than just pollen. Oral reactions to food are often mistakenly self-diagnosed by patients as caused by pesticides or other contaminants. Other reactions to food—such as lactose intolerance and intolerances which result from a patient being unable to metabolize naturally occurring chemicals (e.g., salicylates and proteins) in food—need to be distinguished from the systemic symptoms of OAS. Testing Many people are unaware that they have OAS. However, if swelling, tingling or pain develops while eating certain foods, it is wise to see an allergy specialist. Before a diagnosis can be made, it is best to keep a food diary. This is important as the physician can then perform an allergy test. A comprehensive history is obtained so that random testing is avoided. The diagnosis of OAS may involve skin prick tests, blood tests, patch tests or oral challenges.. Exams To confirm OAS, the suspected food is consumed in a normal way. The period of observation after ingestion and symptoms are recorded. If other factors such as combined foods are required, this is also replicated in the test. For example, if the individual always develops symptoms after eating followed by exercise, then this is replicated in the laboratory. Treatment OAS must be managed in conjunction with the patient's other allergies, primarily the allergy to pollen. The symptom severity may wax and wane with the pollen levels. Published pollen counts and seasonal charts are useful but may be ineffective in cases of high wind or unusual weather, as pollen can travel hundreds of kilometers from other areas. In addition, patients are advised to avoid the triggering foods, particularly nuts. Peeling or cooking the foods has been shown to eliminate the effects of some allergens such as mal d 1 (apple), but not others such as celery or strawberry. In the case of foods such as hazelnut, which have more than one allergen, cooking may eliminate one allergen but not the other. Antihistamines may also relieve the symptoms of the allergy by blocking the immune pathway. Persons with a history of severe anaphylactic reaction may carry an injectable emergency dose of epinephrine (such as an EpiPen). Oral steroids may also be helpful. Allergy immunotherapy has been reported to improve or cure OAS in some patients. Immunotherapy with extracts containing birch pollen may benefit those with apple or hazelnut related to birch pollen-allergens. Even so, the increase in the amount of apple/hazelnut tolerated was small