How many of you have complained that you feel your lips or mouth tingling after eating some fruits or vegetables?
🤧If you also suffer from Hayfever, we are talking about Oral Allergy Syndrome, also known as Pollen Food Syndrome.
⚠️𝗪𝐡𝐚𝐭 𝐢𝐬 𝐢𝐭 𝐭𝐡𝐞𝐧?
This is an allergic reaction, with swelling and itchiness, affecting the mouth, 👄lips, 👅tongue, and throat only.
🔶️Usually, the symptoms are seen within a few minutes of eating certain fruits and vegetables, mainly when they are raw.
It is not common to cause swelling of the throat.
Even less common to cause anaphylaxis.
⚠️𝗪𝐡𝐲 𝐝𝐨𝐞𝐬 𝐭𝐡𝐢𝐬 𝐡𝐚𝐩𝐩𝐞𝐧?
Some proteins in foods are similar to some of the proteins found in certain pollens, so a cross-reaction might occur. That is also why it is called Pollen Food Syndrome.
⚠️𝗪𝐡𝐞𝐧 𝐜𝐚𝐧 𝐬𝐲𝐦𝐩𝐭𝐨𝐦𝐬 𝐬𝐭𝐚𝐫𝐭?
🧒For a child to suffer from hayfever, they usually need to be exposed to 2 pollen seasons.
For Oral Allergy Syndrome to develop, they need to be exposed to the food causing the reaction, many times.
This means it is not common to find it in toddlers.
⚠️𝐒𝐨 𝐢𝐭 𝐦𝐚𝐢𝐧𝐥𝐲 𝐚𝐟𝐟𝐞𝐜𝐭𝐬:
This type of symptoms are not associated only with the pollen season, this as we can find those foods available throughout the year.
Saying this, symptoms usually are higher when the pollen count is also higher.
⚠️𝗪𝐡𝐚𝐭 𝐚𝐫𝐞 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐜𝐨𝐦𝐦𝐨𝐧 𝐩𝐨𝐥𝐥𝐞𝐧𝐬 𝐰𝐞 𝐧𝐞𝐞𝐝 𝐭𝐨 𝐥𝐨𝐨𝐤 𝐟𝐨𝐫, 𝐭𝐨 𝐬𝐚𝐲 𝐭𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐜𝐨𝐧𝐧𝐞𝐜𝐭𝐢𝐨𝐧?
🔷️𝘎𝘳𝘢𝘴𝘴𝘦𝘴 (𝘢𝘴𝘴𝘰𝘤𝘪𝘢𝘵𝘪𝘰𝘯 𝘪𝘴 𝘥𝘰𝘶𝘣𝘵𝘧𝘶𝘭)
➡️Ragweed (association still unclear)
➡️Parietaria species (a member of the Urticaceae family - nettles among others)
⚠️𝗪𝐡𝐚𝐭 𝐜𝐚𝐧 𝐰𝐞 𝐝𝐨 𝐚𝐛𝐨𝐮𝐭 𝐢𝐭?
We usually suggest that parents or patients cook the fruits or vegetables that might be causing the symptoms.
➡️This is because the protein involved in this reaction is not stable to high heat, thus changing its form leading to the absence of reactions in most patients.
⚠️Caution as in the case of roasted hazelnuts and cooked celeriac, in some cases, minute amounts of the protein might still cause symptoms in highly sensitized patients.
✅There is also the possibility that immunotherapy directed at the pollen involved in the cross-reaction, might lead to a decrease of symptoms.
🔶️After having a diagnosis made (and this is one of the reasons component diagnostics are needed), a dietitian's cooperation is required, so appropriate follow-up and plan to introduce other foods that are closely related to the one initially the patient reacted to.
If your child has a reaction, the best course of action is:
- give antihistamines
- call 999 if worried
- avoid food(s) thought to be causing symptoms
- ask GP to refer to a Consultant Paediatric Allergist
The incidence of peanut allergy has been increasing significantly in developed countries.
Many reasons have been found for such growth, but so far no proper treatment has been found to deal with it.
Often, antihistamines are the first choice when there is an allergic reaction, with the occasional need to use adrenaline as well.
Most of the symptoms start in childhood and persists throughout life.
Due to this, the search for ways to deal with this specific allergy is ongoing, though not matching current needs.
As such, today, I will focus on a promising medication that might lead to a significant change in the way we deal with peanut, and possibly nut, allergy.
⚠️On a Phase 2a randomized placebo control trial, running for six weeks, a single injection of Etokimab showed that it could desensitize peanut allergic adults.
➡️Food challenges, skin prick tests and blood tests were done at day 15 and 45, after injection
➡️73% (first challenge) and 57% (second challenge) passed a food challenge with 275mg of peanut protein (versus 0% in the control group)
➡️Several immune mediators were also reduced
❗They concluded that it could potentially desensitize peanut-allergic participants and possibly reduce atopy-related adverse events.
❓I understand the first part, but what is the connection to atopy?
Let me explain.
🔸️IL33 belongs to a group of proteins (cytokines) important in cell signalling (basically part of the immune cascade).
🔸️It also belongs to a small group called alarmins, which are biomolecules that can initiate and maintain a non-infectious inflammatory response (like in allergies).
🔸️It is also known to be released or elevated when there is skin damage, like in atopic dermatitis or eczema (independently of its origin).
▶️Can you see me coming again to the top priority of maintaining the skin barrier to prevent allergy?◀️
⚠️My opinion about it:
How does it compare to the current two available oral peanut immunotherapy?
CA002 (Cambridge) and AR101 (London)
🔹️Both use an “up-dosing” programme to achieve a specific tolerable dose (1600mg for the former and 600mg for the latter).
🔹️AR101 had limitations, like participants being selected based on sensitivity to a maximum of 100 mg of peanut protein.
🔹️This does not represent the entire population with peanut allergies, half of whom have reactions to doses >100 mg.
⚠️Michael R. Perkin, Consultant Paediatric Allergist PhD, wrote that the major concern regarding this immunotherapy is that 𝐚𝐥𝐥𝐞𝐫𝐠𝐞𝐧 𝐭𝐨𝐥𝐞𝐫𝐚𝐧𝐜𝐞 𝐭𝐡𝐚𝐭 𝐢𝐬 𝐢𝐧𝐝𝐮𝐜𝐞𝐝 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐭𝐞𝐦𝐩𝐨𝐫𝐚𝐫𝐲, 𝐚𝐧𝐝 𝐥𝐨𝐬𝐭 𝐢𝐟 𝐫𝐞𝐠𝐮𝐥𝐚𝐫 𝐜𝐨𝐧𝐬𝐮𝐦𝐩𝐭𝐢𝐨𝐧 𝐜𝐞𝐚𝐬𝐞𝐬.
▶️Neither groups have attempted to establish the duration for which allergen tolerance is maintained in the absence of ongoing consumption, potentially lifelong, 𝐫𝐞𝐠𝐮𝐥𝐚𝐫 𝐜𝐨𝐧𝐬𝐮𝐦𝐩𝐭𝐢𝐨𝐧 𝐦𝐚𝐲 𝐛𝐞 𝐧𝐞𝐞𝐝𝐞𝐝 𝐭𝐨 𝐦𝐚𝐢𝐧𝐭𝐚𝐢𝐧 𝐚𝐥𝐥𝐞𝐫𝐠𝐞𝐧 𝐭𝐨𝐥𝐞𝐫𝐚𝐧𝐜𝐞.
𝐓𝐡𝐢𝐬 𝐦𝐞𝐚𝐧𝐬 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐰𝐨𝐮𝐥𝐝 𝐧𝐞𝐞𝐝 𝐭𝐨 𝐭𝐚𝐤𝐞 𝐭𝐡𝐞 𝐦𝐞𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧 𝐨𝐧 𝐚 𝐝𝐚𝐢𝐥𝐲 𝐛𝐚𝐬𝐢𝐬 𝐨𝐫 𝐭𝐡𝐞𝐫𝐞 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐫𝐞𝐯𝐞𝐫𝐬𝐚𝐥 𝐨𝐟 𝐬𝐲𝐦𝐩𝐭𝐨𝐦𝐬. 𝐀𝐧𝐝 𝐭𝐡𝐢𝐬 𝐰𝐚𝐬 𝐚𝐥𝐫𝐞𝐚𝐝𝐲 𝐩𝐫𝐨𝐯𝐞𝐧 𝐢𝐧 𝐚 𝐫𝐞𝐜𝐞𝐧𝐭 𝐬𝐭𝐮𝐝𝐲.
➡️To consider that AR101 will cost between $5000 to $10,000 for the first six months of use, and $300 to $400 per month after that.
🌞As the weather warms up, starts raining less and flowers start blooming, my clinic begins getting filled with (as Prof Warner likes to call them) itchy, sneezy, wheezy patients.
💐And this because they suffer with Allergic rhinitis, which is an inflammation of the nasal mucosa caused by an airborne allergen.
These can be either tree pollen or grass pollen.
The name Allergic Rhinitis wasn't used until the 20th Century.
Initially it was called "Summer Catarrh" as described by Dr Bostock, when an association was made with the hay season.
Due to that is was then commonly called "Hayfever", with the name persisting up to now.
The name "Allergic Rhinitis" is the true name of this pathology.
Allergic due to the reaction being made by allergens.
Rhinitis is due to the combination of two Greek words:
The main cause, aroud Spring and Summer, is Pollen.
Being it from Trees or from Grasses.
But Allergic Rhinits can also be due to other airborne allergens. Such as:
⚠️On its own, it is not life threatening.
⚠️The main problem is when associated with poorly or uncontrolled asthma.
⚠️Can also be troublesome for sufferers of Pollen Food Syndrome/Oral Allergy Syndrome.
The most common symptoms are:
🔶️Itching: Nose, eyes, ears, palate
🔶️Loss of smell
🔶️Runny and/or red eyes
✅Skin prick tests are the main source for diagnosis.
💉Blood tests can eventually be done, mainly in primary care.
❓What to do:
𝘚𝘰𝘰𝘯 𝘐'𝘭𝘭 𝘮𝘢𝘬𝘦 𝘢 𝘱𝘰𝘴𝘵 𝘰𝘯 𝘗𝘰𝘭𝘭𝘦𝘯 𝘍𝘰𝘰𝘥 𝘚𝘺𝘯𝘥𝘳𝘰𝘮𝘦 𝘢𝘯𝘥 𝘦𝘹𝘱𝘭𝘢𝘪𝘯 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴, 𝘪𝘯𝘷𝘦𝘴𝘵𝘪𝘨𝘢𝘵𝘪𝘰𝘯 𝘢𝘯𝘥 𝘵𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵.
𝘒𝘦𝘦𝘱 𝘺𝘰𝘶𝘳 𝘦𝘺𝘦𝘴 𝘱𝘦𝘦𝘭𝘦𝘥!
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.