When taking the initial history of a presenting complaint, the clinician will try to elicit whether the patient suspects one or more foodstuffs. As discussed in Chapter 1, there is a limited list of foods that cause the majority of reactions. Patients, however, may not be aware of which specific food caused their reaction; there are many cases of reactions resulting from the consumption of food contaminated with only traces of the harmful ingredient.19
Strawberries, other berries, tomato and citrus fruits are commonly reported as producing a flush or rash, particularly on the faces of young children. This phenomenon does not appear to be an IgE-mediated reaction but may have a pharmacological basis.
The oral allergy syndrome discussed in Chapter 1 solely involves the oropharynx (mouth, tongue and throat). Patients describe the rapid onset of itching of the mouth and angioedema (swelling of the lips, tongue, palate and throat). This is generally followed by a rapid resolution of symptoms. They are most commonly associated with the ingestion of various fresh fruit and vegetables. Patients with allergic rhinoconjunctivitis ('hayfever') associated with airborne allergens are most commonly afflicted with this problem. Care must be exercised when taking the history that these symptoms were not in fact the herald of more generalised systemic symptoms.
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