How To Tell If My Newborn Is Allergic To Formula Pollen Allergy and Food Sensitivity: The Oral Allergy Syndrome and Food Intolerance

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Pollen Allergy and Food Sensitivity: The Oral Allergy Syndrome and Food Intolerance

Oral allergy syndrome (OAS) is a well-recognized but little-known disease. It is characterized by burning or mouth pain and swelling when you eat certain foods that cross-react with the pollen you are allergic to. Interestingly, the specific foods that cause this reaction are well known to react with certain tree, grass or weed pollen, house dust mites, or latex. There are common food groups that cluster with certain nasal allergies. For example, a ragweed allergy usually causes an oral or intestinal reaction after eating melons or bananas, but usually not other foods. Birch pollen is commonly associated with reactions to many foods, as is latex allergy. Explanations for these reactions include similarities in both protein structures and chemicals found in some foods.

Although this reaction is well documented in the allergy literature, it is generally not recognized or diagnosed by most physicians, including some allergists and many gastroenterologists. Various allergy websites have 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 associations between a pollen group and a food group can cause confusion.

In its classic form, OAS should be easily recognizable. After eating a pollen-related food to which you are allergic, you will experience an almost immediate burning sensation in your mouth or throat, with or without swelling. However, it is generally accepted in medicine that symptoms do not occur “classically” or typically in a particular person. In other words, how doctors are taught “patients don’t read textbooks”. Therefore, you may experience variations in the response, such as throat swelling or tightness, a burning sensation when swallowing, a lump in your throat, or difficulty swallowing, but you cannot connect to what you are driving or what is happening to you.

You or your doctor may misinterpret your symptoms. Often, people think it happened because they had a choking attack on food that was chewed poorly, swallowed too quickly, or eaten or drunk that was too hot or cold. A disorder of the esophagus (swallowing tube), especially acid reflux with a hiatal hernia, is usually assumed to be the cause. Acid reflux can cause a narrowing of the esophagus called a stricture or ring, which can cause food to feel stuck, but is usually associated with heartburn symptoms or food retention that requires an upper endoscopy or scope study. Other times, especially when it occurs in the elderly, a neurological condition such as stroke or Parkinson’s disease is blamed. Sometimes doctors decide that your symptoms are due to a nervous reaction or neurosis, historically called globus hystericus. The hysterical part of the term is now usually relegated to the shorter term globus or globus sensation, especially since it has not been proven to be due to a psychiatric problem. However, the diagnosis may be a globe if your complaint is that you feel a lump in your throat and the “evaluation” shows nothing, even if OAS was not considered or ruled out.

Eosinophilic esophagitis (EE) or allergic esophagitis is an unusual condition recently recognized in the field of gastroenterology (diseases of the stomach and intestines) that may be associated with OAS or its variant. It was first described in children but is now known to occur in adults. Classically described in teenage boys and young men with episodes of food sticking without symptoms of heartburn or acid reflux, it is associated with a strange appearance of the esophagus on endoscopy (examination of the upper digestive tract with light). The doctor who takes the survey sees that the esophagus resembles a cat’s esophagus. This means that it has rings (cats have rings of cartilage in their esophagus, we don’t) and it is called a “ringed esophagus” or felinization of the esophagus. A biopsy of such a ringed or felinized esophagus (which is often also narrowed, resulting in food sticking) shows microscopic signs of allergy. The lining contains numerous eosinophils, the reddish-pink white blood cells characteristic of allergic conditions. These eosinophils release chemicals such as histamine that cause swelling, pain and tissue damage.

Food allergies are usually found in EE, although sometimes the search for a food allergy using traditional skin tests or IgE blood tests is negative. Treatment is avoidance of known food allergens and ingested nasal steroid sprays for use in the nose for nasal allergies. Although not yet specifically proven, eosinophilic esophagitis (EE) may be a variant of OAS.

Eosinophilic gastroenteritis and eosinophilic or allergic colitis also exist and can be diagnosed by biopsies of the stomach, small intestine, and colon, respectively. Allergic colitis usually occurs in infants with a cow’s milk protein allergy. It manifests as colic-type abdominal pain, diarrhea, weight loss, and bloody diarrhea in formula-fed infants or sometimes in breast-fed infants whose mothers drink a lot of cow’s milk.

Allergic gastroenteritis occurs in all age groups, usually presenting as abdominal pain with or without intestinal obstruction or perforation; diarrhea; anemia; weight loss; and microscopic bleeding in the intestines, also known as occult blood in the stool. This type of bleeding can only be detected by special stool chemistry tests called an occult blood test (FOBT) or stool guaiac test.

At least some people with food intolerances not limited by food 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 may predispose to reactions to foods that are known to cross-react with allergies listed in the OAS. However, instead of the classic oral allergy syndrome symptoms, other gastrointestinal symptoms or even non-gastrointestinal symptoms may occur.

Support for this concept can be found in the detailed screening of individuals for food intolerance. People with a known pollen or latex allergy, 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 rating scales, followed by a strict elimination diet. This is followed by reassessment of symptom response, reintroduction of meals one at a time, watching for recurrence.

This type of analysis is the basis of the Neopaleo specific diet. In the near future, online symptom assessments and food intolerance screenings, along with individualized dietary recommendations, will be available at www.thefooddoc.com. An online diet symptom diary is also available. A simplified chart is available to illustrate common foods that may cross-react with pollen allergens and latex allergies. Food intolerance is more commonly recognized as a common cause of illness and symptoms. Individualized specific dietary recommendations and trials of elimination diets may be more helpful in discovering possible connections between what you eat and how you feel.

Copyright 2006 The Food Doc, LLC. All rights reserved.

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