The constellation of immediate symptoms less than one hour after exposure and usually confined to the mouth has been called the oral allergy syndrome (OAS), first characterised in 1987 by Amlott etal.13 The initial group of 36 subjects was broadly divided into those whose symptoms did not progress (50%) and those who responded to larger doses of allergen, with more severe reactions. For each individual subject the quantity of food required to cause OAS and other symptoms varied.13
The typical symptoms of OAS involve a tingling in the lips, swelling of the tongue and maybe a feeling of swelling in the back of the throat. Patients often will complain of something stuck in their throat, feeling like a cherry stone or a food bolus. It can be difficult to distinguish this from more severe laryngeal oedema (swelling of the voice box), but the latter usually causes noisy inspiration or repetitive coughing. OAS needs to be distinguished from the early warning features of a gradually generalising reaction.
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