Talk:Oral allergy syndrome

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section.

Merge proposal with Food allergy

The term "Oral allergy syndrome" is in this article is stated in the leadin as "not actually an allergy to food" but just prior to that states "is an allergic reaction to certain (usually fresh) fruits, nuts, and vegetables". Then the bulk of the article, by length, is the table claiming that those with hayfever to certain pollens may have cross reactivity to certain foods.

A quick search on PubMed indicates that the term "Oral allergy syndrome", in official biomedical literature, seems to be often used synonymously for "food allery", e.g.:

Liu X, Feng J, Xu ZR, Wang YZ, Liu JX (2007). "Oral allergy syndrome and anaphylactic reactions in BALB/c mice caused by soybean glycinin and beta-conglycinin". Clin Exp Allergy. doi:10.1111/j.1365-2222.2007.02893.x. PMID 18070164.{{cite journal}}: CS1 maint: multiple names: authors list (link)

in the first sentance of the abstract switches terminology to "Background Soybean protein is used in a number of food products but is also a common cause of food allergy"

Many of the reports seem to address Japanese studies on raw fish (a food product not mentioned by the article at all), eg:

Sugita K, Kabashima K, Nakashima D, Tokura Y (2007). "Oral allergy syndrome caused by raw fish in a Japanese sushi bar worker". Contact Derm. 56 (6): 369–70. doi:10.1111/j.1600-0536.2006.01069.x. PMID 17577388.{{cite journal}}: CS1 maint: multiple names: authors list (link)

which makes no mention of requirement to have hayfever. By comparison many papers do seem reserve term for a food allergy to fruit and then proceed to discuss association with pollin allergies (eg PMID 16285612).

A good reference that does discuss fruit-pollen cross-reactivities is:

Inomata N, Morita A, Kirino M; et al. (2007). "[Oral allergy syndrome due to plant-derived foods: a clinical review of 63 patients over a period of 6 years]". Arerugi (in Japanese). 56 (10): 1276–84. PMID 17982289. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

but this does not require exclusivity to pollen reactions, stating "Forty-one of 63 patients with OAS (66.1%) had pollinosis and/or allergic rhinitis", which presumably means that 33.9% had OAS without any reactions to pollens.

This seems at complete odds with PMID 17357673 abstract introduction that quite clearly gives an absolute definition that "History of oral allergy syndrome goes back to 1987 year, when Amlot for the first time used this name for pollen-food cross-reactive reactions". It would seem that use of the term has broadened since it was first coined. Worse, PubMed gives just single paper by Amlot for 1987 which seems make no such fruit-pollen association at all ! See abstract of:

Amlot PL, Kemeny DM, Zachary C, Parkes P, Lessof MH (1987). "Oral allergy syndrome (OAS): symptoms of IgE-mediated hypersensitivity to foods". Clin. Allergy. 17 (1): 33–42. PMID 3829369.{{cite journal}}: CS1 maint: multiple names: authors list (link)

So what are we to do with this article?

1. Verification for the precise original definition of the term OAS seems lacking
2. Use of the term OAS has certainly broadened in reliable sources to consider use in just fruit allergies where no pollinosis exists,and
3. Use of the term even to describe non-fruit allergies (raw fish)
4. The lead-in 1st sentance that OAS is not "an allergy to food" is obviously false; at best, OAS might be better described as "a food allergy to various fruits in association with various pollinosis".

So this article either needs a radically rephrased lead-in definition, or possibly merging into Food allergy David Ruben ^Talk 04:01, 25 January 2008 (UTC)

• Oppose merge - First, the lead in could be rephrased. The key point here is not that OAS is a reaction to food, but not an allergy to the food. For example, OAS patients (myself included) often have allergic reactions to food, however, when tested for an food allergy, they turn up negative. For example, I react to fresh melon, but I turn up negative for melon allergy on a skin test because the reaction is to the grass pollen. I don't know the mechanism behind this, but I know thats what happens. If you want to call OAS a "food allergy," fine. As far as I know, it's semantic. However, the above discussed distinction between OAS and other food allergies needs to be made. Regarding your assertion that the definition of OAS has broadened, I wouldn't jump to that conclusion. Scanning PubMed, I find many examples of articles making a distinction between OAS and food allergy. (e.g., see here). Searching "Oral Allergy Syndrome" in Google turns up many lay articles, some from legitimate health organizations, that use the term in the manner described here. You cite several cases where the authors seem to use these terms interchangeably, but this is a small selection of articles my Asia based researchers. I think there's a good chance this is the result of mistranslation. In any case, I don't think we should base usage of a term on its use in a few papers written by researchers working outside English-speaking countries. Finally, this article definately should not be merged. OAS is at least a distinct type of food allergy that presents itself in a manner different from other food allergies. It wouldn't do any good to lump it in. The Food allergy article is already fairly long and a lot more could be added. No need to take up that space.--Bkwillwm (talk) 04:57, 25 January 2008 (UTC)

• Thanks for above points, greater clarity of definition/distinction (as you set out) are required, not least because most doctors (at least in UK), like myself, have not previously encountered this term (as PMID 17357673 from Poland in 2006 makes clear). PubMed gives a total of 194 hits for search on just '"Oral Allergy syndrome"', out of which specific searches on '"Oral Allergy syndrome" fish' gives 7 hits (3.6%) (sources Japan but also Sweden, Denmark, Estonia, Lithuania, Russia & Germany), '"Oral Allergy syndrome" nuts' has 28 hits (14.2%), PMID 9494454 describes occuring with chicken and finally 63 hits (31.9%) match '"Oral Allergy syndrome" "without pollinosis"' (of course a search hit for a paper including these terms anywhere, does not always equate to a paper claiming "OAS occurs without pollinosis"). The bulk of references obviously support limitation to reaction after fruit and association with pollinosis (probably supporting a non-merger), but I also agree that usage of the term seems a little "loose" (for want of a better assessment) in even the official literature.

  By comparison PubMed search for '"food allergy"' has 3252 hits, so OAS has only 6% as many hits which really is in comparison a small amount of research. The overlap of papers including both terms, i.e. search '"food allergy" "oral allergy syndrome"', gives 60 hits (just over 30% of all OAS hits).

  Can anyone at least verify the claim made in several of the above given refs of it being Amlot in 1987 who defined the syndrome? Was it the paper reference that I gave above, which fails to make any definition in the abstract available to us from PubMed, or is it later made in the rest of that full article? Or was it an entirely different paper published by Amlot in 1987, not listed by PubMed, that first defined the syndrome ? David Ruben ^Talk 16:35, 25 January 2008 (UTC)

Bkwillwm, can you tell me what constitutes a food allergy in your mind? I think that being clear about this definition will make this conversation easier.

My immediate concern is that we have an article that states that OAS both is and is not an allergy to food, which is nonsense. WhatamIdoing (talk) 21:20, 25 January 2008 (UTC)

I think we need to maintain the distinction between OAS and other food allergies. The current article doesn't say "OAS is not a food allergy, "it says "The allergy is not actually an allergy to food but a syndrome that develops in hay fever sufferers." If we want to call OAS a type of food allergy, as far as I know, that's fine. However, OAS is a cross-reaction between pollen and food, not a direct food allergy. I think the best example may be nuts. Someone with OAS may have problems eating nuts, however they do not have a "nut allergy." The two conditions have different patterns. With OAS, if you eat a nut you will have a reaction that subsides in a few minutes after the food gets broken down and the proteins that cause the cross reactions denature. Someone with a nut allergy may have symptoms that may get worse after the food leaves the digestive track and may not show up for several hours.[1] People with nut allergies have a reaction to more than just the protein in the nut, so reactions last after the protein has denatured. This article talks some about these distinctions[2].

Once again, I think the crucial matter is maintaining a distinction between OAS and other food allergies. So, while we could say OAS is a food allergy, I think we need to clarify that an OAS reaction to nuts is not equivalent to a "nut allergy" since someone with a nut allergy reacts to the nut itself while someone with OAS is having a cross-reaction related only to the proteins in the nut.--Bkwillwm (talk) 04:13, 26 January 2008 (UTC)

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My answer, part 1: Definitions

Thank you for your response. What I got out of your message is that your defintion of "food allergy" is not simply a slightly more compact way to say "an allergy to one or more foods." Your definition of "food allergy" is much closer to "an allergy to food that causes a certain pattern of symptoms," although you seem willing to be flexible about it.

I also understand from your description that you have no specialized knowledge about this area (that is, that you're a normal person).

So let me tell you my perspective on food allergy. First, I think that "food allergy" and "an allergy to food" are identical in meaning. I do not believe that it is possible to have an allergy to any specific food without having that specific food allergy. For example, all of my nephews are allergic to peanuts, and they all have peanut allergies. These phrases communicate precisely the same information to me, and I suspect that any attempt to make a fine distinction here would be entirely lost on the average reader, even if it was warranted.

I define a food allergy as an antibody-based immune system response against a material (such as a plant or animal) that is normally considered edible. If 99% of people can eat oranges without triggering an antibody response, and your body mounts an antibody response against oranges, then I say you are allergic to oranges. I do not care how or why your body came to mount this antibody response: if it does so, then you are allergic. In this field, my definition is generally considered to be slightly on the expansive side because I do not limit it to specifically IgE-based reactions (IgE is a kind of antibody, and it's the most common one involved in allergies).

My defintion also reflects my bias towards theoretical biology instead of clinical practice, because I do not require any specific clinical symptoms. To give you a concrete example of the distinction here, when I say that I'm personally allergic to cats, I specifically mean that my body produces antibodies against a cat protein called Fel d 1. When my doc says that I'm allergic to cats, she means that my eyes water and my skin itches and my head aches and my nose runs and I sneeze repeatedly whenever I'm around cats, and that none of this happens when I avoid cats (and it's not hay fever season).

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The rest of my answer: Details

Technically, OAS is not a "cross-reaction between pollen and food." That phrasing suggests that the pollen and the food are interacting with each other, and they're not. In OAS, the allergic-reaction-causing antibody that binds to the pollen proteins is also capable of binding to some food proteins (specifically, to those food proteins which are similar to pollen proteins). It's the antibody that is cross-reactive; the allergens do not interact with each other. The relationship between pollen allergies and food allergies is entirely explained by this mechanism.

Your understanding of mechanisms involved in nut allergies is incorrect. People with regular nut allergies and OAS-prompted nut allergies both react to the nut proteins -- indeed, both groups react solely to nut proteins. The actual difference here is that antibodies against Jug r 1 (to use walnuts as an example) respond to the linear (amino acid) sequence of the protein, not to a conformational epitope. In practice, this means that no matter how much you cook it/denature it, the anti-walnut antibodies can still attack it. This is true both for people with OAS and for people with plain walnut allergies. Furthermore, some people with OAS do not find relief by eating cooked foods. Even for susceptible foods (e.g., peaches), protein denaturing only works for a subset of people with OAS.

Additionally, people with OAS can have serious, even deadly, reactions to foods. Just because your (and my) experience with OAS is that the symptoms are mild and temporary doesn't mean that everyone has the same experience. If people with hay-fever-deranged immune systems didn't have serious reactions to foods, then there would be no need for them to carry EpiPens into restaurants, and anaphylaxis would not be mentioned in the article.

At bottom, OAS is an explanation for how you and I came to have food allergies in the first place, not a special style of food allergy. My OAS-related symptoms happen to be identical to my friend's almond-allergy symptoms: a little swelling in the lips, a little itching of the mucus membranes. The only difference is that I have hay fever and she doesn't, so I technically have OAS and she doesn't.

(I realize that I've just dumped a lot of technical information on you, so I encourage you to ask questions about anything that I've written that seems unclear or incorrect. I am happy to [try to] explain.) WhatamIdoing (talk) 07:01, 26 January 2008 (UTC)

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Oppose Merge. I was going through some of my history and came across this page, which now has a large, ugly factual dispute tag at the top. I don't think this is necessary for what is essentially a semantics debate.

Although I'm probably going to offend quite a number of doctors, as a sufferer of OAS myself, I don't really care whether it's technically a "food allergy" or a "cross-reaction pollen allergy" or whatever... It's easiest for a layman like myself to think of it as a food allergy, because when I eat certain foods, I get sick.

I propose a compromise between those who wish to be technical about this (which is important, for the doctors who come across this article) and those who wish to be non-technical (which is important, for laymen like myself who come along): Let's start off the article with something like "Although not technically a food allergy, OAS is commonly described as one because those who have it become sick after eating certain foods." Then, we can create a section called "Technical/Medical Definition" and put all the gory details in there, and link part of the first sentence to it. I'm going to make these changes, using the wording from WhatamIdoing above. Since I may botch the technical stuff, someone smart please fix it!  :) Michael ^(talk) 05:53, 29 April 2008 (UTC)

Opose Merge

For example, OAS patients (myself included) often have allergic reactions to food, however, when tested for an food allergy, they turn up negative. - Bkwillwm
That is precisely what happens with me as well. I was also told by the allergist that interpreted my scratch test that eating, say a watermellon, would not induce anaphalaxis. It would make my mouth and pharynx swell up with the same practical conclusion as anaphalaxis, but it would not effect my lungs.

The difference is, from what I can tell, is that OAS is not systemic. The immune response does not spread to parts of the body not in contact with the offending protien. I'll try to find something to back me up on this later. Lizz612 (talk) 18:28, 28 May 2008 (UTC)

Regardless of the question if OAS is preceeded by pollen allergy or not, OAS gives an immune respons after eating food. So it is a food-allergy.--Wickey-nl (talk) 08:51, 1 June 2008 (UTC)

Exactly. WhatamIdoing (talk) 05:04, 2 June 2008 (UTC)

On the Food allergy page, under Signs and Symptoms, it lists the physical responses of a IgE-mediated reaction, then says that the above symptoms are "Type-I immediate hypersensitivity reaction." OAS is also IgE-mediated and is listed as such, but as a separate item.

OAS, while IgE-mediated, does not produce swelling in the face, hives, or anaphylaxis. It is an immune response, it is mediated by the same immunoglobulin isotype, but the physical symptoms are not the same as classic, Type-I food allergy. The immune response does not spread to the rest of the body.

I concede that it is a type of food allergy, but I believe it is sufficiently different to warrant keeping its own page. Lizz612 (talk) 05:02, 11 June 2008 (UTC)

I don't care one way or the other about the merge, but your information is entirely incorrect. OAS can result in swelling in the face, hives, and anaphylaxis. It even says so in this article. Furthermore, "normal" food allergies do not always produce these three symptoms. My nephew has (recently outgrown) a food allergy to wheat, and his sole symptom was breaking out in a eczema-like rash -- no swelling, no hives, and no anaphylaxis. WhatamIdoing (talk) 00:35, 14 June 2008 (UTC)

• At the risk of beating a dead horse, there is no way on earth this should be merged with food allergy. That's like merging the lion article with cat. All lions are cats, but not all cats are lions. And more importantly, OAS (like lions) have enough substance as a topic to merit its own article. --Esprit15d • talk • contribs 14:06, 19 June 2008 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

External links

The external links look pretty weak to me. Imagine the "perfect" article on OAS for a minute. Is there anything on any of these links that wouldn't be included in that perfect article? Do they provide any unique resource to the general reader? WhatamIdoing (talk) 23:00, 18 June 2008 (UTC)

Grammar

I'm not sure that we want this to be the non-restrictive clause. The idea is closer to "In case of foods that have more than one antigen (hazelnut is an example of this)" than to "In case of foods like hazelnut (or, for that matter, any other food that has more than one antigen)". I think the solution is a restrictive clause with the example moved to the end: "In the case of foods that have more than one allergen, such as hazelnut..."

What do you think? WhatamIdoing (talk) 03:37, 29 September 2009 (UTC)

Yeah, that works much better. —RobinHood70 ^{(talk • contribs)} 06:07, 29 September 2009 (UTC)

OAS Symptom Contradiction?

I noticed at the beginning of the article it states "in oral allergy syndrome, the reaction is limited to the mouth, lips, tongue and throat." However, under symptoms, it states that "If a sufferer swallows the food, and the allergen is not destroyed by the stomach acids there is a good chance that there will be a reaction from histamine release later in the gastrointestinal tract. Vomiting, diarrhea, severe indigestion, or cramps may occur. Rarely, OAS may be severe and present as wheezing, vomiting, hives and low blood pressure." Perhaps the first sentence should rephrase it more like "...the reaction is usually limited to..." ?

Also, an allergic reaction to raw doughs such as cookie dough, cake batter, and raw noodles can occur (possibly caused by the flour). I'm not certain if it's part of OAS or if it's a plant allergy, but some people get a skin reaction, such as hives on the hands when handling certain foods and in some cases even just smelling the food can cause a reaction. Not sure if it should be added to the article, but I didn't see it mentioned and thought it should at least be somewhere. Kamiyu910 (talk) 19:14, 8 February 2011 (UTC)

As I understand it, your examples above would be plain old food allergies or even non-allergic contact dermatitis, rather than OAS.

OAS seems to be an overactive case of hay fever—so overactive that 'tree pollen allergy' turns into 'not just tree pollen, but also anything that looks even remotely like part of a tree'. To be OAS, the person absolutely must have hay fever, and the allergens absolutely must be (at the chemical level) related to the hay fever allergen(s). It is possible for a person to have both OAS and non-OAS issues (e.g., hay fever that grew into a fruit allergy for OAS, and an egg allergy, which is unrelated). WhatamIdoing (talk) 19:46, 8 February 2011 (UTC)

Some one reverted my edit

Oral allergy syndrome (OAS) is an allergic reaction in the oral cavity following consumption, of food,especially through fruits and vegetables.

The reaction occurs in entire oral cavity , previous edit "Only mouth" Especially the reaction occurs through fruits and vegetables

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655061/

(KEKAPETA (talk) 15:32, 26 September 2018 (UTC))

Please watch this discussion,

https://en.wikipedia.org/wiki/User_talk:Wtmitchell#Requesting_you

user:Bonadea please discuss the matter at article talk page.

(KEKAPETA (talk) 13:17, 28 September 2018 (UTC))

Present the definition :(After revert by user:Bonadea)

Oral allergy syndrome (OAS) is a type of food allergy classified by a cluster of allergic reactions in the mouth and throat in response to eating certain (usually fresh) fruits, nuts, and vegetables that typically develops in adults with hay fever.

The definition Before revert : Oral allergy syndrome (OAS) is an allergic reaction in the oral cavity following consumption, of food,especially through fruits and vegetables.

1. "Oral cavity" is a better meaning. 2. Really allergy develops only in hay fever subjects? 3. Consumption Is better meaningful than 'eating' (KEKAPETA (talk) 13:32, 28 September 2018 (UTC))

Again a revert: Revert is not solution, correct the grammatical errors.

https://en.wikipedia.org/w/index.php?title=Oral_allergy_syndrome&diff=861581403&oldid=861580539

(KEKAPETA (talk) 14:14, 28 September 2018 (UTC))

1) The use of "oral cavity" so soon after "oral allergy syndrome" is actually bad writing. It is very clunky to read and inspires a response of "well, duh!"

2) "following consumption" removes the element of causal linkage. The allergic response does not just occur after eating, it occurs because of what was eaten. This is why the construction "in response to eating" is preferred.

3) The comma before "of food" in your text is superfluous.

4) "Through fruits and vegetables" is meaningless.

5) It does not say that OAS only develops in hay fever sufferers, it says that it "typically develops" in them. Which implies that there are non-typical cases where no such connection is known.

--Khajidha (talk) 15:07, 28 September 2018 (UTC)

PS-When the text before your edits was correct and your text is incorrect, then reverting IS the solution. --Khajidha (talk) 15:10, 28 September 2018 (UTC)

Include eggplant/aubergine

Hey, so I initially found this article when looking for reasons why my mouth feels uncomfortable after eating eggplant, yet there is no mention of eggplant anywhere so far. Could someone do me a favour and find a external source for eggplant in Oral Allergy syndrome so we can include it in the list of foods? Thanks

Wiki nol ege █[:]====▶• 03:15, 13 January 2020 (UTC)