Pollen allergy and food sensitivity: oral allergic syndrome and food intolerance

Oral Allergic Syndrome (OAS) is a well known but little known condition. It is characterized by a burning sensation or pain in the mouth and swelling when eating specific foods that pass through react to the pollens to which you are allergic. Interestingly, the specific foods that cause this reaction are well established for cross-reacting with certain trees, weeds or pollen from weeds, house dust mites or latex. There are common food groups that group together with some nasal allergies. For example, ragweed allergy commonly causes an oral or intestinal reaction after eating melons or bananas but usually not other foods. Birch pollen is commonly associated with reactions to numerous foods, such as latex allergy. The explanation for these reactions includes similarities in protein structures and some chemicals in 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 stomach specialists. Various allergy websites include lists of common foods associated with certain pollen, dust mites or latex. However, a complete 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, OAS should be easy to recognize. After eating a food associated with a pollen you are allergic to, you experience an immediate burning sensation in the mouth or throat with or without swelling. However, it is commonly recognized that often in medicine, symptoms do not occur in a “classic” or typical way in a specific person. Formulated in another way in which doctors are taught “patients don’t read textbooks”. Therefore, you may experience changes in the reaction such as swelling or stiffening of the throat, burning when swallowing, a lump in the throat or a sense of difficulty swallowing, but may not establish a connection with what you have eaten or what is happening to you.

You or your doctor can misinterpret your symptoms. Often people assume that it happened because they had a suffocating spell on food that was poorly chewed, ingested too quickly or eaten or drunk while it was too hot or cold. Commonly, it is assumed that the cause is an esophageal disorder (swallowing tube), in particular acid reflux with a hiatal hernia. Acid reflux can cause an esophageal constriction called a stenosis or ring which can cause a feeling of attachment of the food, but this is usually associated with heartburn symptoms or food that freezes and therefore requires a higher endoscopy or examination. of flow. At other times, especially if it occurs in an elderly person, a neurological condition such as stroke or Parkinson’s disease is attributed. Sometimes doctors decide that the symptoms are due to a nervous reaction or neurosis that was historically called globus hystericus. The hysterical portion of the term is usually dropped these days to the feeling of short-term globus or globus, mainly because it is not proven that it is due to a psychiatric problem. However, globus may be the diagnosis achieved if your complaint is that you feel a lump in the throat and an assessment & # 39; it appears to show nothing even if OAS has not been considered or excluded.

An unusual condition that has recently been recognized in the field of gastroenterology (diseases of the stomach and intestines) that may be related or a variant of the 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 people who presented episodes of food attachment without heartburn or acid reflux symptoms, it is associated with a strange appearance of the esophagus under endoscopy (examination of illuminated flow rate of the upper gastrointestinal tract). What the doctor is doing is that the esophagus resembles a cat’s esophagus. That is, it appears to have rings (cats have cartilage rings in their esophagus, no) and this is referred to as “ringed esophagus” or felinization of the esophagus. Microscopic signs of allergy are noted on the biopsy of such an apparent ringed or felinized esophagus (which is also often narrowed with consequent attachment of food). The lining shows numerous eosinophils, a reddish pink that appears white blood cell, characteristic of allergic conditions. These eosinophils release chemicals such as histamine that trigger swelling, pain and tissue damage.

Food allergies are commonly present in the EE although the search for a food allergy through traditional skin tests or IgE blood tests is sometimes negative. Treatment consists of avoiding known food allergens and ingested nasal steroid sprays designed for use in the nose for nasal allergies. Although not yet specifically demonstrated, eosinophilic esophagitis (EE) can be a variant of the OAS.

There are also eosinophilic gastroenteritis and eosinophilic or allergic colitis which can be diagnosed by biopsies of the stomach, small intestine and colon respectively. Allergic colitis is typically found in infants with cow’s milk protein allergy. It presents as a type of abdominal pain colic, diarrhea, weight loss and bloody diarrhea in a child with cow’s formula or sometimes breastfed infants whose mom is drinking 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 is only detectable by special chemical stool tests known as stool occult blood tests (FOBT) or stool trouble tests.

At least some people with food intolerance who don’t make sense about limited diet diary information, blood tests, biopsies or allergy tests, may have a form of OAS. In other words, the presence of known allergies to pollen or latex can predispose to reactions to foods known to cross-react with allergies detected in the OAS. However, instead of the classic symptoms of oral allergy syndrome, other stomach and intestinal symptoms or even non-gastrointestinal symptoms may occur.

The support of this concept can be found in the detailed screening of individuals for food intolerance. Those with known allergies to pollen or latex, to 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 followed by a strict elimination diet. This is followed by a re-evaluation of the response of symptoms while reintroducing foods one at a time while monitoring recurrence.

This type of analysis is the basis of the specific Neopaleo diet. Online symptom assessments and food intolerance screening will be available in the near future along with specific dietary recommendations for individuals at www.thefooddoc.com . An online dietary symptom diary will also be available. A simplified table is available that illustrates common foods that can cross-react with the broad categories of pollen allergens and latex allergy. Food intolerances are most commonly recognized as a common cause of disease and symptoms. Personalized specific diet tips and elimination diet tests can be more helpful in finding out any links to what you are eating and how you feel.

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