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Oral allergy syndrome and risk of food-related anaphylaxis: a cross-sectional survey analysis


Oral Allergy Syndrome (OAS) is an IgE-mediated allergic response to fresh fruits, nuts and vegetables caused by cross-reactivity between pollen allergens and structurally similar food proteins. Alder pollen is a prominent allergen in coastal British Columbia, present at high levels from February- April. We hypothesized that this exposure may lead to increased prevalence of Alder pollen allergy and OAS. We sought to determine our population-based prevalence, cross-reactivity patterns, and incidence of food-related anaphylaxis.


A chart review of 574 allergic rhinitis patients seen from January 2010 - June 2011 was performed. 274 OAS patients were invited to participate in an online, telephone or in-person survey. Patients completing the survey in the clinic were invited to undergo a panel of skin prick tests.


63 patients were surveyed, 14 underwent skin testing. Patient characteristics included: median age=37 (range 20-77), 83% female, 36% atopic dermatitis, 24% asthma. OAS prevalence among seasonal allergic rhinitis patients=242/574 (42%). 14/14 patients were skin test positive for Alder and Birch. The most common OAS foods were apple 44/63 (70%), cherry 37/63 (59%), and peach 38/63 (60%). 28 had epinephrine auto-injector devices; 4 had used their device; 6/10 reactions involved foods that had caused OAS including apple, celery, green pepper, tomato, peanut, walnut.


In our population, the prevalence of OAS was slightly lower than expected at 42%. The most common OAS/pollen allergy was Alder, correlating with the high Alder pollen exposure in coastal British Columbia. OAS may be associated with serious reactions requiring use of epinephrine.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Jagdis, A., Kanani, A. & Stark, D. Oral allergy syndrome and risk of food-related anaphylaxis: a cross-sectional survey analysis. All Asth Clin Immun 7 (Suppl 2), A2 (2011).

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