OAS vs. LTFA: What's the distinction?

[Mookie86]

Having recently realized that I have OAS, I'm struggling to understand it.  We tell people with nut allergies that there's no such thing as a minor allergy to peanuts or tree nuts, and that one reaction does not necessarily predict the next one.  I have seen many people be advised that, even if it's only an itchy throat that subsides on its own or with an antihistamine, next time it could be a full-blown, life-threatening reaction.  Why is the identical reaction to an apple viewed as mere annoyance and not potentially serious?  I know that you can be LTFA to fruits, so how is that different than OAS?

[hopechapel]

ditto the confusion. awaiting the replies. 

The Dr. thinks my son's reaction to walnut is OAS.  She did not keep challenging because she did not want to mess up the hazelnut pass. But his mouth was itchy.  When he described his reaction to our friend and neighbor he said his mouth got itchy and his throat got tight. 

Thoat got tight ?? 

She also thought he might have an itchy mouth with raw hazelnut and that both could be attributed to his pollen allergy.  She does not want him to eat nuts at school because f he were to have such a reaction it would confuse them. WTF?  It would confuse me too.  I think I have a handle on all this and I don't. 

[MamaMia]

I understood that OAS is related to pollen allergy, what they call cross-reactivity & one can only be allergic to raw fruit and veggies (but nothing else).  Baked in fruit or cooked veggies don't seem to cause problems.  OAS only affects certain areas but "rarely" lead to respiratory problems (ana).  Areas affected can be ithcy mouth and tongue and sometimes hives around mouth.

Here's a great explanation from CHOP (great chart too):
http://www.chop.edu/service/allergy/allergy-and-asthma-information/oral-allergy-syndrome.html

[rebekahc]

DS has OAS to bananas.  Our allergist advised us that OAS can be just as serious as true food allergy because the swelling in the mouth/throat from OAS could still obstruct the airway. 

I think the biggest difference is that with OAS, a person might be able to tolerate the food peeled, heated, not in pollen season, etc. and is likely only to react upon major ingestion.  No need to worry about it in the environment or cross-contamination, etc. 

[CMdeux]

My understanding is that to some extent, once a person has a demonstrated ability to anaphylax, then it doesn't really matter what the "nature" of the trigger happens to be.

So in someone with environmental allergies and OAS... it may be fairly mild and not something to "worry" about in that direction.

On the other hand, in someone who has been intubated for a shellfish or insect venom reaction?  Birch pollenosis (OAS to apples, etc.) may well be much more serious.

If it can trigger symptoms at all, basicaly, then it is tinkering with that mast-cell cascade. 


So I'm not sure that there is a clear differentiation in a person who has had anaphylaxis to another allergen. 

[Mookie86]

I took two bites of an apple and my nose began running a lot, I was coughing a ton, my throat was very itchy, and my ears felt clogged/stuffy and itchy.  That's clearly more than having a reaction localized just around my mouth/in my mouth. 

So everyone is saying that I don't have to worry about it becoming worse than my prior reaction history?  Obviously I'll avoid apple skin, but the question is whether it's safe to try a peeled apple, processed apples (applesauce), and cooked apples.  I guess I also don't need to worry about xcontamination or need an epipen?

 

[CMdeux]

I think that it's probably too soon to know exactly, Mookie.

You won't know about cooked apples (or, for that matter, the peel OUT of pollen season) until you try, from what I know.

I mean, if it seems to be stable over the next year or two, then no, probably no reason to actually "worry."  Annoying, but not actually scary.

But if the symptoms are unpredictable, increasingly severe relative to exposure, or involve more than localized symptoms (and yes, I know that what you're describing sounds like a lot more than "just itching" but it's still all centered on the palate, which indicates contact with the allergen), then it's definitely something to address further with an allergist. 

Do you have any history of systemic allergic reactions to anything else?

If you do, then I'd address it sooner.  Ditto if you try something like applesauce and it causes symptoms.

[MamaMia]

I took two bites of an apple and my nose began running a lot, I was coughing a ton, my throat was very itchy, and my ears felt clogged/stuffy and itchy.  That's clearly more than having a reaction localized just around my mouth/in my mouth. 

So everyone is saying that I don't have to worry about it becoming worse than my prior reaction history?  Obviously I'll avoid apple skin, but the question is whether it's safe to try a peeled apple, processed apples (applesauce), and cooked apples.  I guess I also don't need to worry about xcontamination or need an epipen?

 

As far as it being safe to eat peeled apples etc, that's a question for your allergist.  We are new to OAS as my daughter was just diagnosed with banana and apple allergies.  We cannot do food challenge (since she had eaten b4 but seemed ok) because we have other health issues that could put her at risk that we need to take care of.  But as far as I understood OAS, it's "usually" localized around the mouth.  That being said, I do know people who can become ana to it so eh.  Unclear but there you have it. 

[Mookie86]

To answer the question about prior reactions, I vomit if there's severe dust.  I also have vomited from freshly cut grass, but only during the spring.  Vomiting stops if I get away from the allergen, so moving to a new area leads to feeling better without doing anything, not even taking an antihistamine.  Otherwise, I can smell dust when nobody else can, but otherwise I have the normal environmental reactions to things.

I thought about it, and I've eaten a lot of applesauce over the past few months without problem, and I had an apple-baked dessert a few months ago without a problem. 

I also thought more about eating whole apples.  I always thought the skin was irritating my throat a little because it can be a little tough.  In hindsight, I've probably always been reacting to apples.  Obviously it's gotten more severe, though.

Based on everyone's advice and with tonight being the start of Rosh Hashana, I've decided that I'll eat peeled apple and see how it goes.  I am on an antihistamine these days (Allegra), so that'll help.  When I had that reaction I described, I hadn't been taking Allegra because a lot of rain had washed away ragweed, but I took Allegra and felt enormously better in 15-20 minutes.

Thanks for your help, and good luck to the others also dealing with OAS!

[AllergyMum]

Oh no that sounds terrible.  Are apples a requirement of Rosh Hashana?  I hope your doctor can help suggest a safe solution to this issue.

[twinturbo]

My birch-apple is systemic with hives and GI. I carry in my purse a tryptase blood test order from the allergist to measure mast cell activation the next time I have a systemic reaction landing in the ER. While it doesn't really help me in any way it can at least provide some more solid data on the anaphylaxis line when you're wondering LTFA or really bad OAS.

[catelyn]

I took two bites of an apple and my nose began running a lot, I was coughing a ton, my throat was very itchy, and my ears felt clogged/stuffy and itchy.  That's clearly more than having a reaction localized just around my mouth/in my mouth. 

So everyone is saying that I don't have to worry about it becoming worse than my prior reaction history?  Obviously I'll avoid apple skin, but the question is whether it's safe to try a peeled apple, processed apples (applesauce), and cooked apples.  I guess I also don't need to worry about xcontamination or need an epipen?

 

Years and years ago my allergist told me itchy swollen ears IS a respiratory symptom.

Mookie, DD's allergist told us to microwave apples for 20 seconds because it essentially cooks them.  You can then put them in the fridge and they look, taste and feel like normal apples.  It worked for DD for a very short while and then she reacted to them too.

Its been VERY difficult to tease apart with her if its the birch and OAS (which she is highly allergic to) and or or the actual fruits.  She has had bad rx to apple and peach and just itchy mouth from cherries and plums.  She seems to rx to all the stone fruits.  She was fine with the cross reactive veggies until this summer.  Now she said her mouth itches from carrots.  We ended up doing a RAST and on the RAST it was only peach and hazelnut that she had high numbers for.  She had a neg spt to apple and peach.  Who really knows.  Her old allergist moved and we are seeing someone new next month.  Just OAS shouldn't make your eyes swell shut from a bite of an apple.  She also seems to have different rx to apples and peaches.  Apples seem to go to her eyes.  Peaches are mega hives and swollen lips.  She had nutella once at about 5 and spit it out long before we knew any of this.  The hazelnut is a mystery with her but at a RAST of 49 the old allergist thought it was likely pretty real especially when combined with all of the other stuff.  He didn't want to even challenge it because he felt it was too high.  I am secretly hoping that the new allergist will at least let her challenge the hazelnut and see what would happen.  sigh.  She eats pisatchios with abandon but "hates" peanuts and would never volunteer to eat a peanut butter sandwich or the like so her overall peanut exposure is very small even though she is not allergic to peanut.

I think I react a little to apples and cherries too.  Cherries will make my mouth itch a little and I feel apples in my throat like you said even when I think back to when I was a kid.  With me it definately seems seasonal but with DD its most def not.  Her initial apple incident was mid february and there is NOTHING alive outside in canada in february except the snow flies.

I guess this is a long way of saying you likely won't know if its JUST OAS or an allergy.  Its all so circular. 

[Janelle205]

Agreeing with what catelyn said.  I've been hesitant to post here, because I don't think that I have any terribly helpful distinctions, and I've been told by three allergist that my case is unusual.  My OAS isn't seasonal, and it's hard to tell which ones are OAS and which are true allergies with the exceptions of apples, peaches, and cherries.  Those I know are 'real' allergens.  Two of my three recent (last couple of years) cases of anaphylaxis were from processed apple - apple juice in a gummy worm and contact ingestion from applesauce.  I have positive rast and spts to apples, peaches, pears, bananas, and melon.

I don't think that my allergist is even really sure of the exact distinction for me - doctor's orders are to avoid all raw fruits and veggies, since even lettuce makes me itchy.  I get away with eating fresh pineapple, berries, occasionally some citrus, and small amounts of spinach, but everything else is off limits.  I can handle corn salsa that I make fresh as long as I give the peppers a quick microwave before cutting, but I can't eat much of that either.


Not really helpful at all, I guess....just commiserating.

[twinturbo]

Do any of you or your kids get cholinergic urticaria as well during showers particularly shampoo washing then break out all over the neck, face? Angry red flares with tiny points that show up fast and dissipate in about 15 minutes? And it doesn't matter the shampoo, no matter what you try the same reaction?

[MamaMia]

Do any of you or your kids get cholinergic urticaria as well during showers particularly shampoo washing then break out all over the neck, face? Angry red flares with tiny points that show up fast and dissipate in about 15 minutes? And it doesn't matter the shampoo, no matter what you try the same reaction?

At one point my daughter had heat induced urticaria from hot showers. Now takes the "not so hot" showers.    Now both my son and daughter have cold induced urticaria where exposures to extremely cold temperatures can induces hives to exposed areas.  They can still play in snow if I bundle up really good.  However, we are still very careful b/c we don't know how severe it can be.  Right now it's just exposed skin gets hives but some can get full body anaphylaxis when exposed to cold air.