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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 burning or pain in the mouth and swelling when eating specific foods that cross the reaction to pollens that you are allergic to. Interestingly, the specific foods that cause this reaction are well established to cut certain trees, grass, or weed pollens, poultry or latex. There are common groups of food allergies and certain nasal allergies. For example, a ragweed allergy often causes an oral or intestinal reaction after eating melons or bananas but usually not other foods. Birch tree pollen is commonly associated with many food reactions such as latex allergies. An explanation for this change involves the similarity of protein structures and other chemicals in food.
Although this reaction is well documented in the allergy literature it is not commonly seen or diagnosed by many doctors including some allergists and many gastroenterologists. Different allergy sites include a list 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 iipollens or common links between the groupPollens and food groups can be confused.
In its old form the OAS should be easy to understand. After eating pollen-related foods to which you are allergic you experience an immediate burning sensation in the mouth or throat with or without swelling. However, it is understood that often in treatment, symptoms do not occur in a “classic” or normal way for a particular person. Another way doctors are taught is that “patients don’t read textbooks”. Therefore, you may experience fluctuating reactions such as throat swelling or stiffness, burning when swallowing, a lump in the throat or a feeling of difficulty swallowing but do not make a connection to what you ate or what is happening to you.
You or your doctor may misinterpret your symptoms. People usually think it happened because they had a spell from not chewing food well, swallowing too quickly, or eating or drinking while it was too hot or cold. Generally, it is thought that esophageal (swallowing tube), especially acid reflux with a hiatal hernia is the cause. Acid reflux can cause a narrowing of the esophagus called a stricture or ring that can lead to a feeling of sticking to food, but this is often associated with symptoms of heartburn or food obstruction that prompts an upper endoscopy or borderline test. Sometimes, especially if it occurs in an elderly person, a neurological condition such as a stroke or Parkinson’s disease is suspected. Sometimes doctors decide that your symptoms are caused by a nervous reaction or a neurosis called globus hystericus. The hystericus part of the name is often spent these days in the short-term globus or globus sensation especially since it is not guaranteed that it is due to a mental problem. However, a globe may be the diagnosis reached if your complaint is that you feel a lump in your throat and the ‘examination’ appears to be negative even if OAS has been ruled out or excluded.
A rare condition that has recently been recognized in the field of gastroenterology (diseases of the stomach and intestines) that may be related or different from 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. It is usually described in teenage boys and young men who have shown episodes of food attachment without heartburn or acid reflux symptoms, and is associated with an abnormal appearance of the esophagus on endoscopy (a lighted examination of the upper gastrointestinal tract). What the doctor who makes the diagram sees is that the esophagus is like a cat’s throat. That looks like it has rings (cats have rings in their esophagus, we don’t know) and this is referred to as “ringed esophagus” or felinization of the esophagus. On biopsy of the ringed or ruptured esophagus (which is often narrowed leading to food adhesions) visible signs of allergy are noted. The lining shows many eosinophils, a pinkish red from the white blood cell, a sign of allergic conditions. These eosinophils release chemicals such as histamine that cause inflammation, pain, and tissue damage.
Food allergies are often diagnosed in EE although sometimes screening for food allergies with a routine skin test or IgE blood test is negative. Treatment is known food avoidance and nasal steroid sprays intended for use in the nose for nasal allergies. Although not yet proven, eosinophilic esophagitis (EE) may be a variant of OAS.
Eosinophilic gastroenteritis and eosinophilic or allergic colitis also exist and can be diagnosed with biopsies of the stomach, small intestine and colon respectively. Allergic colitis appears in infants with cow’s milk protein. It manifests as colic-type abdominal pain, diarrhea, weight loss and bloody diarrhea in infants on cow’s milk powder or sometimes in breastfed infants whose mothers drink a lot of cow’s milk.
Allergic gastroenteritis occurs in any age group and presents as abdominal pain, with or without intestinal obstruction or perforation; diarrhea; anemia; weight loss; and minor bleeding in the intestinal tract known as occult blood in the stool. Bleeding can only be detected by a special stool chemical test known as a fecal occult blood test (FOBT) or stool guaiac test.
At least some people with food intolerances that don’t make sense based on limited diary information, blood tests, biopsies, or allergy testing, may have a form of OAS. In other words, the presence of known pollen or latex allergies can be a risk factor in reacting to foods known to share allergies observed in OAS. However, instead of the classic oral allergy syndrome, other gastrointestinal symptoms or non-gastrointestinal symptoms may occur.
Support for this view can be found in detailed observations of individuals with food intolerances. Those 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 list of symptoms and severity rating scales followed by a strict diet which ends. This is followed by re-evaluation of the symptom response while reintroducing one food at a time while monitoring for recurrence.
This type of analysis is the basis of the Neopaleo Specific Diet. In the near future an online symptom test and food intolerance test as well as personalized dietary advice will be available at www.thefooddoc.com. An online food diary will also be available. A simplified table showing common food allergies and a wide variety of pollen allergens and latex allergies is available. Food intolerance is often seen as a common cause of illness and symptoms. Special dietary recommendations and food elimination trials can be especially helpful in finding any possible links between what you eat and how you feel.
Copyright 2006 The Food Doc, LLC. All rights reserved.
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