Treatment of Oral Allergy Syndrome from Kiwi

Acute Management

• For mild oral allergy syndrome (OAS) symptoms from kiwi, the American Academy of Allergy, Asthma, and Immunology recommends treating with H1 and H2 antihistamines while monitoring closely for progression to more severe symptoms 1
• Administer H1 antihistamines (e.g., diphenhydramine 1-2 mg/kg per dose, maximum 50 mg) for isolated oral symptoms such as tingling, itching of lips, tongue, or throat, as suggested by the American Academy of Allergy, Asthma, and Immunology 1, 2
• Add H2 antihistamines (e.g., ranitidine) for enhanced symptom control, according to the American Academy of Allergy, Asthma, and Immunology 1
• Maintain close observation during and after antihistamine administration to detect any progression to systemic symptoms, as recommended by the American Academy of Allergy, Asthma, and Immunology 1, 2
• Immediately administer intramuscular epinephrine (0.01 mg/kg of 1:1,000 solution, maximum 0.5 mg in anterolateral thigh) if cardiovascular symptoms (hypotension, dizziness) develop, as advised by the Mayo Clinic 3
• Immediately administer intramuscular epinephrine (0.01 mg/kg of 1:1,000 solution, maximum 0.5 mg in anterolateral thigh) if gastrointestinal symptoms beyond the oral cavity (nausea, vomiting, abdominal pain) develop, as advised by the Mayo Clinic 3
• Immediately administer intramuscular epinephrine (0.01 mg/kg of 1:1,000 solution, maximum 0.5 mg in anterolateral thigh) if diffuse urticaria or angioedema develop, as advised by the Mayo Clinic 3
• Immediately administer intramuscular epinephrine (0.01 mg/kg of 1:1,000 solution, maximum 0.5 mg in anterolateral thigh) if any progression of symptoms despite antihistamine treatment occurs, as recommended by the American Academy of Allergy, Asthma, and Immunology 2

Long-Term Management

• Strict avoidance of kiwifruit is the cornerstone of management, as recommended by the American Academy of Allergy, Asthma, and Immunology 4, 5, 6
• Prescribe epinephrine auto-injector for all patients with kiwi allergy, even those with isolated OAS, due to risk of progression, as advised by the Mayo Clinic and the American Academy of Allergy, Asthma, and Immunology 1, 3
• Provide comprehensive education on recognition of anaphylaxis symptoms, proper epinephrine auto-injector technique, and when to use epinephrine, as recommended by the Mayo Clinic and the American Academy of Allergy, Asthma, and Immunology 1, 3, 6
• Allergen immunotherapy for kiwi-related OAS remains investigational, according to the American Academy of Allergy, Asthma, and Immunology 7, 8
• Refer to allergist for comprehensive evaluation including assessment for cross-reactive allergens, as recommended by the Mayo Clinic and the American Academy of Allergy, Asthma, and Immunology 1, 3, 8
• Nutritional counseling if multiple food avoidances are necessary, as advised by the Mayo Clinic 6