Oral Allergy Syndrome & Nuts

[kilo90]

My son (7 yrs) was diagnosed with OAS last fall. The biggest offender are carrots and he can't have some type of apples. Carrots and some apples make this throat tighten up, swollen lips, itchy mouth, etc.  A few months after his diagnosis, we found that pistachios gave him a reaction. Itchy mouth/lips, no throat interference. When I called the allergist to ask about it she said not a huge deal/some nuts may not bother him and some may. She basically considers it a trial and error thing. Since then, he's had things with various nuts in them but not whole nuts. Nutella doesn't bother him so I'm guessing hazelnuts are fine.  But I'm not sure where to go from here. I don't want to avoid nuts that he may not have a problem with, but the idea of "experimenting" has me a little unnerved. 

Those of you with experience with OAS, are there nuts that tend to problematic? I know all folks are different, but thought someone might be able to offer up some helpful advice. We do have an epi-pen, are armed with Benadryl, and are literally 2 minutes from the hospital. That said, I still don't like the idea of "experimenting"?!?  

 

Thanks for any advice!

 

 

 

 

[Upward Journey]

I have severe OAS, as in I can only eat lettuce raw.  All nuts and seeds are out for me unless they've been roasted.  The thing about OAS is that you're not really *allergic* to the offending food.  You're body is just getting the protein confused with whatever the environmental allergen is that you do have an allergy to (grasses or birch or ragweed....) so you can denature it with cooking, and sometimes freezing.

 

Anyway, you need to find out what his environmental allergens are and then you should be able to find a list of which foods/nut/seeds are most likely to cause a problem.

 

I've had OAS for over a decade now.  The severity cycles with the allergy season.  There are some things I can consume in small quantities, after having claritin and sudafed ;)  But never when there are a lot of allergens in the air.  I do avoid all raw nuts/seeds all.the.time. because nut allergies seem to be unpredictable and so scary.  So better safe than sorry.  I have never reacted to any nut that has been cooked in a dish and have never had to worry about reading cross contamination labels.

 

One thing to look out for is that he may develop a latex allergy.  For some reasons it seems to manifest in those with OAS. 

[kilo90]

That is very helpful information! Thank you so much. Funny thing with my son is even cooked carrots are a problem for him. Even diced carrots in ragu sauce, casseroles, etc.  Since he hasn't had any other nut issues outside the pistachio maybe things containing cooked/roasted nuts are fine. 

Birch is his biggest problem; however, not all fruits and veggies in that family are problems for him. I have wondered if it might develop over time. 

 

I appreciate the heads-up on the possible latex issue!

 

Thanks for your time in replying!

[Upward Journey]

That sounds like a true allergy (the carrots), not just OAS.

[Karen in CO]

I'd be very careful with OAS reactions in a child.  My dd had OAS sensitivity to several things.  Her allergist warned that it could be a developing allergy.  She tested negative to nut allergies.  Within a year of nuts causing her itchy mouth, she had anaphylactic reactions to them instead.  She had been generally avoiding them because it was uncomfortable until one day she had a cookie at a reception that had nuts. Then her throat, tongue and lips started to swell, she broke out in hives and had trouble breathing.    We went through the same thing with citrus fruits.

[Spryte]

Yes, please be careful.  I know you said it's OAS, but do you have an epipen just in case?

 

My mother has had OAS all of her life.  She has had several life threatening reactions, as well.  Total avoidance helped her the most.  

 

DS has multiple LTFAs, plus OAS.  I tend to take the OAS fairly loosely, because, well, it's not as scary as anaphylaxis, and it subsides with Benadryl.  But his allergist tells us to avoid all foods to which he's had OAS reactions.  That leaves us with almost no raw foods.  :(   And frankly, it's hard to tell the difference - is the itchy throat due to OAS?  Is it the start of ana?  It's nerve-wracking.

 

If I were in your shoes, I'd probably ask for skin tests for the nuts at least.  Have you gone that route?  Recently?  You may want to re-check if it wasn't recent.  I think I'd want more specific guidance re: nuts.  Can you make an appt to talk about this with your allergist?

 

If you are very concerned, you can do in-office challenges for some foods.  It can be a long appt - up to 4 hours, if there's no reaction - but well worth it for the peace of mind.  It's scary to think of experimenting on one's child.  

 

 

[Upward Journey]

That is very helpful information! Thank you so much. Funny thing with my son is even cooked carrots are a problem for him. Even diced carrots in ragu sauce, casseroles, etc.  Since he hasn't had any other nut issues outside the pistachio maybe things containing cooked/roasted nuts are fine. 

Birch is his biggest problem; however, not all fruits and veggies in that family are problems for him. I have wondered if it might develop over time. 

 

I appreciate the heads-up on the possible latex issue!

 

Thanks for your time in replying!

 

 

Most likely.  Mine has gotten progressively worse over the years.  It started with strawberries & watermelon (just the itchy mouth etc.)  and now encompasses almost everything.  I can't be in the same room as someone peeling/cutting citrus or my throat starts to tighten.  I can't be in the house if my husband is cutting cilantro, same thing happens.  I had trouble the other day when my kids were peeling cucumbers :(  I can't peel a potato w/o getting itchy hands.  I can't be around balloons, or tennis balls.  I take Claritin everyday, and many days I also take sudafed.  Benadryl is my friend & I have 3 epi-pens.  I didn't have any enviromental allergies growing up, and was only allergic to shrimp, which I outgrew.  I know that OAS is not considered to be a "real" allergy, but do continue to be careful, because unfortunetly the reactions tend to increase with time.

[Upward Journey]

Yes, please be careful.  I know you said it's OAS, but do you have an epipen just in case?

 

My mother has had OAS all of her life.  She has had several life threatening reactions, as well.  Total avoidance helped her the most.  

 

DS has multiple LTFAs, plus OAS.  I tend to take the OAS fairly loosely, because, well, it's not as scary as anaphylaxis, and it subsides with Benadryl.  But his allergist tells us to avoid all foods to which he's had OAS reactions.  That leaves us with almost no raw foods.   :(   And frankly, it's hard to tell the difference - is the itchy throat due to OAS?  Is it the start of ana?  It's nerve-wracking.

 

If I were in your shoes, I'd probably ask for skin tests for the nuts at least.  Have you gone that route?  Recently?  You may want to re-check if it wasn't recent.  I think I'd want more specific guidance re: nuts.  Can you make an appt to talk about this with your allergist?

 

If you are very concerned, you can do in-office challenges for some foods.  It can be a long appt - up to 4 hours, if there's no reaction - but well worth it for the peace of mind.  It's scary to think of experimenting on one's child.  

 

I agree.

[kilo90]

I really appreciate all the input from your experiences. 

 

We do have an epipen. Typically 2 doses of Benadryl does the trick but we carry it just in case. 

 

It is definitely something that is changing over time. Use to be carrots would just make him red around the mouth, then the itching started, and then the throat.  :crying:  Apples are becoming more problematic. The things y'all have shared just reinforce that I need to always be prepared. He knows to avoid apples and carrots, but you never know when something will bother him that hasn't in the past. 

 

 

 

If I were in your shoes, I'd probably ask for skin tests for the nuts at least.  Have you gone that route?  Recently?  You may want to re-check if it wasn't recent.  I think I'd want more specific guidance re: nuts.  Can you make an appt to talk about this with your allergist?

 

I think I will. The nuts so have me a bit concerned and I don't like the trial and error concept. 

 

Thanks again for the replies!

[Mom in High Heels]

I have the same issue with carrots and some apples!  The only apples I can eat without reacting are Pink Lady and Braeburn; anything else just does me in.  I have a problem with a lot of stone fruits, though most are mild with the exception of cherries (which is of COURSE my favorite stone fruit).  I can only eat a few cherries before the itching starts.  The worst is when my eustachian tube itch, because I can't do anything for it, but wait for it to go away.  Still, I love cherries.  Sigh.  Peaches and plums are not bad at all, but apricots must be dried or I have a reaction.  I don't react to any nuts (other than coconuts, but they're not really nuts), but for my kids, I'd insist on getting tested before "trying" them to see what happens.  No way!

[joannqn]

My son never cared for fruit much, but never said anything about weird reactions or had a visible reaction.  Then we moved thirty minutes south to an area with a lot more trees, and he suddenly began breaking out in hives at random times.  It was this board that diagnosed him with OAS before we got in to see the allergist.  The allergist confirmed allergies to 5 different trees, a grass, soy, and OAS.  There was also a false positive for peanuts, which he eats without any reaction at all on a regular basis.

 

He OAS stems from both alder and birch allergies.  So far, we've discovered that he reacts to apples, peaches, nectarines, pears, apricots, plums, strawberries, blackberries, bananas, and avocado.  He avoids all of them in their fresh form except avocado. He loves guacamole, and his reaction to avocado is just some mild itching, so he chooses to continue to eat it. His blackberry reaction is the worst (with some throat swelling after just one berry), so he also avoids all of the other berries.  Blueberries are ok though.

We think he has reacted to almonds twice.  It was the only thing in the meal that we could pinpoint as an unknown and also on the OAS list for birch or alder.  He avoids them.  Hazelnuts and walnuts are also on the birch and alder list.  He is also allergic to both the hazel nut and walnut trees, so he avoids them to be safe.  Getting him into the allergist again to discuss testing for nuts, specifically, is on my list of things to do.  

 

[Mergath]

I started have issues with OAS a couple years ago.  I can't eat apples. peaches, plums, cherries, eggplant, and, um, I know there's a few more I'm forgetting.  It started a couple years after I began having tree pollen allergies every spring, and that began after I was pregnant.  I haven't had any nut issues that I can recall, but I really only ever eat cashews and peanuts, so that might have something to do with it.  I do quite a bit of experimenting, and have a lot of Benadryl on hand.  Last time I tried to eat shrimp I had some issues too, but I'm thinking that's probably an actual allergy, and not the OAS.

[Tess in the Burbs]

My son has lots of peanut/tree nut allergies and others.  He commented this year about fresh peaches and watermelon making his throat itch like the peanuts do.  

I have lists of OAS and which tree pollen affects that fruit/veggie and to avoid those in his list.  Sure enough, his allergy to the tree is the issue to the OAS reaction to the list of foods listed with each tree.  

 

It means he can't have those items fresh.  Which is sad, but he likes canned fruits.  

 

Our Dr said he can do allergy shots for the tree allergies which will lesson the OAS reaction....when he's less sensitive to the tree pollen.  

 

But gosh, get some food allergy testing done and environmental stuff done(trees) and get that OAS list so you know what to avoid.  

 

My son was happy to find this out and now we just know to avoid fresh stuff. 

[treestarfae]

We have issues with birch and apples. The birch cross pollinates with a list of food. We also have tree nut issues and seafood.

 

Do the other trees come across in foods as well? If anyone has lists/links that would be great.

[kilo90]

 

 

Our Dr said he can do allergy shots for the tree allergies which will lesson the OAS reaction....when he's less sensitive to the tree pollen.

I had not thought/heard of allergy shots for tree allergies. Interesting that they could lessen the OAS reaction. Don't think I'd do it while he's young, but it might be an option he would like when he's older. 

 

I think it's definitely time to head back to the allergist to see about more testing. Y'all have assured me that I'm not crazy(i.e. nuts) to be leery of experimenting with various nuts.  :glare:   

 

Thanks again, ladies!

[joannqn]

I know someone who has OAS pretty severely.  He can't have most fruits and vegetables when they are fresh.  He had allergy shots as a kid, and they worked when he was getting the shots, but the OAS came back as soon as he quit the shots.

[TravelingChris]

Well I thought my dd had OAS with citrus fruits.  Not, now- she is severely anaphalactic to citric acid and inhaling it is the worse.  Unfortunately, she has the most serious type of anaphactic reaction (giant drop in blood pressure) and she got it this summer after putting on a chapstick that did nor have it labeled (only natural flavors, I think).  She started putting it on her lip, breathed, and got an immediate reaction.  Went to wash it off, took benadryl, took other meds, took epipen, needed inhaler, and still needed lots of medications at the ER.

[Guest Bradenrussom]

I agree on the shots. I have had OAS for 10 or so years. I Started getting shots 18 months ago and symptoms are all but gone.

 

I still avoid all nuts I've reacted to. Just don't want to mess around with that kind of stuff.

 

I ended up writing a cookbook of OAS friendly recipes. If your son still reacts to cooked carrots, it might not be for him, but I'd be happy to send you a couple recipes if you'd like.

 

Best of luck. It can be scary stuff, but being careful and attentive makes a huge difference. And the shots might really help.

 

(Here's the book link http://www.cookingthreetimes.com/why-write-an-oral-allergy-syndrome-cookbook)

[Susan in TN]

Where have I been all this time? I had no idea this was a "thing" - OAS. I'm going to look up some more info, but I'm quite sure dh and dd15 must have this (dh is more severe).

[emzhengjiu]

I have never heard of this!  My 16 dd carries epi-pens for fire ant bites.  At least she would have them in an emergency.  Last year, she noticed her mouth started feeling itchy and swollen after eating fresh pineapple and also after eating dandelions fresh from the yard.  She can eat canned pineapple with no problems at all.  So far thankfully, I have not found canned dandelions!  She just doesn't eat them anymore.   Now thanks to the Hive, I know about OAS.  My sweetie scares me because she is my naturalist.  So far, she loves to try new (and often odd foods) as well as edible wild plants.  She's, also, the one that loves anything that creeps, crawls, leaps, trots, etc.  Now at least I can warn her to be very aware.

 

 

[Susan in TN]

For the OP, dh has a problem primarily with walnuts and pecans and some seeds, but is fine with almonds and peanuts. It sounds like it is very individual, though.

[Susan in TN]

Oops, dp