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Month: February 2021

Oral Allergy Syndrome

Oral allergy syndrome (also known as pollen food allergy syndrome) affects approximately one third of people with seasonal allergic rhinitis (i.e., hay fever).

The symptoms of seasonal allergic rhinitis may include nasal congestion, runny nose, itchy nose, sneezing, itchy eyes, watery eyes, and/or red eyes during tree, grass and/or weed pollinating seasons. In our geographical area, the trees and grasses pollinate mostly in Spring and early Summer and the weeds, especially ragweed, pollinate in the Fall. It is common for these individuals to experience the symptoms during those seasons. The underlying mechanism of oral allergy syndrome is a genetically determined “sensitization” of the immune system to various pollens and subsequent “reactions” when exposed to these pollens. The immune system considers these pollens as “foreign” and thus reacts against them resulting in the annoying symptoms of hay fever.

A number of individuals with pollen allergies will experience a situation where they will develop itching of the lips, gums, tongue, palate and/or throat after eating raw fresh fruits and/or vegetables. This condition is termed pollen food allergy syndrome or oral allergy syndrome. This occurs because of the similarity of the protein antigens in the pollen and the protein antigens of the fresh fruits and/or vegetables. The immune system which is previously sensitized to pollen will also react to the similarly structured proteins in the fruits and/or vegetables. This phenomenon is termed cross-reactivity. Thus when an individual who has a pollen allergy eats certain raw fresh fruits and/or vegetables, the person’s immune system “thinks” that they are being exposed to pollen proteins when in fact they are being exposed to fruit/vegetable proteins that have a very similar structure to the pollen proteins. The body in turn reacts to the fruit/vegetable proteins in a similar fashion as a typical allergic reaction but is usually more localized to where the food makes direct contact, such as the lips, gums, tongue, palate, and/or throat.

This condition tends to be more prominent and bothersome in the Spring months when we are exposed to higher levels of pollen. Specific tree pollen sensitivity cross-reacts with specific fruit/vegetable proteins due to the closeness in the amino acid sequences. For example, patients with birch pollen sensitivity tend to react more commonly with fresh raw pitted fruits (e.g., peaches, apricots, plums), apples, and/or carrots. Birch pollen allergy can also cross-react with peanuts and/or tree nuts.

Individuals with allergies to grasses may have a reaction to peaches, celery, tomatoes, melons (e.g., cantaloupe, watermelon, honeydew), and oranges. Ragweed pollen sensitivity in the Fall usually cross-reacts with melons, bananas, zucchini, and/or cucumbers.

The symptoms usually begin within a few minutes after eating the raw fresh fruits and/or vegetables and generally subside within a few hours. The symptoms of oral allergy syndrome typically include itching of the lips, mouth, and/or throat as mentioned above. The symptoms are usually mild, but in rare cases, can cause throat swelling and/or difficulty in swallowing. Such severe reactions are more likely to happen with peanuts and/or tree nuts. It is important to note that some people with itchy lips, mouth and/or throat after eating a raw fresh specific fruit and/or vegetable may in fact have a true food allergy to a specific fruit and/or vegetable and not have oral allergy syndrome. These truly food-allergic individuals generally will have the same or similar symptoms even when eating the fruit/vegetable cooked, unlike patients with oral allergy syndrome who can generally tolerate the cooked fruit/vegetable without symptoms.

The diagnosis is established mostly by a history of oral pruritus (i.e., itching) and irritation in patients who have previously tested positive to pollen and are symptomatic during the respective pollen seasons.

The treatment of oral allergy syndrome involves avoiding the offending raw fresh fruits/vegetables. Peeling the skin before eating and/or cooking (i.e., baking, microwaving) before eating may decrease the severity of the symptoms, as heat denatures the protein and reduces its allergenic potential.

Below is a chart from the American Academy of Allergy, Asthma & Immunology of different types of pollens and the corresponding foods that may cause oral allergy syndrome:

SPRING               SUMMER                LATE SUMMER – FALL               FALL

Pitted Fruit
Apple                         X
Apricot                      X
Cherry                       X
Peach                         X                               X
Pear                            X
Plum                          X

Cantaloupe                                                                                                 X
Honeydew                                                                                                   X
Watermelon                                                X                                             X

Banana                                                                                                         X
Kiwi                            X
Orange                                                         X
Tomato                                                        X

Bell pepper                                                                                                                                           X
Broccoli                                                                                                                                                 X
Cabbage                                                                                                                                                X
Carrot                         X
Cauliflower                                                                                                                                           X
Celery                          X
Chard                                                                                                                                                     X
Cucumber                                                                                                    X
Garlic                                                                                                                                                     X
Onion                                                                                                                                                     X
Parsley                        X                                                                                                                        X
White potato                                                X                                           X
Zucchini                                                                                                      X

Aniseed                                                                                                                                                  X
Caraway                                                                                                                                                 X
Coriander                                                                                                                                              X
Fennel                                                                                                                                                    X
Black pepper                                                                                                                                         X

Peanut                       X
Soybean                    X

Almond                     X
Hazelnut                   X

*Mouth or throat itching from peanut, soybean, almonds, and hazelnuts may also be an initial
manifestation of a more serious food allergy with the potential for anaphylaxis. See an
allergist/immunologist if such symptoms are noted.

© 2019 American Academy of Allergy, Asthma & Immunology.


The board certified allergists at Black & Kletz Allergy have been diagnosing and treating oral allergy syndrome and food allergies for more than 50 years. We treat both pediatric and adult patients. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. To schedule an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from an itchy mouth or throat after eating fruits and/or vegetables or you have other food allergy symptoms, we are here to help diagnose and treat your food allergy. The allergists at Black & Kletz Allergy are happy to help you with any allergic condition that you may have as we are dedicated to providing you with the highest quality allergy care in a relaxed, caring, and professional environment.

Bug Bite and Sting Allergies and Reactions

Bug bites are certainly very common. Almost everyone has been bitten by a bug in their lifetime and almost everyone has had at least a minor local reaction to the bug bite. In some instances, an individual may have a more severe reaction that is not an allergic reaction but it can mimic an allergic reaction. In other cases, however, an individual may actually have a true allergic reaction. In order to differentiate between an allergic reaction and a non-allergic reaction, a consultation with a board certified allergist may be necessary.

There are 4 basic types of reactions that may occur from a bug bite. They are classified as follows:

  • Local irritant reaction
  • Allergic reaction
  • Toxic reaction
  • Serum sickness reaction

The first two reactions are by far the most common. Overwhelmingly, a local irritant reaction is the most common of the four reactions. The symptoms of a local irritant reaction may include local redness, pain, itching, and/or swelling. It is generally self-limited and usually resolves on its own without treatment. If treatment is desired, one can use over-the-counter (OTC) antihistamines or OTC topical corticosteroids to treat this type of reaction.

An allergic reaction to a bug bite is not very common, however they do occur. Symptoms can mimic a local irritant reaction but the reaction may be more severe. Additional symptoms may include blistering of the skin, generalized itching of the skin, throat closing sensation, hives (i.e., urticaria), warm feeling, increased heart rate, drop in blood pressure, lightheadedness, dizziness, fainting, wheezing, and/or shortness of breath. It is more common to have true allergic reactions to the venom of stinging insects such as honey bees, yellow jackets, hornets, wasps, and fire ants. The treatment of an allergic reaction to a bug bite is aimed at treating and controlling the symptoms. OTC antihistamines and/or OTC topical corticosteroids are generally adequate enough in to treat this condition. Occasionally, prescription medications such as more potent antihistamines, histamine2-blockers (e.g., Pepcid, Tagamet), leukotriene antagonists (e.g., Singulair), and/or oral corticosteroids may be necessary in order to treat the allergic reaction. Rarely, the use of asthma inhalers (e.g., albuterol) may be necessary in individuals who develop symptoms of asthma which may include shortness of breath, chest tightness, coughing, and/or wheezing. An individual who has had a systemic allergic reaction to a stinging insect (e.g., honey bees, yellow jackets, hornets, wasps, fire ants) should be skin tested by a board certified allergist. If that individual reacts to the venom skin testing, it is strongly recommended that this person go on a course of venom immunotherapy (i.e., allergy shots for stinging insects) as they are very efficacious in preventing anaphylaxis. It is very important that such an individual carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) in case they are stung, as insect sting allergies can be fatal. If the epinephrine device is used, it is imperative that the patient go immediately to the closest emergency room. It also should be known that honey bees leave their stingers in their victims and if stung by a honey bee, never pull out the stinger. Instead, one should scrape off the stinger. Pulling out a stinger may cause the pinching of the venom sac, which may in turn cause the venom sac to introduce more venom into the affected person.

A toxic reaction to bug bites or stings occurs when a bug introduces various substances into an individual such as a toxin or venom. Assuming there is not an allergic reaction to the venom, as mentioned above, the venom may act as a poison and cause direct harm to the tissues of the individual. Toxic reactions can occur from one sting or bite from a highly toxic insect or spider, or from multiple stings or bites from insects or spiders not normally considered poisonous. The symptoms of a toxic reaction may include nausea, vomiting, fever, fainting, lightheadedness, pain or redness or swelling at the site of the sting or bite, headache, muscle spasms, seizures, and/or shock. It is even potentially fatal. The treatment of a toxic reaction to bug bites or stings is primarily based on supportive care. Antihistamines and corticosteroids may be used. In addition, standard wound care precautions and treatment should be utilized as it is not uncommon for the site of the bite or sting to become infected. Antibiotics should be used when needed.

The fourth type of reaction that can occur due to a bug bite or sting is serum sickness. Serum sickness can occur as a result of a reaction towards the venom of either insect stings or spider bites. The symptoms generally manifest hours to days after the sting or bite. The classic symptoms may include fever, joint pain, itching, rash or hives, and/or fatigue. Other symptoms may include swollen lymph nodes, enlarged spleen, drop in blood pressure, and/or shock. In addition to venom, medications (e.g., penicillins, cephalosporins, allopurinol), blood products (e.g., transfusions), and antitoxins (e.g., antivenom) have been known to rarely cause serum sickness. The treatment of serum sickness usually entails antihistamines, corticosteroid creams, and/or nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen). In severe cases, oral corticosteroids are often utilized.

If you or someone you know have experienced an insect sting or bug bite and had more than a minor reaction, the board certified allergists at Black & Kletz Allergy are here to help. We diagnose and treat both adults and children in all facets of allergy, asthma, and immunology. We often see patients for consultations about insect stings and bug bites. Our allergists will perform venom testing on those individuals who meet the requirement for testing. In addition, a specific plan for future stings and/or bites will be discussed with the patient in order to reduce the individual’s fear and confusion regarding reactions to the bite and/or sting. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, caring, and professional environment as we have done for over 50 years.