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Oral allergy syndrome: Pollen allergy & mouth discomfort

February 11, 2004


Dear Allergy Nurse

A friend of mine mentioned that she has problems with certain foods causing burning in her mouth and throat. She also has allergies to pollens that cause runny nose and watery eyes. Her doctor said the two are related. Is this true? I have allergies to pollens also, but I've never had any problem with foods causing my mouth to burn. -- C.R.F., Arkansas

Yes, there is a cross-reactivity between some pollens and foods. This can cause burning sensations in the mouth and throat, and in some cases can cause hives and dangerous swelling of the throat and windpipe.

Just this week I spoke with a patient who is allergic to pollens. He told me that he had experienced sensations of burning in his mouth after eating certain fruits a few times. The last time, about a year ago, his windpipe started closing up so he could barely breathe. He has not eaten these fruits since then, a very wise decision.

This is known as "oral allergy syndrome." It is most commonly associated with allergy to birch pollen, but can occur with other pollens such as ragweed, mugwort sage, plantain, and grasses. Fruits and nuts are the foods most commonly implicated, but other foods can cause the symptoms as well.

Most authorities I've consulted say it is not necessary to avoid all foods associated with a given pollen allergy. They recommend avoiding only the foods which cause symptoms. Often it is the raw food that causes the oral allergy symptoms, and many people find they can tolerate these foods without symptoms when the foods are well cooked.

The exception is nuts, which usually cause symptoms whether raw or cooked. Many authorities feel that nuts pose a higher risk and should always be avoided if there is any indication you are allergic to them. Always consult your physician before eating any food which has caused symptoms, or to which allergy testing has indicated you are allergic.

Here is a list of foods that have been reported to cross-react with pollen as well as latex allergy:

Allergy: May be Associated with a reaction to:
Birch Apple, carrot, cherry, pear, peach, plum, prune, nectarine, apricot, kiwi fruit, honey, potato, tomato, spinach, celery, parsnips, green pepper, lentils, peas, beans, peanut, parsley, anise, dill, fennel, caraway, coriander, cumin, wheat, buckwheat, hazelnut, walnut, almond
Mugwort Sage Celery, carrot, spices, melon, watermelon, apple, chamomile, hazelnut, anise, fennel, coriander, cumin.
Grass Potato, melon, tomato, watermelon, orange, cherry, peanut, kiwi
Ragweed Watermelon, cantaloupe, honeydew, chamomile, honey, banana, sunflower seeds, zucchini, cucumber
Latex Avocado, potato, banana, tomato, chestnut, kiwi fruit, herbs, carrot
Peanuts Legumes, grass, wheat, corn
Plantain Melon

Oral allergy syndrome is not the only type of food allergy. Allergies to foods can cause hives and swelling without oral sensations, and in people who are not allergic to pollens.

In addition, many patients I've tested and found allergic to pollens have not shown allergy to foods.


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References:

  1. Allergy Advisor Allergy and Intolerance Software for diagnosis and management, designed by Dr. Harris Steinman, whose research work in the field of allergy, asthma, and specifically preservatives and additives has appeared in professional publications such as Journal of Allergy and Clinical Immunology. Dr. Steinman is also an advisor to the Department of Health on food legislative issues.
  2. Oral allergy syndrome Canadian Food Inspection Agency Fact Sheet, Government of Canada.
  3. Cough flow chart American Academy of Family Physicians.
  4. Oral allergy syndrome The Allergy/Asthma Information Association of Canada.