Allergy · London
Pollen food syndrome (oral allergy) clinic - London.
Raw apple, hazelnut, celery or melon making your mouth itch? A consultant allergist appointment, skin prick with fresh food, component-resolved diagnostics, and a clear plan that separates mild pollen food syndrome from LTP allergy.
Why patients choose us
- 01
A specialist allergist, in a recognised London unit
Not a general clinic. A named consultant allergist with hay fever and food allergy expertise, in a BSACI-recognised centre.
- 02
Component-resolved diagnostics from day one
ISAC or ALEX component testing separates Bet v 1 cross-reactivity from LTP allergy, so the advice you get is safe and specific.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private pollen food syndrome workup costs in London.
Indicative ranges across our partner allergy units. Send us the story and we quote firm figures across two or three options.
In short
A private allergist consultation with skin prick and component IgE in London: £450 to £850, results in 5 to 10 days.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial allergist consultation, skin prick and component IgE | £450–£850 | 45–60 min | Same visit |
| ISAC 112 or ALEX 295 multiplex component test | £350–£550 | Blood draw | 5–10 days |
| Follow-up consultation and results interpretation | £250–£450 | 30 min | Same visit |
| Grass pollen sublingual immunotherapy (Grazax, 3-year course) | £1,400–£2,400 | Daily at home | 3 years |
| Birch pollen sublingual immunotherapy (Itulazax, 3-year) | £1,800–£2,800 | Daily at home | 3 years |
| Adrenaline auto-injector training and prescription | £120–£220 | 20 min | Same visit |
Prices vary by unit and by whether component-resolved diagnostics is included. Sublingual immunotherapy is a 3-year commitment and is usually self-funded. We come back with a firm quote within one working day.
What it is
Pollen food syndrome, in one paragraph.
Also called oral allergy syndrome. A common, usually mild cross-reactive food allergy driven by pollen sensitisation.
Pollen food syndrome (PFS), also called oral allergy syndrome, is an IgE-mediated food allergy that piggybacks on pollen sensitisation. The immune system makes antibodies against pollen proteins (most often birch Bet v 1), and those same antibodies cross-react with homologous proteins found in raw fruit, vegetables and tree nuts.
Symptoms start within minutes of the food touching the mouth: itching or tingling of the lips, tongue, palate or throat, sometimes mild lip swelling. The offending Bet v 1 protein is fragile, denatured by heat and stomach acid, so cooked, tinned and baked forms of the same food are usually well tolerated.
Most people have mild, mouth-limited symptoms that settle within an hour. A smaller group progresses to systemic reactions, especially where profilin or lipid transfer protein cross-reactivity is involved, and that is why a proper workup with component-resolved diagnostics matters.
The two pathways
- Bet v 1 driven PFS. Mild, mouth only, raw food only. Cooked forms safe. Rarely systemic.
- LTP allergy. Heat and digestion stable. Cooked forms still trigger. Systemic reactions well described.
- Profilin cross-reactivity. Broad and often mild. Occasional systemic reactions where sensitisation is high.
The journey
From enquiry to a written plan - what happens, in order.
One team from the first message to your component results and, if it fits, a sublingual immunotherapy course.
Phase 1 · Before your appointment
Concierge, off-stage for you
Phase 2 · On the day
45 to 60 minutes in clinic
Phase 3 · After
Concierge, back on
- 01
Before
You send us the story
A short, confidential form. Which raw foods trigger you, how quickly, hay fever season, and any systemic reactions.
- 02
Before
We come back with a recommendation
Within one working day: which allergist fits your picture, whether you need ISAC or ALEX, and indicative cost.
- 03
Before
We arrange the appointment
Usually within one to two weeks. Skin prick antihistamines are paused for five days beforehand where safe.
- 04
On the day
History, skin prick and component IgE
A 45 to 60 minute consultation. Skin prick with fresh food and pollen extracts, then blood for component-resolved diagnostics.
- 05
On the day
Diagnosis and a written plan
PFS versus LTP allergy, a foods-to-avoid list, an antihistamine plan, and an adrenaline auto-injector if the pattern warrants it.
- 06
After
Component IgE results in 5 to 10 days
Bet v 1, Phl p 12, Pru p 3 and profilin components confirm the pathway. Written interpretation sent to you and your GP.
- 07
After
Hay fever and immunotherapy review
If grass or birch immunotherapy fits, we set that up. PFS symptoms often improve as the pollen sensitisation is treated.
Typical end-to-end: 1–2 weeks to appointment. Component IgE: 5–10 days. Immunotherapy: 3-year course.
Common presentations
The patterns we see, and the red flags.
Symptoms usually start within minutes: mouth, lip or tongue itching, mild throat scratching, and lip swelling that improves within 30 to 60 minutes. Systemic features change the plan.
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Birch pollen and apple, pear, hazelnut
The classic Bet v 1 cross-reactive pattern. Mouth itch on raw apple, pear, cherry, hazelnut, celery, carrot or kiwi.
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Grass pollen and tomato, melon
Grass profilin (Phl p 12) cross-reacts with tomato, melon and citrus. Milder mouth symptoms, seasonal.
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Mugwort and celery, spices, carrot
Celery-mugwort-spice syndrome. Symptoms often stronger, sometimes systemic. Warrants careful workup.
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Ragweed and melon, banana, cucumber
Ragweed sensitisation, more common in continental Europe, cross-reacts with cucurbits.
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Latex-fruit syndrome
Latex allergy cross-reacts with banana, avocado, kiwi and chestnut. A separate pathway, worth screening.
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LTP allergy, Mediterranean pattern
Pru p 3 sensitisation to peach, apple, hazelnut, walnut. Heat and digestion stable, systemic reactions common.
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Hay fever with new food symptoms
Adult-onset birch-season hay fever followed by mouth itch on raw fruit. A very typical PFS story.
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Red flag: throat closing, wheeze, hives
Systemic features beyond the mouth suggest LTP or true food allergy. A full allergist workup and often an auto-injector.
Diagnosis and management
History first, then component IgE if the picture is not clean.
For classic PFS with hay fever, the history is often diagnostic. Component-resolved diagnostics is reserved for uncertain cases, systemic reactions, or where LTP allergy needs excluding.
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Focused clinical history
Which foods, raw versus cooked, how fast, seasonal or year-round, hay fever pattern, personal and family atopy. Often diagnostic on its own.
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Skin prick testing with fresh food
A prick through the raw fruit or vegetable, then through the skin. Considerably more sensitive than commercial extracts for labile Bet v 1 proteins.
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Specific IgE blood testing
Serum IgE to whole allergens (birch, grass, apple, hazelnut) plus components. Useful when antihistamines cannot be paused for skin prick.
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Component-resolved diagnostics
ISAC 112 or ALEX 295 measure IgE to individual protein components. Bet v 1, Phl p 12 and Pru p 3 separate PFS from LTP allergy.
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Oral food challenge (selected)
Supervised, staged ingestion in clinic. Reserved for uncertain diagnoses or when reassurance about cooked food safety is needed.
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Baseline tryptase
A one-off baseline mast cell tryptase in anyone with systemic reactions, to screen for underlying mastocytosis.
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Written management plan
Foods to avoid raw, foods safe when cooked, antihistamine dose, adrenaline auto-injector plan, and a BSACI-format allergy action plan.
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Second-opinion review
A specialist review of prior allergy tests, so you can decide whether more testing, immunotherapy or an auto-injector is genuinely needed.
Management
For Bet v 1 driven PFS the plan is simple: avoid the raw form of the offending fruit, vegetable or nut, and enjoy the cooked, tinned or baked version. Carry a non-sedating antihistamine (cetirizine or fexofenadine) to take at the first sign of a reaction. For LTP allergy, any prior systemic reaction, or coexisting asthma, an adrenaline auto-injector is prescribed with training and a written action plan.
Treating the root
Treat the hay fever, and the food symptoms often ease.
Pollen food syndrome is a downstream consequence of pollen sensitisation. Reduce the pollen response, and the mouth symptoms often follow.
Baseline treatment is a daily intranasal corticosteroid (fluticasone, mometasone or triamcinolone) started before the season, combined with a non-sedating oral antihistamine such as cetirizine, loratadine or fexofenadine. Add-on montelukast is helpful where wheeze is also a feature.
For patients with severe pollen allergy that continues despite optimal medication, sublingual immunotherapy is the disease-modifying option. Grazax (grass) and Itulazax (birch) are once-daily tablets taken for 3 years under specialist supervision. First dose in clinic, then continued at home.
Trials of birch and grass sublingual immunotherapy have shown reductions in pollen food syndrome symptoms as well as in hay fever, so patients whose PFS is disruptive often benefit twice over. Immunotherapy is not started in uncontrolled asthma or pregnancy.
Where we send patients in London
- The Portland Hospital Allergy. Central London, adult and paediatric allergy.
- HCA The Wellington Hospital. Adult allergy service with component testing on site.
- London Allergy Clinic. Independent consultant-led clinic with immunotherapy pathways.
- Guy's and St Thomas' Private Adult Allergy. Academic-led private service.
- Chelsea and Westminster Private Care. Consultant allergist appointments and testing.
Our vetted London network
A small panel of consultant allergists, we picked them.
Consultants on the GMC Specialist Register for Allergy, in BSACI-recognised units. Not listed publicly - introductions are made privately, once we understand your case.
Selection criteria
How we choose every allergist in our network.
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Consultant allergists on the GMC Specialist Register for Allergy
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BSACI-recognised units with skin prick and component-resolved diagnostics on site
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Sublingual immunotherapy pathways for grass and birch pollen
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Adrenaline auto-injector training and BSACI-format written action plans
Safety and when to worry
When PFS is mild, and when it is not.
Classic pollen food syndrome is mild and mouth limited. LTP allergy, cofactor-augmented reactions and any prior systemic feature change the picture and the plan.
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Most PFS is mild and mouth-limited
Symptoms usually settle within 30 to 60 minutes without treatment. An oral antihistamine speeds recovery. Cooked forms are generally safe.
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LTP allergy is a different beast
Lipid Transfer Protein allergy (Pru p 3) is heat and digestion stable. Systemic reactions, including anaphylaxis, are well described.
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Adrenaline auto-injector, when
Prescribed for LTP allergy, any prior systemic reaction, asthma with food allergy, or co-factor triggered reactions (exercise, NSAIDs, alcohol).
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Cofactor-augmented reactions
A food that is normally tolerated can trigger a systemic reaction with exercise, alcohol, NSAIDs or a viral illness. Worth knowing.
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Pause antihistamines before skin prick
Non-sedating antihistamines are stopped for five days before skin prick testing so the results are valid. We plan this with you.
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Pregnancy and immunotherapy
Sublingual immunotherapy is not started in pregnancy. If you become pregnant during a course, we advise on whether to continue or pause.
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Asthma control comes first
Uncontrolled asthma increases the risk of severe reactions and is a relative contraindication to immunotherapy. We optimise inhalers first.
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Emergency response
Any tongue or throat swelling with breathing difficulty, wheeze or collapse: use adrenaline auto-injector, call 999, lie flat with legs raised.
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Written action plan
A BSACI-format plan lists your triggers, antihistamine dose, when to use adrenaline, and what to tell paramedics. Kept with you.
Reading your allergy report
Your allergy report in four parts. Read the last one first.
However the workup is done, the letter the allergist sends you keeps to the same shape.
A quiet reminder
Allergy language is precise and can read coldly, we translate it for you.
If you would like us to talk you through the report before your review, just ask.
- 01 History
Pattern, timing and cofactors
Which foods, raw versus cooked, how fast symptoms appear, seasonal pattern, and any exercise, alcohol or NSAID cofactors.
- 02 Testing
Skin prick and component IgE results
Wheal sizes to pollen and fresh food extracts, and specific IgE to Bet v 1, Phl p 12, Pru p 3 and profilin components.
- 03 Diagnosis
PFS versus LTP versus true food allergy
Which pathway explains your symptoms, what to expect long term, and whether raw or cooked foods are the concern.
- 04 Plan
Foods, antihistamines, adrenaline, SLIT
Read this first: foods to avoid raw, safe cooked forms, antihistamine plan, auto-injector prescription and immunotherapy options.
Recognised by major UK insurers
Cover for allergy consultation and testing varies by insurer. Sublingual immunotherapy is often self-funded. We confirm cover before booking.
Frequently asked
Everything we get asked about pollen food syndrome.
Quick answers on raw versus cooked, insurance, LTP allergy and sublingual immunotherapy.
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Do I only react to raw fruit and vegetables?
In classic pollen food syndrome, yes. The proteins responsible (Bet v 1 homologues) are broken down by heat and stomach acid, so raw apple, pear, cherry or hazelnut triggers mouth itch but the cooked, tinned or baked version is usually well tolerated. If you also react to cooked forms, we look hard for LTP allergy or a true food allergy instead.
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Are cooked and baked forms really safe?
For Bet v 1 driven pollen food syndrome, cooked, tinned, baked and processed forms are almost always safe because the offending protein is denatured. Apple pie, tinned pears, roasted hazelnut and celery in a stock are usually fine. LTP allergy is different: those proteins survive cooking and gastric acid, so cooked foods can still cause reactions.
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Will private allergy testing be covered by insurance?
Most UK private medical insurers cover an initial consultation and skin prick or specific IgE testing when there is a clear allergy history. Component-resolved diagnostics (ISAC, ALEX) is sometimes limited, and sublingual immunotherapy is often self-funded. We confirm cover with your insurer before booking.
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My symptoms are getting worse each year, why?
Pollen food syndrome can broaden as pollen sensitisation strengthens over years, with new fruit or vegetable triggers appearing. A component blood test clarifies whether you are still on the mild Bet v 1 pathway or whether LTP sensitisation has developed, which changes the safety advice materially.
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How is LTP allergy different from pollen food syndrome?
LTP allergy is driven by Pru p 3 and related lipid transfer proteins in peach, apple, hazelnut, walnut and grains. These proteins are stable to heat and digestion, so cooked foods still trigger reactions and systemic reactions are more common. It is more prevalent in Mediterranean populations and usually needs an adrenaline auto-injector.
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Can sublingual immunotherapy cure my pollen food syndrome?
It is not a cure, but a 3-year course of grass (Grazax) or birch (Itulazax) sublingual immunotherapy substantially reduces hay fever symptoms and, in trials, reduces pollen food syndrome symptoms for many patients. It is a daily home treatment, started under specialist supervision.
Book a private allergist
A consultant appointment, component IgE, and a written plan you can trust.
Send us your story and we come back within one working day with two or three options across our London network, honest pricing, and a clear next step.
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