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Welcome

Celebrating 80 Years Of Service!

The American Academy of Otolaryngic Allergy (AAOA) represents over 2,700 Board-certified otolaryngologists and health care providers. Otolaryngology, frequently referred to as Ear, Nose, and Throat (ENT), uniquely combines medical and surgical expertise to care for patients with a variety of conditions affecting the ears, nose, and throat, as well as commonly related conditions. AAOA members devote part of their practice to the diagnosis and treatment of allergic disease. The AAOA actively supports its membership through education, research, and advocacy in the care of allergic patients.

"Advance the comprehensive management of allergy and inflammatory disease in Otolaryngology-Head and Neck Surgery through training, education, and advocacy."

ADVOCACY UPDATES

Changes To E/M Codes Beginning On January 1st

Effective January 1, 2021, the Centers for Medicare & Medicaid (CMS) finalized significant changes to…

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Additional COVID-19 Relief Up in the Air

House Speaker Nancy Pelosi (D-CA) and Treasury Secretary Steven Mnuchin appeared to be moving closer…

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CY 2021 Physician Fee Schedule Proposed Rule Summary

On August 3, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician…

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Changes in MACRA

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Before the close of 2017, all physicians must take action to avoid the 4 percent cut that will be assessed in 2019 for not participating in the new Quality Payment Program (QPP) authorized by the Medicare Access and CHIP Reauthorization Act (MACRA).  Read More

CMS Announces Changes in MACRA Implementation Timeline. The Centers for Medicare and Medicaid Services (CMS) announced major changes to the implementation of the Medicare Access and CHIP Re-authorization (MACRA).
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Upcoming Dates

03/15/21: 2021 Annual Meeting Crowdsourcing
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03/15/21: Call for Proposals
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04/01/21: Fellow Exam Application Deadline
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06/01/21: Research Grant Cycle
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06/26/21: Membership Application Deadline to be eligible for AAOA Member rate for the 2021 Basic Course

07/15/21: Call for Scientific Papers

09/01/21: Membership Application Deadline to be voted in at the 2021 Annual Meeting

12/01/21: Research Grant Cycle
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EDUCATION

Don't miss the opportunity to curate content you need now conveniently in your own office or home! The content will only be available until March 25th!

NEW YEAR, SAME PANDEMIC

Looking for insights as you focus on 2021 and practice growth? Still struggling with some of the reboot challenges from COVID? AAOA is re-releasing core content from its summer Pandemic course to help give you access to content you need now. Register now for the great way to gain insights, earn up to 13 hrs CME, and help meet your maintenance of certification (MOC) requirements.

JUST THE BASICS

Do you have new staff and need help training them on the core concepts of allergy diagnosis and management in ENT? In your practice reboot, are you reconsidering your practice set up or considering adding allergy to your practice? Are you looking for great review tools for you and your staff?

To help you we are offering time-limited access to our core allergy education library to give you and your staff the tools you need to get up to speed or refresh on the key concepts in allergy diagnosis and management. Register today and earn up to 8.75 hrs of CME (MOC eligible).

IFAR

IFAR Impact Factor: 2.454

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IFAR Featured Content: COVID-19 - Free Access
Endonasal instrumentation and aerosolization risk in the era of COVID‐19: simulation, literature review, and proposed mitigation strategies . Read More

Now Available

Changes in Managing Practices

Working together with AAOA staff, volunteer leadership and members will enable us to have a positive impact on our members’ practices.

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Live and Online CME

New Year, Same Pandemic
January 25-March 25 | On-Demand
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Just the Basics
January 25-March 25 | On-Demand
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2021 Basic Course in Allergy & Immunology
On-demand Mid-June Live Stream Targeted For July 8-11 | Virtual
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USP 797 Online Module
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2021 AAOA Annual Meeting
Pre-launch Mid-September
Live Stream Starting on Oct 16 | Virtual
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News and Updates

CMS Coding 2021 – AAOA Zoomcast

A brief summary of the CMS Coding 2021 – AAOA Zoomcast Series: Just In Time…

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Re-Engaging Patients During and Post COVID-19 Pandemic – AAOA Zoomcast

A brief summary of the Re-Engaging Patients 2021 - AAOA Zoomcast Series: Just In Time…

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College Allergy Symptoms Treatment Back to Shcool

PRACTICE RESOURCES

AAOA Practice Resource Tool Kit

The American Academy of Otolaryngic Allergy (AAOA) Practice Resource Tool Kit is intended as a guide to help AAOA members integrate allergy into their otolaryngology practice and to continually improve on this integration as new information, regulations, and resources become available.

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PATIENT CORNER

Allergic woman using handkerchief on runny nose. AAOA, allergy

Cross-Reacting Foods, Oral Allergy Syndrome, or “Why Do Bananas Make My Throat Itch in the Fall?”

By Alfred M. Sassler, DO, FAAOA, FACS

Many people with seasonal allergies know they are sensitive to pollens that increase and decrease in prevalence at different times of the year depending on the climate where they live.  Sometimes called “Hay Fever”; people may react to one or more tree pollens, weed pollens, or grass pollens and develop the classic allergy symptoms.

Some have also noticed a strange phenomenon where eating certain foods seems to trigger throat symptoms such as tickling or tightness in the throat or throat clearing and cough.  Or they may note even more typical inhalant allergy symptoms like sneezing, runny nose, and post-nasal drainage.  This may lead to the belief that they are “allergic” to those foods.  Does this happen to you?  Have you observed any trends in these symptoms?  Do these reactions happen every time you eat the food or is it more likely these reactions don’t necessarily happen all the time?  Do they seem to correlate to times when seasonal allergy symptoms are more prevalent?

What’s going on here is a quirk of our immune system called co-allergy or cross-reactivity.  The response has lots of names: “Oral Allergy Syndrome,” “Pollen-Food Allergy,” “Concomitant Allergy,” and “Pollen-Associated Food Allergy Syndrome” to name a few.

For an allergy response to occur, a group of cells that act as the “sentries” or “bouncers” of our immune system called “mast cells” must somehow be notified that we have come in contact with a substance that for some reason our body recognizes as not part of us (“non-self”) and potentially harmful.  When that happens, they are programmed to release chemicals including histamine and others that trigger a series of reactions that serve to eject and/or destroy that substance. 

The way these mast cells identify these “foreign invaders” (or those substances that are “not on the list to get in”) is by having specific receptors on their surface called antibodies (IgE) that will link up with specific segments of the DNA chains that are integral parts of pollen molecules (mostly proteins) that have come into contact with that person.   DNA of course, is the basic component or “computer code” of life and the basis of all proteins that make up all life forms including people, animals, plants, their pollen, bacteria, fungi, etc.

Example of a Protein Molecule

Our guardians (mast cells and others) are in highest concentration in the parts of the body that are most likely to come in contact with the outside world such as the skin, nose, sinuses and oral mucous membranes, membranes covering the eyes, the upper and lower airways, and the GI tract.  When these “sentries” are engaged and the “invaders” (most often pollens that arrive through the air) link up with their surface receptor antibodies, they release their entire weapon system to cause the all-too-familiar reactions we call “allergy”.  These may include  itchy, red bumps on the skin (hives), itchy/runny nose, sneezing, itchy/runny eyes, swollen inflamed eyelids, itchy throat, throat clearing, increased mucus in the airway, cough, wheezing, throat tightness, hoarseness, etc.

Now for the really interesting part!  Many people get a similar reaction when they eat specific foods. For example, people who exhibit allergy to birch tree pollen may notice many of the same reactions when they eat peaches, pears, kiwi, apples, and some other foods.  What seems to happen is a miscue to our immune system.  When the digestion process starts, those foods get broken down into their basic components by our GI tract, starting with chewing and saliva action in the mouth. Some of the food proteins contain DNA chain segments that align very similarly to those of the pollen molecule DNA that are programmed to link to the antibody receptors on the mast cells.  Well, when those similar DNA chain segments match up closely enough to the pollen antibody receptors on the mast cell surfaces, they are “fooled” into cross-linking and then releasing their arsenal of chemicals (histamine and others) and the allergy response is triggered.  This response is most often felt in the throat but can encompass the entire spectrum of allergic responses noted earlier.  

We have recognized many such cross-reactions.  Another commonly noted one is ragweed pollen sensitive folks may get these reactions when eating melon or banana.  Dozens of these reactions have been recognized, and many have been studied at a molecular level. Sure enough, each time we see similar DNA chain segments between the pollen and the broken-down foods that are very similar and are capable of “cross-linking” with the mast cell surface receptor antibodies, we note a triggering release of the allergy causing chemicals.

This is definitely not an exact phenomenon and here’s why.  It is a matter of percentage and chance.  When allergic patients are exposed to their allergens, this system gets ramped up by the body that thinks it’s in a battle with something that causes harm (disease).  That means more sensitized mast cells will be available to look for “the enemy.” Remember, they are programmed to react to specific substances based on their surface receptors.  If you are ragweed-pollen sensitive and there is lots of that pollen in the atmosphere, say August and September in the Northeastern US, you will have lots of ragweed sensitized mast cells around looking for this stuff.  If the surface receptors come in contact with a bit of DNA that is 80% similar, that may be enough to trigger the response in some mast cells during the ragweed season. If it’s winter and you are eating a nice cantaloupe that just got shipped to your local grocery store from South America, you might not even have the reaction.  The reason is that you don’t have as many ragweed-sensitive mast cells available since you aren’t currently contacting that pollen in your home environment and the cross-reaction isn’t perfect so not enough mast cells “go off” for you to notice much of a response.  

It gets even more complex. Those of us who do have allergy to ragweed, as an example, will have variable allergic sensitivity because we may be more or less sensitive to different parts of the ragweed molecule (known as “major proteins” or “epitopes”: those little segments of DNA chains mentioned earlier).  This is why some of us seem to be more or less allergic at varying times to the elevated pollens in our environment.  Pollens are biologic products that may vary slightly from crop-to-crop, year-to-year, and season-to-season. They may contain more or less of these specific bits of DNA chains.   Again, the response has to be fairly specific for the specified surface receptors on the mast cells to recognize them as “the enemy.”  So if the pollen molecule or the cross-reacting food that we eat doesn’t break down to a closely enough related DNA strand…. no response!

If you have seasonal allergies, you are likely to have an “ah hah moment” when you look at some of these foods and others will make you scratch your head.  This is not a universal phenomenon for the reasons mentioned above so trial and error might be in order.  It is highly unlikely that cross-reacting foods would cause anaphylaxis.  If you are not being exposed to your inhalant allergen, you may not notice the response so it may have to be tried while “in-season.”  

A word of caution: If you are undergoing immunotherapy to desensitize yourself to pollens, you are actually getting small amounts of the very thing you react to in order to “fool” your immune system to become less sensitive.  If you also eat cross-reacting foods simultaneously to being exposed to those inhalants in your environment, you may notice greater reactions from your allergy shots or sublingual allergy treatment (drops or soluble tablets).   It is advisable to avoid known cross-reacting foods when you are undergoing allergy immunotherapy and are also in-season for your allergies.

Look at trusted online sites or speak with your ENT allergy office for lists of potentially cross-reacting foods.

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