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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.

A stethoscope on a clinical desk

Indicative pricing

What a private pollen food syndrome workup costs in London.

Indicative ranges across UK allergy units.

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
Initial allergist consultation, skin prick and component IgE £450–£850
ISAC 112 or ALEX 295 multiplex component test £350–£550
Follow-up consultation and results interpretation £250–£450
Grass pollen sublingual immunotherapy (Grazax, 3-year course) £1,400–£2,400
Birch pollen sublingual immunotherapy (Itulazax, 3-year) £1,800–£2,800
Adrenaline auto-injector training and prescription £120–£220

Prices vary by unit and by whether component-resolved diagnostics is included. Sublingual immunotherapy is a 3-year commitment and is usually self-funded.

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.

Common presentations

The common patterns, 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.

  • 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.

  • Grass pollen and tomato, melon

    Grass profilin (Phl p 12) cross-reacts with tomato, melon and citrus. Milder mouth symptoms, seasonal.

  • Mugwort and celery, spices, carrot

    Celery-mugwort-spice syndrome. Symptoms often stronger, sometimes systemic. Warrants careful workup.

  • Ragweed and melon, banana, cucumber

    Ragweed sensitisation, more common in continental Europe, cross-reacts with cucurbits.

  • Latex-fruit syndrome

    Latex allergy cross-reacts with banana, avocado, kiwi and chestnut. A separate pathway, worth screening.

  • LTP allergy, Mediterranean pattern

    Pru p 3 sensitisation to peach, apple, hazelnut, walnut. Heat and digestion stable, systemic reactions common.

  • Hay fever with new food symptoms

    Adult-onset birch-season hay fever followed by mouth itch on raw fruit. A very typical PFS story.

  • 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.

  • 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.

  • 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.

  • Specific IgE blood testing

    Serum IgE to whole allergens (birch, grass, apple, hazelnut) plus components. Useful when antihistamines cannot be paused for skin prick.

  • 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.

  • Oral food challenge (selected)

    Supervised, staged ingestion in clinic. Reserved for uncertain diagnoses or when reassurance about cooked food safety is needed.

  • Baseline tryptase

    A one-off baseline mast cell tryptase in anyone with systemic reactions, to screen for underlying mastocytosis.

  • Written management plan

    Foods to avoid raw, foods safe when cooked, antihistamine dose, adrenaline auto-injector plan, and a BSACI-format allergy action plan.

  • 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.

Examples of private allergy services 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.

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.

  • 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.

  • 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.

  • Adrenaline auto-injector, when

    Prescribed for LTP allergy, any prior systemic reaction, asthma with food allergy, or co-factor triggered reactions (exercise, NSAIDs, alcohol).

  • Cofactor-augmented reactions

    A food that is normally tolerated can trigger a systemic reaction with exercise, alcohol, NSAIDs or a viral illness. Worth knowing.

  • Pause antihistamines before skin prick

    Non-sedating antihistamines are stopped for five days before skin prick testing so the results are valid. The allergist will plan this with you.

  • Pregnancy and immunotherapy

    Sublingual immunotherapy is not started in pregnancy.

  • Asthma control comes first

    Uncontrolled asthma increases the risk of severe reactions and is a relative contraindication to immunotherapy. Inhalers are optimised first.

  • Emergency response

    Any tongue or throat swelling with breathing difficulty, wheeze or collapse: use adrenaline auto-injector, call 999, lie flat with legs raised.

  • 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 London allergist reviewing component IgE test results

A quiet reminder

Allergy language is precise and can read coldly, so ask your care team to explain anything unclear.

If you would like the report talked through before your review, just ask your allergist.

  1. 01 History

    Pattern, timing and cofactors

    Which foods, raw versus cooked, how fast symptoms appear, seasonal pattern, and any exercise, alcohol or NSAID cofactors.

  2. 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.

  3. 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.

  4. 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

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for allergy consultation and testing varies by insurer. Sublingual immunotherapy is often self-funded.

Frequently asked

Common questions about pollen food syndrome.

Quick answers on raw versus cooked, insurance, LTP allergy and sublingual immunotherapy.

  • 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, LTP allergy or a true food allergy needs to be looked for instead.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

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