Oral Allergy Syndrome Case History

It all started two years ago for Caroline. She was eleven years old when she first noticed that something was amiss. Her mouth went numb and her upper lip swelled after eating melon. It passed of its own accord, she shrugged her shoulders and forgot about it. Two months later she had a similar experience, this time with an apple. Her lips and tongue felt ‘funny’, a bit numb, or maybe there was a slight tingle (she found it hard to describe). Within weeks, she was reacting in this way to carrots, peppers, lettuce, kiwi and cherries. By the time I saw her, she had stopped eating all fruit and vegetables. However, she discovered that if these foods were cooked first they caused her no trouble — except, perhaps, for carrot. Of some concern was the fact that she was now likely to get chest pain and shortness of breath if she inadvertently ate a forbidden food, such as when she visited a friend and the vegetables were cooked al dente (slightly raw, the way they should be). She denied any other allergic history, and this is the only unusual aspect of her case. On skin-testing she reacted as expected to silver birch pollen (see below). She also had positive skin tests to egg, potato, peanut, soy bean, orange, strawberry, pear, banana, lemon, coconut, grape, peas, tomato and onion! I gave up testing her at that stage, and I did a blood test to confirm that the skin tests were truly positive, and not just a quirk of her funny skin, or my imagination! Every single blood test came back positive. On blood test, she was allergic to all of the foods mentioned above, but she was also positive to grass pollen and mould! Caroline had a classical case of Oral Allergy Syndrome.



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