Recurrent Itchy Mouth

  • Charmi Patel
  • Punita PondaEmail author

Practical Points

  • Pollen-food allergy syndrome is caused by cross reactivity of pollen-related protein with raw fruits, vegetables and nuts

  • Symptoms are a result of contact urticaria in the oral and oropharyngeal mucosa

  • Prick to prick is the best diagnostic method for pollen food syndrome in combination with typical history

  • For certain nuts such as peanut and hazelnut, component testing can be helpful for diagnosis

  • Patients can continue to have cooked or heated foods as tolerated


Pollen-food allergy syndrome Prick to prick test Contact urticaria 


  1. 1.
    Nowak-Węgrzyn A, Burks AW, Sampson HA. Reactions to foods. In: Middleton’s allergy: principles and practice. 8th ed. Philadelphia, PA: Saunders; 2014. p. 1310–39.Google Scholar
  2. 2.
    Smith HR, Basketter DA, McFadden JP. Irritant dermatitis, irritancy and its role in allergic contact dermatitis. Clin Exp Dermatol. 2002;27(2):138–46.CrossRefGoogle Scholar
  3. 3.
    Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Gimenez-Arnau A, Godse K, Goncalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Nast A, Saini SS, Sanchez-Borges M, Schmid-Grendelmeier P, Simons FE, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Maurer M. European Academy of A, Clinical I, Global A, Asthma European N, European Dermatology F, World Allergy O. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69(7):868–87.CrossRefGoogle Scholar
  4. 4.
    Price A, Ramachandran S, Smith GP, Stevenson ML, Pomeranz MK, Cohen DE. Oral allergy syndrome (pollen-food allergy syndrome). Dermatitis. 2015;26(2):78–88.CrossRefGoogle Scholar
  5. 5.
    Vieths S, Hoffmann A, Holzhauser T, Muller U, Reindl J, Haustein D. Factors influencing the quality of food extracts for in vitro and in vivo diagnosis. Allergy. 1998;53(46 Suppl):65–71.CrossRefGoogle Scholar
  6. 6.
    De Knop KJ, Verweij MM, Grimmelikhuijsen M, Philipse E, Hagendorens MM, Bridts CH, De Clerck LS, Stevens WJ, Ebo DG. Age-related sensitization profiles for hazelnut (Corylus avellana) in a birch-endemic region. Pediatr Allergy Immunol. 2011;22(1 Pt 2):e139–49.CrossRefGoogle Scholar
  7. 7.
    Hansen KS, Ballmer-Weber BK, Sastre J, Lidholm J, Andersson K, Oberhofer H, Lluch-Bernal M, Ostling J, Mattsson L, Schocker F, Vieths S, Poulsen LK. Component-resolved in vitro diagnosis of hazelnut allergy in Europe. J Allergy Clin Immunol. 2009;123(5):1134–41. 41.e1-3.CrossRefGoogle Scholar
  8. 8.
    Asarnoj A, Nilsson C, Lidholm J, Glaumann S, Ostblom E, Hedlin G, van Hage M, Lilja G, Wickman M. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012;130(2):468–72.CrossRefGoogle Scholar
  9. 9.
    Masthoff LJN, Mattsson L, Zuidmeer-Jongejan L, Lidholm J, Andersson K, Akkerdaas JH, Versteeg SA, Garino C, Meijer Y, Kentie P, Versluis A, den Hartog Jager CF, Bruijnzeel-Koomen CAFM, Knulst AC, van Ree R, van Hoffen E, Pasmans SGMA. Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults. J Allergy Clin Immunol. 2013;132(2):393–9.CrossRefGoogle Scholar
  10. 10.
    Hoffmann-Sommergruber K, Mills ENC. Food allergen protein families and their structural characteristics and application in component-resolved diagnosis: new data from the EuroPrevall project. Anal Bioanal Chem. 2009;395(1):25–35.CrossRefGoogle Scholar
  11. 11.
    Radauer C, Adhami F, Fürtler I, Wagner S, Allwardt D, Scala E, Ebner C, Hafner C, Hemmer W, Mari A, Breiteneder H. Latex-allergic patients sensitized to the major allergen hevein and hevein-like domains of class I chitinases show no increased frequency of latex-associated plant food allergy. Mol Immunol. 2011;48(4):600–9.CrossRefGoogle Scholar
  12. 12.
    Fernández-Rivas M, van Ree R, Cuevas M. Allergy to Rosaceae fruits without related pollinosis. J Allergy Clin Immunol. 1997;100(6):728–33.CrossRefGoogle Scholar
  13. 13.
    Pascal M, Munoz-Cano R, Reina Z, Palacin A, Vilella R, Picado C, Juan M, Sanchez-Lopez J, Rueda M, Salcedo G, Valero A, Yague J, Bartra J. Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens. Clin Exp Allergy. 2012;42(10):1529–39.CrossRefGoogle Scholar
  14. 14.
    Gao Z-S, Yang Z-W, Wu S-D, Wang H-Y, Liu M-L, Mao W-L, Wang J, Gadermaier G, Ferreira F, Zheng M, Van Ree R. Peach allergy in China: a dominant role for mugwort pollen lipid transfer protein as a primary sensitizer. J Allergy Clin Immunol. 2013;131(1):224–6.e3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Allergy and ImmunologyDepartment of Medicine, Albany Medical Center, Albany Medical CollegeAlbanyUSA
  2. 2.Division of Allergy and Immunology, Cohen Children’s Hospital of New YorkDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellGreat NeckUSA

Personalised recommendations