Inflammatory Reaction of The Anterior Dorsal Tongue

Oral Hypersensitivity

Image 1: Photo taken after hyperemia and burning sensation on the tip of the tongue that appears just after eating strawberries
Image numbered 2 and 3: Photo taken after the contact with strawberry was terminated, 1 scale of oral antihistaminic syrup was given and waiting for 1 day, the redness has almost completely disappeared

Some foods can cause a local inflammatory allergic reaction when they come into contact with tissues in the mouth. I have attached photos of the tongue of a 5-year-old patient who developed a burning sensation and redness towards the tip of the tongue after eating strawberries. In the tongue photograph taken one day after the patient ingested a single dose of oral antihistamine syrup and the strawberry contact was terminated, it is seen that the redness has almost completely disappeared. 

Food-induced hypersensitivity reactions are abnormal allergic reactions of the immune system that occur in response to exposure to normally harmless substances. These reactions include true allergic and other non-allergic reactions, and the severity of the reaction can sometimes reach life-threatening levels (source >> Oral Hypersensitivity Reactions). The severity of the reaction may increase due to repeated contact.

Types of Oral Hypersensitivity Reactions

Oral hypersensitivity reactions can be summarized as follows:

- Stomatitis

- Angioedema

- Lichenoid reactions

- Erythema multiforme

- Plasma cell gingivitis

Oral allergy syndrome (OAS) or pollen-food allergy syndrome (PFS) is a form of contact allergic reaction that occurs when the mouth and throat come into contact with raw fruits or vegetables. It may increase with the consumption of genetically modified greenhouse products that are not seasonal fruits and vegetables and may develop against more than one product by cross-reaction. The most common symptoms of OAS include itching or swelling of the mouth, face, lips, tongue, and throat (source >> Oral allergy syndrome (OAS)).

Symptoms of Oral Hypersensitivity

The most common symptoms seen in patients are itching in the lips, tongue and mouth.

Symptoms usually occur soon after eating raw fruit or vegetables, but in rare cases, the reaction may occur. It may occur more than an hour later. In the child patient I shared with you here, only half an hour after eating strawberries, a swelling, redness and burning sensation appeared on the tongue. OAS is generally considered to be a mild form of food allergy, the reaction may be exacerbated by repeated contact. Rarely, In the form of an anaphylactic reaction, it can cause severe throat swelling that causes difficulty in swallowing or breathing, which can be life-threatening.When feeding your children fruits and vegetables, it is especially important that you give them those produced by organic farming, not greenhouse products, genetically modified and without the use of industrial chemical fertilizers. as well as confectionery containing artificial sweeteners containing coloring matter, It is necessary to be careful when giving drugs or other products. The amount of allergic reaction that occurs may increase with repetitive contacts, and it is very important to be careful in this regard and to cut off the contact. Atopic people with an allergic body should be careful when eating such foods. Sometimes, families may express that their children make food choices, are reluctant to certain fruits, or spit up after eating. There may be underlying, local mucosal allergic reactions and include Genetically Modified Foods, greenhouse products, extremely sour and acidic, spicy foods in general. Oral allergy syndrome can be seen together with seasonal allergic rhinitis and other allergic diseases.

Symptoms associated with oral hypersensitivity in patients include :

• an itching or tingling on tongue or the roof of mouth
• swollen or numb lips
• a scratchy throat
• sneezing
• nasal congestion 

Trigger foods for oral allergy syndrome

Food-related oral hypersensitivity or food-related oral allergy, which I want to share with you here, are foods that are not severe and can only be seen in the oral mucosa and can cause hypersensitivity reactions. These usually present with milder symptoms than systemic nut allergies, which can be more deadly.

Foods that can trigger oral allergy syndrome (source >> Oral Allergy Syndrome: Food List, Treatment, and More):

• bananas
• cherries
• oranges
• apples
• peaches
• tomatoes
• cucumbers
• zucchinis
• bell peppers
• sunflower seeds
• carrots
• fresh herbs, such as parsley or cilantro

We detected systemic allergic reactions to walnut and walnut subproteins in my own daughter. Every time he ate walnuts, symptoms such as sagging and swelling of the palate, edema of the lips, pain in the abdomen and weakness were observed, leading to anaphylaxis. He had only accidentally eaten walnuts a few times until now. Apart from that, we realized that he was also allergic to cajun and pine nuts. Unfortunately, it is seen as a systemic allergic reaction, not just oral hypersensitivity, which is much more dangerous. Although the severity may decrease in advancing ages, if there is no contact; this is an allergy situation that maybe he should pay attention to throughout his life.

Oral Hypersensitivity Treatment

If patients suspect food allergy or oral hypersensitivity due to food, they should test each food separately and avoid contact with any food allergy as much as possible. In some patients, allergy to more than one fruit may occur in patients who are allergic to one fruit with cross-reactions. For example, those with a blueberry reaction may have symptoms when eating foods such as bananas, cucumbers, melons, and zucchini. This style is ideal for patients who develop hyperemic lesions on the tongue and palate after eating to note the following:

- avoiding extremely hard, spicy, sour and bitter foods that may cause irritation to the oral mucosa

- avoiding foods with sharp and pointed edges

- avoiding the consumption of genetically modified products such as corn in kiwi, strawberry, tomato and all other greenhouse grown fruit and vegetables (consuming those produced with organic fertilizers or natural fertilizers)

- to apply to a health institution urgently if there is respiratory distress

- treatment with allergy vaccines can improve symptoms of oral hypersensitivity! (The effects of oral immunotherapy on food allergy were previously emphasized (source >> Improving the safety of oral immunotherapy for food allergy). The desensitizing effect highlighted here can likewise be beneficial in oral hypersensitivity.)

- cooking some fruits and vegetables can reduce the risk of allergic reactions, and at high temperatures, they can break down protein structures that cause allergic reactions (you'd better try this first)

- consuming canned products, peeling fruits and vegetables (proteins that cause allergic reactions are usually found in the peel section, and these substances usually accumulate in the peel section when spraying is done)

In medical treatment, oral antihistamine tablets, immunotherapy, and cortisone treatment in severe cases are available.

Oral Hypersensitivity Diagnosis

Although there is no specific test for the diagnosis of oral hypersensitivity, tests for allergens, the patient's symptoms and examination findings are useful in the diagnosis. Oral allergy or oral hypersensitivity should be suspected in case of burning and itching sensation in the mouth, edema and redness on examination, which typically occurs when the same food is eaten.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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