Have you ever experienced oral itching or tingling when eating a fresh apple with the peeling on? However, eating apple sauce of a freshly baked apple pie doesn’t bother you? Have you wondered if you are allergic to apples? Do you get similar symptoms with other pitted raw fruits like peaches and cherries? If you’ve answered yes, then you could be suffering from Oral Allergy Syndrome (OAS).
As we enter a season full of baking apple pies and apple crisps, it’s important to be aware of OAS, also known as Pollen-Food Allergy Syndrome (PAS). This type of food allergy is relatively common in adults who have a pollen allergy, regardless of whether or not they have obvious hay fever symptoms from their pollen allergy. Most patients will complain of oral itching or tingling, mild swelling of the lips or mouth/, throat itching. Symptoms will occur immediately following the ingestion of certain uncooked fruits, nuts or raw vegetables. The symptoms are driven by pollen-related proteins found in the foods.
Risk factors include:
- Sensitization to tree pollens (especially birch tree)
- Higher levels of pollen-specific IgE (allergen antibody)
- Allergy to multiple pollens
- Patients with hay fever symptoms due to pollen allergy
- Living in certain areas where pollens are prevalent
In most cases, patients will only develop symptoms after eating the raw, uncooked foods. There are some patients who only react to the peel of the raw fruit or vegetable. Typically cooking or baking the raw fruits or vegetables is sufficient to alter the allergens responsible for triggering symptoms. The one notable exception is peanut and tree nuts.
Individuals with OAS typically have inhalant allergies to birch pollen, ragweed pollen and/or grass pollens. Birch tree pollen, commonly seen in the spring, shares cross-reactivity with apple, peach, pear, plum, cherry, apricot, carrot, celery, soybean, peanut, almond and hazelnut. Grass pollenss commonly seen in late spring and summer are associated with melons, orange, potato, tomato and peanuts. Ragweed pollen, seen in the fall, is associated with banana, cucumber, zucchini and melons.
If you think you may have OAS or are interested in learning more, make an appointment to speak with one of our board-certified allergist. Until then, try one of my favorite baked apple recipes from the Barefoot Contessa, Old-Fashioned Apple Crisp, which is best served a la mode. I will make this recipe multiple times each year as the weather cools off. It can be served in a large dish or individual ramekins and is a delicious treat to serve friends and the kiddos love it!