Tag Archives: allergy

seasonal allergies

Seasonal Allergies

by allergies,

Fall can be a beautiful time of year. Unfortunately, it can also bring on seasonal allergies.

Allergies are your body’s reaction to a foreign substance it views as harmful, a type of “invader”, and for many people fall pollens can be big offenders. Over 24 million Americans suffer from seasonal allergies. Symptoms of these allergies can include nasal stuffiness, sneezing, runny and itchy nose, itchy throat and eyes, headaches, fatigue, sore throat, wheezing, coughing, and trouble breathing. In other words, these symptoms can make you feel downright miserable.

Common seasonal allergens

Many people are familiar with springtime allergies. The plants that are blooming which tend to most problematic are:

  • Grasses – These are among the biggest offenders. You’ll need to be aware of which grasses grow in your area. If you move to another location check to see if there’s a different grass that may be a problem for you.
  • Flowers – The spring flowers that are most likely to cause an issue are chamomile, chrysanthemums, daisies, and goldenrod, lilacs, and roses. But be aware that any plant pollen can be a trigger.
  • Trees – Because trees are so big they tend to put out a lot of pollen, making anyone with an allergy truly miserable during this time.  Just as with flowers, any tree pollen can be a candidate for inducing allergies.  The most common tree allergies are to ash, birch, cedar, cypress, hickory, pine, poplar, and willow.
  • Mold – Unfortunately mold can be both indoors and outdoors. And in the spring, especially in damp climates, it can cause high production of spores. Be sure to use a dehumidifier and try to keep your home as dry as possible.

But allergies don’t only happen in the spring.  Common fall allergens include ragweed, sagebrush, pigweed, tumbleweed, Russian thistle, cocklebur, burning bush, lamb’s quarters, and mugwort.

Reducing your allergy exposure

Avoiding these allergens is best but really not always possible so let’s look at some ways to mitigate some of the symptoms that accompany seasonal allergies.

  • Check local pollen counts
  • Keep windows and doors shut on high pollen days
  • Keep the windows of your car shut on high pollen days
  • Use HEPA filters
  • If you have air conditioning, use it on high pollen days
  • Take shoes off in the house
  • Vacuum daily to remove dust and pollen
  • Change your clothes after working or playing outdoors
  • Shower and wash your hair before going to bed to remove pollen from skin and hair
  • Change your pillowcases at least a couple of times a week
  • Wear sunglasses and a hat to protect your eyes from pollen
  • Drink more liquids to stay hydrated which can help thin mucus in the nasal passage.

Dietary support for allergies

seasonal allergies

Your overall health can have an impact on how your body reacts to these allergens so eating a healthy diet of fresh fruits and vegetables along with quality protein and healthy fats is very important. There are various foods and herbs that can also help.

  • Quercetin is believed to stabilize the release of histamines, inhibits inflammation, and helps control allergy symptoms. It is naturally found in broccoli, cauliflower, green tea, and citrus fruits.
  • Nettle is a strong herb that is known as one of the best anti-allergy herbs as it is an antihistamine. It has been shown to have positive effects in the management of allergic rhinitis.
  • Rosemary has antiseptic properties that can help fight respiratory infections and clear congestion.
  • Garlic is considered a great natural decongestant to help relieve sinus pressure. It is the allicin in crushed garlic that helps thin mucus and reduce inflammation. It can shorten the duration of the reaction by stimulating the immune system.
  • Butterbur is well researched and promising for treating seasonal allergies. It can work as well as pharmaceutical antihistamines without the drowsiness.
  • Turmeric has antihistamine properties because of the active ingredient curcumin. Scientists consider turmeric to be effective in relieving the airways, combat allergic reactions by palliating the immune response. It can inhibit histamine release also.
  • Ginger can help reduce inflammatory issues such as swelling and irritation in the nasal passages, eyes, and throat thereby reducing allergy symptoms naturally.

Some people who deal with seasonal allergies may also be allergic to certain foods as a result of eating allergy-triggering substances. Check out the posts about Oral Allergy Syndrome and Food Allergies 

 

[expand title="Sources"] 

  • Bakhshaee, M, Mohammad Pour AH, Esmaeili M, Jabbari Azad F, Alipour Talesh G, Salehi M, Noorollahian Mohajer M. Efficacy of Supportive Therapy of Allergic Rhinitis by Stinging Nettle (Urtica dioica)root extract: a Randomized, Double-Blind, Placebo- Controlled, Clinical Trial. Iran J Pharm Res. 2017 Winter;16(Suppl):112-118. PMID: 29844782; PMCID: PMC5963652.
  • Kawamoto, Y., Ueno, Y., Nakahashi, E., Obayashi, M., Sugihara, K., Qiao, S., Iida, M., Kumasaka, M., Yajima, I., Goto, Y., N., Kato, M., and Takeda, N. (2016) Prevention of allergic rhinitis by ginger and the molecular basis of immunosuppression by 6-gingerol through T cell inactivation. The Journal of Nutritional Biochemistry, Volume 27, 112-122, Retrieved from https://doi.org/10.1016/j.jnutbio.2015.08.025.
  • Kurup VP, Barrios CS. Immunomodulatory effects of curcumin in allergy. Mol Nutr Food Res. 2008 Sep;52(9):1031-9. doi: 10.1002/mnfr.200700293. PMID: 18398870.
  • Schapowal, A. (19 January 2002). Randomized controlled trial of butterbur and cetirizine for treating season allergic rhinitis. Retrieved from https://www.bmj.com/content/324/7330/144.short.
  • Thornhill, S. and Kelly, A. (2000). Natural treatment of perennial allergic rhinitis. Alternative Medicine Review. Volume 5 Number 5 2000. Retrieved from http://www.anaturalhealingcenter.com/documents/Thorne/articles/AllergicRhinitis.pdf.
  • Yamada, S., Shira, M., Inaba, Y., and Takara, T. Effects of repeated oral intake of a quercetin-containing supplement on allergic reaction: a randomized, placebo-controlled, double-blind parallel-group study. European Review for Medical and Pharmacological Sciences. Retrieved from https://www.europeanreview.org/wp/wp-content/uploads/4331-4345.pdf.
  • Yousef, M. Assessment of the effects of rosemary extract on mast cell-mediated allergic inflammation. Brock University. Retrieved from https://dr.library.brocku.ca/handle/10464/13676.

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food allergies

Food Allergies

by allergies, lacto-fermentation, ,

There are a number of different ways that our body can react to foods, food additives, toxins, molds, and environmental exposures.  But the terminology used by consumers to identify them can be a bit difficult to wrap your head around. What is an allergy? What is a sensitivity? Are all allergies the same? This article will help explain the difference between the two responses and looks specifically at foods and food additives.

The difference between allergy and sensitivity

A food allergy happens when the body’s immune system sees a particular food as harmful and reacts with a variety of symptoms. These can include hives, nausea, vomiting, diarrhea, breathing difficulties, and/or swelling around the mouth.

These types of allergies run the gamut from mild or moderate. Or it can escalate to the most severe reaction of anaphylaxis which can be potentially life threatening and requiring immediate medical attention. This type of allergy is an IgE (Immunoglobulin E) response; and is something an Allergist can test for.  Often it starts with a skin prick or scratch test.

The other reaction to certain foods is food sensitivity.  Instead of a skin prick or scratch test, it is often identified by

  1. Drawing blood and then exposing the blood to various proteins to see which ones cause a reaction, or
  2. Going on a full elimination diet, removing the suspected foods from the diet for a period, of time and then gently re-introducing them in a challenge to see if there is a response. An elimination diet is best for top level foods such as wheat, eggs, dairy, soy, etc rather than embedded ingredients such as calcium propionate, sodium benzoate, or BHA.

Food sensitivities can be overwhelming to the system. However, these are not the same as food allergies although, unfortunately, the term allergy is used interchangeably between the two.  

An example of this would be someone who is allergic to fish or seafood.  They may have a severe physical response to it and should not ever eat them or be exposed to them.  Someone who has a food sensitivity to fish or seafood may be able, with appropriate nutritional support, to eventually include it in their diet again.

Food sensitivities are on the rise

Food sensitivities and food allergies are on the rise, why is this? There are different thoughts, but one is the health of our gut microbiota. A recent study done in Sweden entitled, “Low diversity of the gut microbiota in infants with atopic eczema” appears to show that higher diversity in infant gut microflora lowers the chance of allergies, including eczema.

This is of interest for a number of reasons.  

  1. It appears to support the Hygiene Hypothesis.  This is the idea that if our environment is too clean it doesn't provide the diversity we need and also encourages the body to attack “harmless antigens.”  
  2. It provides further information about the role of certain beneficial bacteria.  Examples included proteobacteria protecting against allergies while Bacteroides appear to be useful against inflammation.  
  3. It shows, yet again, the connection between the gut and health.  
  4. It highlights, to me, the dangers of the over-use of antibiotics.  I have written briefly about antibiotics in our food supply here. 

The more antibiotics that appear in our food system, the higher the toll they take on our bodies.  Dr. Natasha Campbell-McBride, author of Gut and Psychology Syndrome and creator of the GAPS Diet, tells us that when she looks at dysfunction in the gut she traces it back over at least three generations.  The less healthy flora the parents have to pass on, the fewer strains will be available to inoculate the baby.  Dr. Campbell-McBride has found the effect of reduced intestinal flora to be cumulative over the generations.

What does all of this mean?

In addition to cleaning up our irresponsible use of antibiotics in the food supply, it also means that we need to do what we can to ensure a strong, healthy eco-system in our gut - creating a rich supply of diverse prebiotic and probiotic colonies.  

Adding fermented foods to the diet such as kombucha or kefir is a good start.  Other fermented foods could include yogurt and live culture sauerkraut.  Eating a diet high in fiber, especially soluble fibers which are fermented by the bacteria in the gut will help.  

Should you need to take antibiotics it is vitally important that you take them as prescribed and finish the dose to avoid creating resistant bacteria.  You will also need to re-inoculate your system by taking probiotics (antibiotics wipe out both good and bad bacteria).

In summary

While the study from Sweden highlights the benefits of a richly diverse gut colony in infants for protecting them against allergies, I feel that supporting the gut at any time is beneficial.  I also believe probiotic support can go a long way toward helping to regain or maintain healthy gut function. Having a healthy gut can also be beneficial when dealing with seasonal allergies.

 

[expand title="Sources"] 

Abrahamsson, Thomas R. et al. "Low Diversity Of The Gut Microbiota In Infants With Atopic Eczema". Journal Of Allergy And Clinical Immunology, vol 129, no. 2, 2012, pp. 434-440.e2. Elsevier BV, doi:10.1016/j.jaci.2011.10.025.

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Food allergens allergies

Top Food Allergens And Hidden Sources

by allergies, , , ,

Food allergies are a very serious issue. Thirty-two million Americans have food allergies (I’m one of them). That equates to 1 in 10 adults and 1 in 13 children -- and the numbers of people appear to be increasing. That's why people with food allergies should read labels to avoid food allergens. 

Food Allergy & Food Intolerance

Food intolerances are often confused with food allergies. These intolerances, or sensitivities, don't involve the immune system are not typically life-threatening.

On the other hand, true food allergies are caused by your immune system wrongly recognizing some of the proteins in food as harmful. These allergies can be significant, possibly requiring hospitalization, and sometimes can be fatal. Unfortunately, there is no cure for this. 

The only way to avoid an allergic reaction is to avoid the item. This can be difficult to do with some food allergens as they are used as ingredients in other foods, beverages, or supplements.

That’s why food allergen labeling is so important when purchasing prepared items. For those with a food allergy it’s critical to tell people what your allergies are so they can let you know if they make something with one of those ingredients.

Latest News on Food Allergen Labeling

On April 24, 2021, the president signed legislation making sesame the 9th identified food allergen. Because of lead times required to change packaging and labeling, companies are being given until January 1, 2023, to comply with mandatory labeling for sesame. 

Even after sesame appears on the label as an identified allergen, those 1.5 million Americans who struggle with the allergy need to be aware of foods that may contain sesame or sesame-derived products.

Sesame derived products include:

  • Sesame oil
  • Tahini - sesame seed paste
  • Falafel - may contain sesame seeds and tahini
  • Hummus - may contain tahini
  • Sushi - the oil and seeds may be used in this
  • Halva - sesame based Middle Eastern/Mediterranean sweet
  • Chikki - an Indian sweet
  • Sesame seeds also feature in several dry condiments such as furikake or gomashio
  • Cosmetics (found in many lip balms, ointments, eye products, soaps, oils, creams)
  • Pharmaceutical products (check the package insert)

Top Eight Food Allergens

While over 160 foods can cause allergic reactions in people with food allergies, the law identifies the eight most common allergenic foods. 

Milk/Dairy

Allergy to cow’s milk affects 2.5% of toddlers under the age of 3. Most of these children develop allergies when exposed to cow’s milk protein in their first year of life.

However, about 90% of them can outgrow this allergy when they turn three, making it less common in adults. 

Lactose intolerance is commonly confused with milk allergy, but this condition is not an allergy. 

Dairy products can be a source of protein, calcium, vitamin D, and vitamin B12. Here are some safe food sources to replace these dietary needs: 

  • Protein - meat
  • Calcium - leafy green vegetables, broccoli, collards, kale
  • Vitamin D - fatty fish or supplements (It is recommended to speak with a board-certified allergist before adding this to your diet)
  • Vitamin B12 - Organ meat, poultry, meat, fortified foods (Read the label)

Cow’s milk in unexpected places: 

  • Chewing gum
  • Cold cuts
  • Cereal
  • Non-dairy products
  • Processed and canned meats
  • Frozen and refrigerated soy products
  • Sheep & goat’s milk
  • Deli meats (due to cross-contact from slicing cheese)
  • Cosmetics
  • Supplements & medicines

Eggs

Egg allergy is among the most common causes of food allergies in children. About 68% of them can outgrow this allergy when they turn 16. 

Most allergenic proteins are found in egg whites, but it is recommended to avoid egg whites and egg yolks.  

An egg is an excellent source of dietary fat and protein. Here are some alternatives: 

  • Protein: meat
  • Fat - avocado, meat, vegetable oils

Eggs in unexpected places: 

  • Shiny coats/glazes on pastries/candies. These may be egg washes. 
  • Many egg substitutes may contain eggs.
  • Pasta sold in stores may contain eggs.
  • Marshmallows, marzipan, and nougat may contain eggs.
  • Foams on coffee drinks may also contain eggs.

Peanuts 

Allergy to peanuts is one of the leading causes of fatal food allergies in the United States. Peanut allergies affect around 4–8% of children and 1–2% of adults. However, only about 20% of children with this allergy may outgrow it. Therefore, the treatment is lifelong and requires complete avoidance of peanuts and peanut-containing products. 

Here are some foods that may contain peanut as an unexpected ingredient:

  • Egg roll (used binding agent)
  • Pet food
  • Bird Seed
  • Crepe filling
  • Mole Sauce
  • Glazes and marinades
  • Graham cracker crusts
  • Chili & hot sauces
  • Pesto
  • Gravy

Tree Nuts

This is one of the most common food allergies in adults and children. Around 1% of the US population is affected by tree nuts allergy. Approximately 9% of patients outgrow this allergy.

As you know, tree nuts are not the same as peanuts. Tree nuts grow on trees, while peanuts grow underground and are part of the legume family. 

Tree nuts in unexpected places: 

  • Cereals
  • Crackers & cookies
  • Trail mixes
  • Candy
  • Flavored coffee
  • Frozen desserts
  • Marinades
  • Nutritional supplements
  • Medications
  • Cold cuts like Mortadella

Shellfish 

About 60% of people with this allergy experience their first allergic reaction as adults. 

Allergy to crustacean-type shellfish (shrimp, crab, and lobster) is more common than allergy to mollusks (clams, mussels, oysters, scallops, and octopuses). 

Shellfish in unexpected places: 

  • Asian dishes and in stuffing (i.e., oyster stuffing)
  • Pet food (for those that may have problems even touching it)
  • Nutritional supplements
  • Fertilizers
  • Imitation shellfish (surimi) may contain shellfish or used shellfish as a flavoring. 

Wheat 

Two-thirds of children with this allergy outgrow the wheat allergy by age 12. Unfortunately, some individuals remain allergic to wheat throughout their lives.

Wheat allergy is often confused with Celiac disease since both involve a reaction to gluten. However, a wheat allergy causes an immune response to one of the hundreds of proteins found in wheat. In contrast, Celiac disease is caused by an abnormal immune reaction to gluten and is not life-threatening.

Wheat in unexpected places:

  • Ale & Beer
  • Candies
  • Cereals
  • Crackers
  • Gravy or roux (often thickened with flour)
  • Ice cream products
  • Hot dogs and processed meats
  • Salad dressings, sauces, and soups (usually thicker soups)
  • Soy sauce
  • Surimi (a paste made from fish or other meats) 

Soy

Soy allergies are common in infants and young children. Although it occurs in roughly 0.5% of children under three, around 70% of them outgrow the allergy.

Like peanuts, soybeans are a member of the legume family. Being allergic to soy does not necessarily mean that you are also allergic to another legume. 

Where to find soy: 

  • Asian cuisine
  • Baked goods
  • Canned meats, including canned tuna
  • Processed meats
  • High protein energy bars
  • Infant formulas
  • Protein shakes

Fish

Allergy to finned fish (cod, flounder, salmon, tilapia, tuna, etc.) affects nearly 1% of the population and is more common in adults. 

Since shellfish and fish with fins have different proteins, people who are allergic to shellfish may not be allergic to fish.

Finned fish in unexpected places: 

  • Caesar dressing
  • Caesar salad
  • Bouillabaisse
  • Imitation crab
  • Fish stock
  • Seafood flavorings
  • Worcestershire sauce

 

Always read labels closely, communicate with foodservice professionals clearly, and constantly carry at least two (2) epinephrine auto-injectors.

Checking for Food Allergens

While some of the body's responses to food allergies can be similar to food intolerances, with allergies the response can, over time, become more severe.  This makes knowing whether it is an intolerance or a true food allergy important.  Because the body mechanism for food allergies is different than food sensitivities it’s best to see a board-certified Allergist and have proper testing.  

The testing usually starts with Skin Prick Testing. Depending on the results your doctor may also decide to do a blood test to confirm the findings of the skin prick test.  

[expand title="Sources"] 

"With The Stroke Of President Biden’S Pen, FASTER Act For Sesame Labeling Becomes Law". Food Allergy Research & Education, 2021, foodallergy.org/media-room/stroke-president-bidens-pen-faster-act-sesame-labeling-becomes-law. 

"Facts And Statistics." Food Allergy Research & Education, 2021,  foodallergy.org/resources/facts-and-statistics. 

"Skin Prick Tests". Food Allergy Research & Education, 2021, foodallergy.org/resources/skin-prick-tests.

"Sesame | Description, Uses, & Facts". Encyclopedia Britannica, 2021, britannica.com/plant/sesame-plant. 

“US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up.” The Journal of Allergy and Clinical Immunology, 2010  jacionline.org/article/S0091-6749%2810%2900575-0/abstract. 

“Common Food Allergens.” Food Allergy and Anaphylaxis Connection Team, 2021  foodallergyawareness.org/food-allergy-and-anaphylaxis/food-allergens/the-top-8-food-allergens/. 

“Common Allergens.” Food Allergy Research and Education.  foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens. 

“The 8 Most Common Food Allergies” Healthline, 2017. healthline.com/nutrition/common-food-allergies. 

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Do You Have Oral Allergy Syndrome?

by environment, food intolerance, health, immune system, seasons,

You wake up in the morning and you brush your teeth then wash your face with your all natural face wash.  You’re in a hurry to get out the door for work but know you need to at least try to eat something, so you grab a ripe peach, or my favorite a crisp apple, to eat on the way to work.  You take a few bites and then it starts, your mouth gets itchy and your tongue starts to burn.  You start to think, “Was there something in my toothpaste?  Maybe I got some of the facewash in my mouth?  I think I would have known that.”

While there are real concerns with the products we use for our oral hygiene, there is another concern that may not have crossed your mind, pollen food syndrome, also known as PFS. 

What is PFS?

PFS is an allergic response marked by severe itching of the skin of the lips and mouth that can come with swelling or tenderness in and around the mouth or lips. 

PFS, also known as oral allergy syndrome, OAS, is distinct from another condition affecting the lips and mouth, burning mouth syndrome, or BMS. 

The difference between the two conditions is the cause of the itching and burning.  In BMS, the symptoms can be caused by a variety of things such as a systemic issue like diabetic nerve damage, nutritional deficiencies, hormonal changes, psychological disorders or from other causes like chemotherapy, neurodegenerative diseases like Parkinson’s, simple mouth infections like cold sores, or a candida infection.

When the condition is BMS the issue can sometimes be resolved by removal of the causative factor, such as changing to a different brand of toothpaste if the is caused by a specific chemical in it, such as sodium lauryl sulfate. In the case of systemic causes, dietary changes and treating any nutritional deficiencies can help to solve the overarching issue. In PFS the cause is from an antibody cross-reaction with proteins in the problem food. 

For our immune system to work properly, a protein on a bacteria needs to be recognized by our immune system.  Once recognized, our immune system can then identify and go to work attacking the problem organism.  The issue in PFS, like all allergies, comes when your body starts to recognize proteins as problematic when it shouldn’t.

Fortunately, unlike other food allergies, PFS is rarely life-threatening, though this fact won’t comfort someone who suffers from PFS.  A diagnosis of PFS is typically done on a case by case basis and those with PFS often have a history of hay fever with skin tests to the pollens or foods in question.

Due to the need to rule out other causative factors, people typically don’t get diagnosed until they have a medical history documenting issue. This explains why children are often undiagnosed. Some doctors will look at total or specific IgE antibodies to try and confirm an immune response and to rule out other factors.

How is PFS different?

While the itching, pain, and discomfort from PFS may seem like BMS, there are important differences.  One of these differences is that those who suffer from PFS often have an allergy to something else such as a classic food allergy, or an allergy to pollen. 

Another factor is that in people with PFS, the trigger foods typically come when raw food is consumed, and sufferers don’t have the same reaction when the food is cooked.  If you reacted to a raw apple or peach, you typically don’t get the same reaction to a cooked fruit dessert such as an apple or peach pie. This is because the proteins that cause the reaction in the food are not heat tolerant.  When these foods are cooked, the proteins will start to break down and thus won’t result in an immune response because our body is no longer able to recognize these proteins it thinks are harmful. 

PFS is often seen in people who have cross-reactions to birch, grass, or ragweed pollens.  People who are sensitized to birch pollen often cross-react with apple, pears, carrots, or celery and those sensitized with grass pollen will often cross-react with celery and carrots. There is concern that pesticides applied to plants may increase the expression of cross-reactive proteins in plants.  This means that eating clean foods and minimizing the chemicals in our environment can go a long way in terms of prevention PFS prevention.   

The Cross Reactors

Tree Pollen (typically birch and alder)

Fruits: Apple, apricot, cherry, fig, kiwi, lychee, nectarine, pear, plum, peach, prune, persimmon, strawberry

Vegetables: Beans, carrot, celery, green pepper, potato, parsnip, peas

Nuts: Almond, hazelnut, walnut

Spices: Anise, basil, dill, caraway, chicory, coriander, cumin, fennel, marjoram, oregano, parsley, paprika, pepper, tarragon, thyme

Other foods: Lentils, peanut, soybean, sunflower seeds

Grass

Fruits: Date, fig, kiwi, melons, orange, tomato, watermelon

Vegetables: Peas, potato

Other foods: Peanut

Mugwort (More common in Europe and Asia)

Fruits: Apple, melons, orange, peach, tomato, watermelon

Vegetables: Carrot, celery, green pepper, onion, parsnip

Other foods: Chamomile, sunflower seeds

Ragweed (pollinates in autumn)

Fruits: Banana, melons (e.g. cantaloupe, honeydew), watermelons

Vegetables: Cucumbers, zuchhini

At a glance

What to do if you have PFS?

If you suspect you have, or have been diagnosed with, PFS one of the first things you may be told is that there is no treatment available and to simply avoid the food that is causing the reaction. 

As mentioned above, cooked foods don’t result in the same reaction most of the time. When the food is from a fruit like an apple, you can also remove the skin as a way to weaken or remove the reaction.  The reason removing the skin works for some foods is because the skin often contains more protein than the rest of the food. 

When you remove the skin, you also take the problem causing proteins with it.  This should be done with caution though because fruits and vegetables can contain different amounts of the problematic protein depending on the conditions the food was grown in or how ripe it is. This means that removing the skin of one type of apple might not work while it may for another. 

It’s been estimated that 47-70% of people who suffer from allergic rhinitis also have PFS.  So if you have seasonal allergies it may be worth finding out if you have minor PFS symptoms that have gone unnoticed.

[expand title="Sources"] 

Allergic Living. (2010). Oral Allergy: Plants, Foods That Cross-React.  Retrieved from: https://allergicliving.com/2010/08/30/the-cross-reactors/

Coculescu, E. C., Ţovaru, Ş., & Coculescu, B. I. (2014). Epidemiological and etiological aspects of burning mouth syndrome. Journal of Medicine & Life, 7(3), 305-309Hofmann, A., & Burks, A. W. (2008). Pollen food syndrome: update on the allergens. Current Allergy and Asthma Reports, 8(5), 413-417.

Ludman, S., et al. (2016). Pollen food syndrome amongst children with seasonal allergic rhinitis attending allergy clinic. Pediatric Allergy & Immunology, 27(2), 134-140. doi:10.1111/pai.12504

Ivković-Jureković, I. (2015). Oral allergy syndrome in children. International Dental Journal, 65(3), 164-168. doi:10.1111/idj.12164

Portnoy, J. (2015). IgE in clinical allergy and allergy diagnosis. World Allergy Organization. Retrieved from: http://www.worldallergy.org/professional/allergic_diseases_center/ige/

Rivinius, C. (2009). Burning mouth syndrome: Identification, diagnosis, and treatment. Journal of The American Academy of Nurse Practitioners, 21(8), 423-429. doi:10.1111/j.1745-7599.2009.00424.x

Seto, C. (2010) OAS- When raw food is forbidden.  Allergic Living. Retrieved from: https://allergicliving.com/2010/07/02/oral-allergy-syndrome-a-life-without-fruit/

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