Pollen food syndrome in children

Pollen food syndrome, more commonly known as oral allergy syndrome, can affect children of any age, but usually over the age of 2 years. 

Allergic reactions due to pollen food syndrome can range from mild to severe, so it’s important to know the signs and symptoms of the condition so that you can act quickly to get your child the treatment they need if they’re affected. 

What is pollen food syndrome? 

Pollen food syndrome happens when your child has a hypersensitivity to certain raw fruits, vegetables or nuts – resulting in an immediate allergic reaction that affects their lips, mouth and throat after eating them.

The symptoms of pollen food syndrome may be similar to other food allergies, but the condition is different in that it comes on only after developing a pollen allergy. This means your child can suddenly start having allergic symptoms to foods that they have been eating all their lives, which can be very worrying to both you and your child.

What causes pollen food syndrome?

Pollen food syndrome happens when your child’s allergy antibodies mistake certain proteins in raw fruit, veg and nuts for pollen, triggering an allergic reaction. 

It’s not exactly clear why this happens, but children who also have hay fever, asthma or eczema seem to be at higher risk of developing pollen food syndrome. Reports show that pollen food syndrome affects approximately 50% of children in Britain who have birch-pollen allergy, ranging from 17% to 36% of birch-pollen allergic children under 5 years of age, up to 70% of birch-pollen allergic aged 10 to 18 years.

Common pollen food syndrome triggers

Any raw plant-based foods can cause an allergic reaction but the most common foods involved in pollen food syndrome are:

• Apple 
• Peach and other stones fruits
• Carrot
• Potato
• Peanut
• Hazelnut
• Almond 

Some children will only be affected by one or two foods, while others may react to a wide range of raw fruits, vegetables and nuts. 

What are pollen food syndrome symptoms?

Unlike other food allergies, symptoms in pollen food syndrome are usually limited to the mouth, lips, tongue and throat. This is because the proteins causing the allergic reaction are broken down by saliva and digestive juices in the stomach. 

Symptoms of pollen food syndrome to look out for in your child can include one or more of the following:

• Itchiness or tingling in their lips and mouth
• Swelling of their lips, tongue or inside of the mouth
• Tightness and itching of their throat
• Facial swelling and redness
• Skin irritation on their hands from holding the raw food
• Sneezing and irritation to the eyes if around the food while it’s being prepared
• Abdominal pain
• Very rarely, anaphylaxis (in cases of severe allergy and usually with a large dose of the food)

How common is pollen food syndrome?

Pollen food syndrome is most common in adults. The condition rarely appears in young children but is more common in older children, teens and young adults. 

The exact number of those affected is difficult to pinpoint as pollen food syndrome often goes undiagnosed, but a UK study suggested the condition affects around 2% of the general population.

How is pollen food syndrome diagnosed?

Pollen food allergy syndrome is easily diagnosed through assessment of your child’s symptoms and through performing a few different tests. 

Your paediatric allergist will ask a number of questions regarding your child’s symptoms, previous allergic events and any family history of allergies. 

They will also carry out a skin prick test to help identify which foods your child is allergic to, so you and they know which ones to avoid. 

Pollen food syndrome treatment 

Even if your child’s symptoms are mild, pollen food syndrome can feel worrying, especially the first time it happens. Thankfully, there are several treatments for pollen food syndrome reactions including: 

• Antihistamines – if your child has a mild reaction, over-the-counter liquid or small tablet antihistamines can help treat and relieve their symptoms 
• Auto-injectors – if your child has had a severe allergic reaction, they should have been prescribed an auto-injector, such as the EpiPen, Jext pen or Emerade pen, that you and/or they should carry at all times

If your child needs an auto-injector, you will be trained in how to use this and receive a personalised allergy action plan for your child’s allergies.

Preventing pollen food reactions

There are also a number of ways that you and your child can prevent reactions from occurring in the first place, such as:

• Heating and processing plant-based foods – this destroys the pollen-related allergenic proteins, so your child can safely eat the food that affects them without having an allergic reaction 
• Reading food labels – checking that any pre-prepared foods or drinks your child has do not contain the implicated plant-based allergens
• Controlling other conditions – ensuring that any other conditions your child has, such as asthma, eczema and hay fever, are well controlled can help reduce their chance of having a more severe allergic reaction

How Children’s Allergy Doctors can help 

At Children’s Allergy Doctors, we can differentiate between true immediate IgE-mediated food allergy and pollen food syndrome. We use a combination of history taking, modified skin prick testing and the latest advances in allergy testing (molecular allergology) to do this. 

We also provide advice on how to manage pollen food syndrome, so you can feel more confident in caring for your child. Get in touch to book a consultation.

What parents say:

“Excellent! I highly recommend Dr Brough to any parent with allergy concerns about their children.”