Primary Care Perspectives: Episode 127 - Managing Oral Allergy Syndrome in the Primary Care Setting
Jun 28, 2022
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Dr. Katie Kennedy from Children's Hospital of Philadelphia discusses distinguishing Oral Allergy Syndrome from other allergies, importance of pollen patterns, reactions to raw vs cooked food, antihistamine recommendations, evaluating systemic reaction risk, outgrowing OAS, when to refer to a specialist, and treatment options in primary care.
Cross-reactivity between pollen allergens and foods plays a crucial role in Oral Allergy Syndrome diagnosis.
Referring patients with uncontrolled symptoms to an allergist for specific testing and management is recommended.
Deep dives
Understanding Oral Allergy Syndrome (OAS)
Oral allergy syndrome, also known as pollen food allergy syndrome, is a form of contact allergic reaction triggered by consuming raw fruits or vegetables. It is characterized by localized symptoms in the mouth and throat, such as itching or irritation. The cross-reactivity between certain pollen allergens and specific foods plays a crucial role in OAS. Obtaining a detailed medical history, including respiratory and GI symptoms, and assessing seasonal allergies are essential for diagnosing OAS.
Differentiating OAS Symptoms and Recommendations
OAS symptoms may manifest as mouth itchiness or minor reactions when consuming certain raw fruits or vegetables, while cooked forms of the same foods may not elicit a response. The risk of systemic reactions and anaphylaxis in OAS is generally low, permitting some flexibility in managing mild symptoms without antihistamines. Contact rashes from acidic foods can be distinguished from OAS reactions by their flat, blotchy appearance and quick disappearance after removal of the food.
Management and Referral for OAS Patients
Referring patients with uncontrolled seasonal allergies or significant symptoms to an allergist for further evaluation and specific IgE testing is recommended. Allergen immunotherapy and oral food challenges are effective strategies for addressing OAS and confirming potential allergenic triggers. It is crucial to differentiate between OAS and true food allergies requiring strict avoidance and carrying an EpiPen, emphasizing the importance of appropriate management based on individual patient circumstances.