SHOW NOTES
How common are pollen allergies? [0:40]
- American College of Asthma Allergy and Immunology reports 25 million Americans suffer from seasonal allergic rhinoconjunctivitis (SAR) also known as seasonal allergies, hay fever, particularly in childhood and adolescence
- Primarily sinus-related - runny nose, nasal congestion, sneezing
- Water eyes
- 1 of every 6 Canadians suffer from seasonal allergic rhinoconjunctivitis
Be careful with Benydryl for seasonal allergies [1:50]
- Over the counter medication is an acetylcholine interrupter
- Decreases acetylcholine - important neurotransmitter for motor neuron responsiveness and memory
- Slows reaction time
- Difficulty remembering names/words
- Speak with your doctor about the type of allergy medication that is best for you
Pollen Food Allergy Syndrome [3:20]
- Last week covered that food allergies can be linked to other medical conditions, either caused or made worse by consuming the allergic food
- Pollen Food Allergy Syndrome can be difficult to find/diagnose
- Condition tied to classic pollen allergies
- Pollen food allergy syndrome is a common adverse reaction occurring a few minutes after the consumption of specific pollen-related foods in patients with pollen-induced seasonal allergic rhinoconjunctivitis (SAR)
- Occurs in people who are already proven sensitive to pollen / have seasonal allergies
- Pollen food allergy syndrome often has oral/pharyngeal symptom
- Itchy tongue/throat/mouth
- Sinuses & watery eyes
- Can be any set of symptoms above the neck (head, eyes, ears, nose, throat)
- Skin rashes & hives
- Nausea & vomiting in more severe cases
- In rare cases, anaphylaxis
The pathogenesis of pollen food allergy syndrome [5:45]
- Pathogenesis = development of medical condition or disease
- Linked to respiratory allergy to pollens and cross-reactivity between pollens and plant derived protein
- Respiratory allergy to pollen (inhale the pollen) & plant-derived proteins from a related fruit or vegetable that has similar impact on the immune system akin to the pollen
- Called a homologous epitopes
- Homologous = having the same relation, relative position, or structure
- Epitope = part of the antigen that the immune system recognizes
- Homologous epitopes = similar parts of the antigen that is recognized by the immune system
- Similar parts of the allergen (antigen) are recognized in both the pollen and the food
- Antigen = substance that you are reacting to, stimulates an immune response to attack the “threat”
- Antibody = produced by immune system (B-cells) to target a substance your immune system reacts to
- Will tag an antigen
- Creating an antigen-antibody complex
- Which signals other immune cells to attack the threat
- Can create mast-cell histamine response
- Causes all symptoms of an allergy
- Foods you eat to nourish yourself could be making your seasonal allergy symptoms worse, because you’re allergic to those foods too
There is a difference between a histamine mast-cell response, and a true IgE immune system response
- First contact via the respiratory tract to pollen allergens that leads to the allergen sensitization process and development of allergic rhinitis
- You breathe in pollen, get allergy symptoms
- After that exposure and immune reaction a second step transpires wherein plant-derived foods that contain cross-antigens to the inhaled allergens
- Your immune system is responding to the pollen exposure
- You introduce a fruit that shares the similar allergen epitopes
- Example: birch pollen allergy, eat kiwis - allergy
- Stimulates second immune system response
- Causes a secondary immune response via t cells and IgE memory
- Resulting in a food allergy reaction
- Pollen allergy crosses over to food allergy, both symptoms for both worse
- Need to track down both allergies
- Food allergy can show up at any time
- If more allergenic food proteins appear to show the same epitopes, the IgE antibodies cross-react, binding to the food component causing an antibody antigen reaction without any prior history of contact allergen
How many people that have pollen allergies have Pollen Food Allergy Syndrome? [11:30]
- Most data from children & pediatric population
- 42.7% of children in Korea who had pollen allergies had Pollen Food Allergy Syndrome
- 31% of children in Sweden
- 12% in Mexico
- 29% in Italy
- 29.7% in Croatia
- Under 12.9% in UK & Australia
- Likely underreporting
- Allergists prescribe immune system suppressors to shut off immune system response, can give false negatives
- 1 of 3 people with SAR/hay fever in USA & Canada - reaction is caused by an immune system food response
- Travelling outside of country, exposure to new foods/pollens can cause allergy response
Why is Pollen Food Allergy Syndrome so under-diagnosed? [16:30]
- Allergists typically focuses on external environment
- Often give medication without testing patients
- Won’t look for it unless patient brings up suspected reactions themselves
Cross-reactions can be tested via elimination diet [18:50]
- Write down frequency of suspected foods (see list below)
- Eat each of the foods one at a time without another food
- Wait 4 days to determine reaction
- Record allergy symptoms - flare/same/better/worse/
- Repeat with other suspected foods on the list
- Bring suspected list to doctor for scratch test, regional allergen test & IgE blood test
Pollens and Triggering Foods [21:10]
- List is growing & highly dependant on geographical location, foods consumed and the travel of an individual
- Look at regional environment & surrounding state environmental allergens of all places you reside (vacation homes, extended travel)
- Regional Environmental Allergy Panel IgE
- Molds, pollen, grasses, trees
- These fruits, vegetables, nuts, legumes & seeds species share a similar epitope to the pollen of the plant/grass/tree [23:30]
- Specific similar antigen stimulation of our immune system
- Structure of proteins in the foods are almost identical to the environmental pollen allergen
- Multiple areas of structural similarity
- Component in amino acid structure called a beta sheet
- Example - Alzheimer's patients produce harmful proteins - beta amyloid plaques - structure
- Profilins sequences can be 75% similar in the food & the pollen
- Close enough for immune system to see both as a threat
- Lipid transfer proteins
- LTPs can bind to molecules & travel across membranes
- Shared between both pollen & food
- Ex - Dr. Pastore’s wife - itchy mouth eating banana, secondary reaction to latex due to allergic LTP association. Share same LTP immune system reaction
- Alder Pollen - apple, cherry, peach, pear, parsley, celery, almond, hazelnut
- Birch Pollen - kiwi, apple, pear, plum, apricot, cherry, tomato, celery, carrot, fennel, potato, green pepper, cumin, pear, hazelnut, walnut, almond, peanut, lentils
- Cypress/Cedar - peach, citrus fruit, apple, melon, tomato
- Grass - melon, watermelon, orange, tomato, kiwi, potato, swiss chard, peanuts
- Mugwort - peach, lychee, mango, grape, celery, carrot, parsley, fennel, garlic, cabbage, broccoli, coriander, cumin, sunflower seeds, peanuts
- Pellitory - peach, cherry, melon, pistachio
- Ragweed - watermelon, banana, zucchini, cucumber, squash
- Identify the source, stop the primary immune system response, may not react or have seasonal allergy symptoms anymore
Diagnostic process for Pollen Food Allergy Syndrome [32:00]
- Walk into your allergist’s office prepared
- Write down frequency of consumption of suspected foods (see list below)
- Eat each of the foods one at a time without another food
- Wait 4 days to determine reaction
- Record allergy symptoms - flare/same/better/worse/
- Repeat with other suspected foods on the list
- Bring suspected list to doctor for scratch test, regional allergen test & IgE blood test
- Request that your physician or allergist run the following:
- Skin prick test for full list of foods associated with the pollen
- Total IgE (to rule out false-negatives)
- Regional Environmental Allergy Panel IgE
- IgE panel for full list of foods associated with the pollen
- Once tested, complete an oral food challenge (elimination diet) when allergy symptoms are present, allergy is clear, but test negative IgE
- Stop eating that food, determine how you feel
- If the history & symptoms are clear, you may be reacting in a different (non-IgE) way
- Reintroduce at a later date & assess symptoms
- Keep food fresh/raw when trying
- Heating can affect some of the immune system reactions
- Makes the reaction more mild, but still a reaction
What is the treatment for Pollen Food Allergy Syndrome? [38:00]
- Strict avoidance of triggering foods
- Sadly on 53% of cases that allergists recommend this, rely on medication more
- 9% did not mention food restrictions at all
- Individual patient advice
- Absence makes the immune system grow fonder
- Remove cross-triggering foods, difficult to avoid the environmental pollen when living in the area
- Identify other non-allergy immunological food reactions
- Identifying true food allergies can result in a normalization of blood pressure [43:00]
- The solution to pollution is dilution
Environmental pollen allergen + food allergen occurring at the same time creates dramatic water retention & pulmonary (lung) issues
- Difficult to breath, exercise is difficult
- Reduction in cardiovascular output
- Gut issues in pollen/food allergies too
- Different types of pollen & grasses, severity based on the season
Can you eat the food allergen if the pollen allergen is not in season? [46:00]
- Immune system reaction will still be present, just not as severe
- If the related food is continually consumed, even after pollen goes out of season, can still form IgE allergy (more severe) rather than a mast-cell histamine reaction
- Due to immune system IgE memory
- No pollen in the winter, no symptoms from pollen allergy, but still reacts to the food
- Stop the exposure, immune system can calm down, IgE memory may “forget” and the food won’t stimulate the immune system any more
Wrap Up [52:00]
- Be an advocate for your own health
- Record your symptoms, gather as much data as possible
- Talk to your family about pollen & food allergies
- Share this information with your doctor
- www.drrobertpastore.com
- help@poweronpoweroff.com
- @drrobertpastore
LINKS
Top 9 Food Allergy Podcast
https://drrobertpastore.com/podcasts/070-food-allergies
University of Manchester Foods Cross-Reacting with pollen: http://research.bmh.manchester.ac.uk/foodallergens/facts/pollen/pollenandfood/
Pollens and Triggering Foods
- Alder Pollen - apple, cherry, peach, pear, parsley, celery, almond, hazelnut
- Birch Pollen - kiwi, apple, pear, plum, apricot, cherry, tomato, celery, carrot, fennel, potato, green pepper, cumin, pear, hazelnut, walnut, almond, peanut, lentils
- Cypress/Cedar - peach, citrus fruit, apple, melon, tomato
- Grass - melon, watermelon, orange, tomato, kiwi, potato, swiss chard peanuts
- Mugwort - peach, lychee, mango, grape celery, carrot, parsley, fennel, garlic,
- cabbage, broccoli, coriander, cumin sunflower seeds, peanuts
- Pellitory - peach, cherry, melon, pistachio
- Ragweed - watermelon, banana zucchini, cucumber, squash
Speak to your doctor regarding:
- Regional Environmental Allergy Panel IgE
- A skin prick test
- Stimulates to see if there is a histamine response
- A total IgE
- To ensure you have enough IgE to test for
- If your body is not producing enough IgE, can lead to false negatives
- Total IgE = how much IgE you produce at any given time, you should be producing some
- Cutoff is 187, if less than 5 means you may be IgE deficient
- IgE food allergy blood test against specific foods
- IgE panel should be aggressive as possible, as many foods & environmental allergens as possible
- Definitely run for the top 9 & any other suspected foods
- If something was flagged, practice an elimination diet for at least two weeks
- Then, if symptoms are not as severe as anaphylaxis, in the presence of your physician attempt an oral food challenging
- Eating the suspected allergen to see if it causes a direct response
- NOT appropriate for everyone, but is definitely helpful in revealing cause and effect