Differential Diagnosis

The patient's symptoms suggest an adverse reaction to certain foods, which can be categorized into several potential diagnoses.

• Single most likely diagnosis:

  • Oral Allergy Syndrome (OAS): This condition is likely given the patient's reaction to various fruits, vegetables, and nuts, with symptoms such as vomiting, stomach cramping, itchy throat, and ears. OAS is often associated with pollen allergy and cross-reactivity with certain foods.

• Other Likely diagnoses:

  • Food Allergy: The patient's symptoms could also be indicative of a food allergy, which is an immune system reaction to a specific food. The varying reactions to different foods support this diagnosis.
  • Irritable Bowel Syndrome (IBS) with Food Intolerance: Although less likely, IBS with food intolerance could explain the gastrointestinal symptoms. However, the itchy throat and ears are not typical IBS symptoms.

• Do Not Miss:

  • Anaphylaxis: Although the patient's symptoms do not currently suggest anaphylaxis, it is crucial to consider this life-threatening condition, especially if the patient experiences severe reactions, such as difficulty breathing or a drop in blood pressure, upon consuming specific foods.
  • Eosinophilic Esophagitis: This condition, characterized by an immune system reaction to food, can cause symptoms like vomiting and abdominal pain. It is essential to rule out this condition due to its potential to cause significant morbidity.

• Rare diagnoses:

  • Mastocytosis: A rare condition characterized by an accumulation of mast cells in the body, which can lead to food-induced reactions, including gastrointestinal symptoms and anaphylaxis.
  • Hereditary Fructose Intolerance: A genetic disorder that affects the body's ability to metabolize fructose, leading to symptoms like vomiting and abdominal pain after consuming fructose-containing foods. However, this condition typically presents in infancy and is less likely given the patient's ability to eat certain fruits.