In this episode of The Good GP, host Dr Maria Li speaks with Dr Arthur Price, a clinical immunologist with expertise spanning food allergy and immunodeficiency, on the frequently overlooked condition known as oral allergy syndrome (OAS).

Dr Price begins by defining oral allergy syndrome as a mild form of food allergy where symptoms—typically oral itching—are limited to the mouth, lips, and throat following the consumption of raw fruits, vegetables, or certain nuts. He highlights the prevalence of OAS, noting that it affects up to 10% of the general population and is even more common among patients with hay fever and eczema.

Covering typical clinical presentations seen in general practice, commonly triggered foods (such as apples, stone fruits, and hazelnuts), and the distinct lack of systemic symptoms in classic OAS cases. 

They provide practical advice on recognising OAS, taking a thorough history, and distinguishing it from more severe or systemic food allergies. Dr Price emphasises the importance of a clinical diagnosis and discusses why routine allergy testing is seldom indicated unless the case is atypical. They also talked about the management of OAS, the role of dietary avoidance, the use of antihistamines if symptoms do not resolve quickly, and reassurance regarding the very low risk of severe or life-threatening reactions.

Discussing the impact of food preparation (e.g. tolerance of well-cooked fruits vs. raw forms), when to consider referral to allergy specialists, and how to support patients in making sensible, evidence-based decisions about food avoidance while maintaining good quality of life.

Links & Resources:

• https://www.allergyuk.org/wp-content/uploads/2022/03/Oral-Allergy-Syndrome-v5.pdf
• https://www.allergy.org.au/patients/food-other-adverse-reactions/oral-allergy-syndrome
• https://www.bsaci.org/wp-content/uploads/2024/03/Pollen-Food-Syndrome-PIL.pdf

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