or stiffness of the throat, burning when swallowing, a lump in the throat, or a feeling of difficulty swallowing, but not make the connection with what you ate or what is happening to you.
You or your doctor may misinterpret your symptoms. Often, people just assume it happened because they were having a choking attack on food that was chewed poorly, swallowed too quickly, or eaten or drunk when it was too hot or cold. An esophageal (swallowing tube) disorder, especially acid reflux with a hiatal hernia, is commonly assumed to be the cause. Acid reflux can cause an esophageal narrowing called a stricture or ring that can result in a feeling of food sticking, but this is often associated with symptoms of heartburn or stuck food, leading to an upper endoscopy or scope exam. Other times, especially if it occurs in an elderly person, it is blamed on a neurological condition such as a stroke or Parkinson’s disease. Sometimes doctors decide that your symptoms are due to a nervous reaction or neurosis that was historically called globus hystericus. The hysterical part of the term often falls these days to the feeling of globus or short-term globus, especially since it is not proven to be due to a psychiatric problem. However, globus may be the diagnosis arrived at if your complaint is that you feel a lump in your throat and an “evaluation” seems to show nothing even though OAS has not been considered or ruled out.
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 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 adolescents and young adults who had episodes of food sticking without symptoms of heartburn or acid reflux, it is associated with a strange appearance of the esophagus on endoscopy (illuminated scope examination of the upper gastrointestinal tract). What the doctor doing the endoscope sees is that the esophagus resembles 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 called “ringed esophagus” or felinization of the esophagus. Microscopic signs of allergy are seen on biopsy of such a ringed or felinized esophagus (which also often narrows and causes food to stick). The coating shows numerous eosinophils, a white blood cell with a reddish-pink appearance, characteristic of allergic diseases. These eosinophils release chemicals such as histamine that cause swelling, pain and tissue damage.
Food allergies often present in EE, although the search for a food allergy using traditional skin or IgE blood tests is sometimes negative. Treatment consists of avoiding known food allergens and swallowed nasal steroid sprays that are designed for use in the nose for nasal allergies. Although not yet specifically proven, eosinophilic esophagitis (EE) may be a variant of OSA.
There are also eosinophilic gastroenteritis and eosinophilic or allergic colitis that can be diagnosed by biopsies of the stomach, small intestine and colon respectively. Allergic colitis is often seen in babies who are allergic to cow’s milk protein. It presents as colicky abdominal pain, diarrhea, weight loss, and bloody diarrhea in an infant on cow’s milk formula or sometimes in breastfed babies whose mother is drinking 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; weight loss; and microscopic bleeding in the intestinal tract also known as occult blood in the stool. This bleeding can only be detected by special chemical tests in the stool known as fecal occult blood tests (FOBTs) or stool guaiac tests.
At least some people with food intolerances that don’t make sense on limited information from a diet diary, blood tests, biopsies, or allergy testing, may have a form of OAS. In other words, the presence of known pollen or latex allergies may be predisposing to reactions to foods known to cross-react with the allergies seen in OAS. However, instead of the classic symptoms of the 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 examination 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, should complete a series of symptom assessments and severity rating scales followed by a diet of strict removal. This is followed by re-evaluation of symptom response while reintroducing foods one at a time while monitoring for recurrence.
This type of analysis is the basis of the Specific Neopaleo Diet. In the near future, online symptom assessments and food intolerance screening along with specific dietary recommendations for individuals will be available at www.thefooddoc.com. An online diet symptom diary will also be available. A simplified table is available that illustrates common foods that may cross-react with the broad categories of pollen allergens and latex allergy. Food intolerances are more commonly recognized as a common cause of illness and symptoms. Individualized specific diet recommendations and elimination diet trials can be most helpful in uncovering any possible links to what you’re eating and how you feel.
Copyright 2006 The Food Doc, LLC. All rights reserved.
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