Introduction
Symptoms are usually local and immediate.
Symptoms
- Tingling or itching in the mouth
- Burning sensation on the lips, tongue or palate
- Mild swelling of the lips, tongue or throat
- Itchy throat
- Rarely: difficulty swallowing
Causes
- Pollen sensitisation (birch, grasses, ragweed…)
- Cross-reaction between pollens and raw foods
- Heat-labile proteins (destroyed by cooking)
- Atopic background (allergic rhinitis, asthma, eczema)
- Apple, pear, peach, apricot, cherry
- Kiwi, banana
- Carrot, celery
- Hazelnut, almond
- Raw tomato
Diagnosis
- Detailed history (known pollen allergies, trigger foods)
- Immediate timing of symptoms
- Skin prick tests with pollens and raw foods
- Specific IgE testing if needed
Treatments
- Targeted avoidance of the culprit foods when raw
- Cooked or peeled foods can often be eaten
- Antihistamines if symptoms are bothersome
- Treatment of associated allergic rhinitis
- Adrenaline prescribed only in rare severe cases
- when raw
Management
Identify cross-reactions precisely
Reassure patients that the condition is often benign
Avoid unnecessary food restrictions
Adjust the seasonal management of respiratory allergies