Case Study - Child Allergy and Pollen Food Syndrome

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This week I wanted to share with you Child allergy pfsall - especially those of you who couldn’t attend - some of the most informative points for GPs on paediatric allergy that were discussed in our latest CPD event. In particular I wanted to share my findings on Oral Allergy Syndrome (also known as Pollen Food Syndrome).

Dr Matt Doyle, our special guest speaker, went through a number of salient cases for GPs including the various presentation of IgE versus non-IgE mediated immune responses to triggers or allergens, the abyss of food intolerances versus allergies, the criteria to refer to a paediatric allergy specialist and the practicalities of Epipen prescribing - we were even walked through how to use one. However these very useful insights in to paediatric allergy were topped (for me) by the ins and outs of Pollen Food Syndrome (PFS), after experiencing a ‘light bulb’ moment of self-diagnosis.

For over 15 years I have noticed mild itching or swelling of part of the lips and throat after eating apples, mango, hazelnuts and sometimes almonds. It has never greatly affected me so it had never occurred to me that this might have been a result of a medical condition.

On further discussion and reading, it turns out that this is fairly common. Oral Allergy Syndrome (OAS), also known PFS food allergyas Pollen Food Syndrome (PFS), usually occurs in people who are allergic to pollen from trees, grasses or weeds. It has been shown that pollens from trees, grasses and weeds contain proteins of similar structure to those present in many different fruits, vegetables, nuts and even spices. Fresh fruit, raw vegetables and raw nuts are common causes of PFS. Some people are affected by only one or two foods and others can react to a wide range. Usually this will affect those who suffer from hayfever – although it can occur in non-sufferers. The most common foods involved are usually apples, peaches, kiwis, hazelnuts and almonds, but just about any fruit vegetable or nut can be involved. Fortunately, in most cases the allergens are easily broken down by cooking, processing and digestion.

Soya milk may cause quite severe reactions in some people who have PFS as it contains very large amounts of a protein which cross-reacts to birch pollen. If a child is dairy intolerant and suffers from hayfever, it is important to make the parents aware that soya may also cause a reaction. Lightly cooked vegetables can also cause reactions, so stir fried vegetables such as bean sprouts, mange tout and carrots may also need to be avoided for PFS sufferers. People who have PFS will usually experience mild itching and/or swelling of all or part of the lips, tongue, mouth or throat, but this can on occasions be severe and also include nausea and vomiting. These symptoms usually start within minutes of eating and settle down within an hour.

Treatment is avoidance of triggers and to take antihistamines such as cetirizine or loratidine. Fortunately, most people with PFS do not experience severe symptoms however anaphylaxis can occur, albeit rarely. Anti-histamines can be taken up to four times per day, according to Allergy UK.

Visit their website: http://www.allergyuk.org/oral-allergy-syndrome/oral-allergy-syndrome to see the latest top foods that can trigger oral allergy or pollen food syndrome

 

Dr Ishani Patel
MBBS BSc MRCGP DCH DRCOG
General Practitioner
E-learning CPD Fellow, RCGP
Associate GP, Cancer Commissioning Team – North West & South London
Advisory Committee on Cervical Screening (ACCS), Public Health England

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