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Intriguing Cases


Dr David L. J. Freed, MB, MD, MIBiol

Oral allergy syndrome is a burning sensation in the mouth immediately after eating certain plant foods (classically apple, celery, carrot, avocado) and is associated with and caused by cross-reacting allergens found in these plants and in birch pollen. Two decades of intensive immunobiochemistry have shown several cross-reacting antigens to be implicated in the serology, including the ubiquitous profilins and several carbohydrate antigens. Although oral allergy syndrome is rarely dangerous, it can lead on to anaphylaxis [1-3].

This pleasant 62-year-old lady (retired clerical officer) had always had a "ticklish stomach" (a tendency to nausea, vomiting and weight loss), but had managed well enough until four years previously when she had had an attack of food poisoning while on holiday in Las Vegas, after which she had never fully recovered. The presenting symptoms were burning mouth after most foods, frequent oral thrush, dry mouth and vagina, and nausea. Even drinks of water made her mouth burn. Although a small-bowel biopsy had been pronounced normal, she had decided to try a gluten- free diet and felt quite a bit better, so as time passed she experimented with eliminating other foods, with variable success. By the time she reached me she was notably underweight and eating only carrots, peas, bean sprouts, potatoes, poultry, salmon and tuna. Her consultant physician had also persuaded her to consume "Fortisip" in the hope of arresting the inexorable weight loss. Unusually for oral allergy syndrome, she did not have symptoms of pollen allergy.

I neutralised her for six foods (meats and greens) in the hope of enabling her to expand her diet. For two weeks afterwards she was indeed able to eat these foods without symptoms but after that the trouble recurred. This meant to me either (a) that the neutralising dilutions had changed rapidly, or (b) that she had recruited new allergens, or (c) that this syndrome really was all in the mind. There are no diagnostic tests to distinguish between these possibilities but clearly neutralisation was not going to be a useful treatment for her.

I therefore initiated treatment with EPD (XT), and when she returned two months later for her second dose she astonished and delighted me by reporting that she had been very much better for most of that time. She had been eating freely and had gained half a stone in weight, to her delight and that of her worried family. Within the last fortnight she had started to get symptoms again, so she felt ready for the second dose.

She continued to get better and better on alternate-monthly EPD although by the end of the first year she noticed that wheat products (which she was now consuming freely) caused her to have low back pain and swelling in the sacral region. I interpreted that to mean that wheat lectins, the actions of which are not immunological and which presumably are not amenable to desensitisation, were affecting the connective tissues to form rheumatic patches [4], and on examination she indeed had new rheumatic patches in those areas. At my advice she moderated her wheat intake, moved more in the direction of a "very mixed diet" [5], and the rheumatism improved.

In the January of the third year she rang to say that she felt "marvellous", and "had had the first proper Xmas for years". We decided by mutual agreement to stop her regular EPD and give her an occasional shot only if needed. The continued steady improvement since starting EPD rules out any suggestion of placebo response, and retrospectively also rules out any psychological theory of causation.

REFERENCES for Oral allergy syndrome

1) Sloane D, Sheffer A. Oral allergy syndrome. Allergy Asthma P roc 2001 22:321- 325.

2) Pemo M. Burning mouth syndrome. J Dent Hyg 2001; 75:245-52.

3) Kwaasi AA, Harfi HA, Parhar RS, Saleh S, Collison KS, Panzani RC, Al-Sedairy ST. Al-Mohanna FA. Cross-reactivities between date palm (Phoenix dactylifera L.) polypeptides and foods implicated in the oral allergy syndrome Allergy 2002- 57:508-18.

4) Fox WW, Freed DLJ. Understanding Arthritis: the Clinical Way Forward. Macmillan, Basingstoke, 1990, 63-71.

5) McEwen LM. Allergy and EPD. McEwen Laboratories, Pangboume, 2002 pp A10.12-13.

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