Click the link below for a message from Dr. Wiens himself!
Dr. Alan Khadavi from southern California.
I appreciate the blog from Dr. Khadavi as the question of “citrus acid allergy” often comes up in my daily allergy practice here in Tulsa. Tomato is just one more food that can cause an intolerance that often is confused with a food allergy. As listed below, mucosal irritation is an intolerance, while oral allergy syndrome and anaphylaxis represent two examples of “IgE-mediated” or true allergy.
Tomato allergy is not commonly reported, but it can cause adverse reactions. Hypersensitivity reactions to other fruits are commonly reported, particularly apples, stone fruits and bananas. Tomato (Solanum lycopersicum) is derived from two wild ancestor species, Solanum pimpinellifolium and Solanum cerasiforme. Tomato flavor is a balance of acid and sugar recognized by the tongue and the effect of volatile compounds within the fruit that cause aroma recognized by the nose. Tomato flavor is commonly described as sweet, tart, tangy or balanced.
Tomato is classified as a fruit because they contain seeds and grow from the flower of the tomato plant. But many people still classify it as a vegetable based on its culinary applications. (how we cook with it!)Credits to Dr. Alan Khadavi
Types of reactions to Tomato:
- Mucosal irritation-Tomato has been implicated in an array of adverse reactions, including uncomfortable mucosal irritation due to acidic pH. The tomato plant can also cause itching of the skin when touched which is a form of allergic contact dermatitis.
- Oral allergy syndrome-symptoms typically occur with mouth itching and swelling of lips and tongue. Patients allergic to grass pollen can describe symptoms of oral allergy syndrome to tomato. This is not a true tomato allergy, but a cross reactivity of the proteins to the grass pollen. Treatment is heating the fruit or just avoiding it. Other foods in the same category are kiwi, melon, peach and celery.
- Anaphylaxis-symptoms that occur are hives, swelling, wheezing, coughing, vomiting, diarrhea and low blood pressure. This is from IgE mast cell degranulation. Allergy skin testing, specific IgE lab testing and fresh food skin testing with tomato all can be used to test for tomato allergy.
Reactions to tomato can thus come in different forms. With a severe reaction to tomatoes, patients will often avoid altogether and the problematic reactions are usually the mucosal irritation or food intolerance. An allergy doctor can help decipher what type of reaction one is having to tomato and to do the appropriate tests for establishing or ruling out a diagnosis of clinical allergy.
In the news a couple of years ago, Ariana Grande was diagnosed with a true tomato allergy. She joked that there was “nothing more unfair than an Italian woman developing an allergy to tomatoes in her mid-twenties.” But food allergies are a serious matter and should be taken seriously. All precautions should be taken place and patients should carry around an injectable epinephrine in case of an accidental exposure.
Not only should patients be aware of tomato allergy, but doctors should also recognize that rare food allergies aren’t so rare if you have the sensitivity. What to do?
- Make sure you have injectable epinephrine
- Skin testing or blood testing can be performed to many foods that cause rare allergies.
- Even if you don’t perform testing, please avoid the food (s) that cause problems, as the reaction may get worse with subsequent exposures.