Should I avoid eating strawberries if they cause an itchy mouth due to a potential allergic reaction?

From the Guidelines

You should avoid eating strawberries if they cause an itchy mouth, as this indicates an oral allergy syndrome or potentially a more serious food allergy. This reaction occurs when your immune system mistakes proteins in strawberries for pollen allergens, triggering the release of histamine and other chemicals that cause itching, swelling, or tingling in your mouth and throat. According to the guidelines for the diagnosis and management of food allergy in the United States, reported by 1, the gold standard test for diagnosing food allergy is a double-blind, placebo-controlled oral food challenge (DBPCFC). However, for practical purposes, single-blind or open-food challenges may be considered diagnostic under certain circumstances.

The symptoms you are experiencing, such as an itchy mouth from eating strawberries, are typical of pollen-food allergy syndrome, or oral allergy syndrome, which can sometimes progress to or overlap with more severe allergic reactions, as noted in the consultation and referral guidelines citing the evidence, 1. While mild reactions might be managed with antihistamines like Benadryl (diphenhydramine) 25-50mg or Zyrtec (cetirizine) 10mg, complete avoidance is safer. Some people with oral allergy syndrome can tolerate cooked versions of trigger foods since heating denatures the allergenic proteins, but this varies by individual.

If you experience more severe symptoms like difficulty breathing, throat tightness, or hives, seek immediate medical attention and consider carrying an epinephrine auto-injector (EpiPen) if prescribed by your doctor. An allergist can perform testing to confirm your specific allergies and provide personalized guidance on managing your condition, as suggested by the guidelines of care for the management of atopic dermatitis, 1. It's also important to note that a true allergy is defined as “an adverse health event that results from stimulation of a specific immune response that occurs reproducibly on exposure,” and broad panel allergy testing independent of a history of a reaction to foods is not recommended, as it may reflect sensitization but have poor correlation with clinical allergic responses.

Key points to consider:

• Avoid eating strawberries if they cause an itchy mouth due to potential allergic reactions.
• Oral allergy syndrome can sometimes progress to or overlap with more severe allergic reactions.
• Complete avoidance of the trigger food is safer than managing mild reactions with antihistamines.
• An allergist can perform testing to confirm specific allergies and provide personalized guidance.
• Severe symptoms require immediate medical attention and potentially an epinephrine auto-injector.

From the Research

Allergic Reactions to Strawberries

• Strawberries can cause an itchy mouth in some individuals due to an allergic reaction, specifically oral allergy syndrome (OAS) 2, 3.
• OAS is a relatively common condition that is strongly associated with seasonal allergic rhinitis, and symptoms include pruritus of the oral mucosa and posterior tongue 2.
• The allergens responsible for strawberry allergies have been reported to include Bet v 1 and profilin, which mainly cause oral symptoms, and lipid transfer protein (LTP) 4.
• A study found that Fra a 1.02, a protein in strawberries, is highly allergenic and can cause cross-reactivity with the major birch pollen allergen Bet v 1 5.

Diagnosis and Management

• Diagnosis of OAS is confirmed by a positive history and positive skin-prick test result triggered by the food's fresh extract 3.
• Oral challenge result is normally positive with the raw food and negative with the similar cooked food 3.
• Patients with OAS may be able to avoid symptoms by cooking the offending foods, such as strawberries 2.
• In some cases, patients may need to avoid eating strawberries altogether to prevent allergic reactions 4.

Farming Practices and Allergenicity

• The method of strawberry production can impact its allergenic properties, with organic production considered the safest in terms of fruit safety and high quality 6.
• A study found that strawberries from organic farming systems contained lower levels of Bet v1 and profilin, which are common allergens, compared to conventional and integrated farming systems 6.