Intended for healthcare professionals

Practice 10-Minute Consultation

Pollen food syndrome in a teenage student

BMJ 2010; 340 doi: (Published 01 February 2010) Cite this as: BMJ 2010;340:b3405
  1. Elizabeth Angier, clinical assistant1,
  2. Aziz Sheikh, professor of primary care research and development2
  1. 1Clinical Immunology and Allergy Unit, Northern General Hospital, Sheffield S5 7AU
  2. 2Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh EH8 9DX
  1. Correspondence to: A Sheikh Aziz.sheikh{at}
  • Accepted 5 August 2009

A first year university student comes to see you with a history of itching and mild lip swelling after eating apples and pears. She has also noticed tingling in her mouth after eating nuts.

What issues you should cover

Detailed history is the cornerstone of diagnosis

Pollen food syndrome (also known as oral allergy syndrome) comprises a set of symptoms usually involving itching and mild swelling—typically limited to the oropharynx—after eating raw fruits, vegetables, peanuts, nuts, and sometimes spices (box 1). The range of symptoms can be wide and may include anaphylaxis, although this is uncommon. The symptoms are due to an immediate (IgE mediated type 1) hypersensitivity reaction typically caused by cross-reactivity between the protein found in these foods and those in pollens. Symptoms are therefore predictable, beginning within minutes of exposure. Affected people are able to tolerate these foods when cooked because the allergen responsible is heat labile.

Box 1 Foods commonly implicated in pollen food syndrome1

  • Birch—fruits: apple, apricot, cherry, kiwi, nectarine, pear, peach, plum, prune, and quince; nuts: almond, hazelnut, and walnut; vegetables: carrot, celery, and potato

  • Grass—fruits: melon, orange, watermelon; peanuts; vegetables: potato, swiss chard, and tomato

  • Plane—fruits: peach, apple, melon, and …

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