SHOW NOTES

• Food allergy podcast from last week: https://drrobertpastore.com/podcasts/070-food-allergies

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

• University of Manchester Foods Cross-Reacting with pollen: http://research.bmh.manchester.ac.uk/foodallergens/facts/pollen/pollenandfood/

• 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