It’s possible to be allergic to apples, where your immune system reacts to the fruit as if it were bad for your body. You may experience a rash, stomach cramps, or diarrhea soon after consuming fruit or any food or drink that contains fruit.
Those who experience allergic reactions after eating apples have symptoms that only affect the mouth — such as itching, tingling, tingling or swelling of the lips and mouth. This is a condition called oral allergy syndrome (OAS), also known as pollen food allergy syndrome.
This article discusses apple allergy and OAS associated with apples, common symptoms, treatments, and when to seek medical attention.
What is an apple allergy?
An apple allergy is when your immune system overreacts to apples. It produces chemicals designed to attack the perceived threat, resulting in a negative reaction.
The severity of the reaction after eating apples or foods containing apples varies from person to person. Symptoms range from mild irritation or itching to a generalized, potentially life-threatening emergency.
Some people with OAS respond only to raw apples, while others may also respond to whether the fruit is cooked or not. This is especially likely if you are allergic to peaches or other foods with proteins similar to those in apples.
What is the cause of an apple allergy?
An apple allergy is caused by proteins in apples that confuse the immune system into thinking it must protect the body from dangerous damage.
The body may have a problem with the apple protein itself, or it may flag the apple protein as a similar protein to which you are actually allergic.
Oral Allergy Syndrome vs. True Allergies
Few people with OAS have a true allergy to the fruit or vegetable to which they react. This can be confusing because oral allergy syndrome is considered a type of food allergy.
This may seem like medical semantics, but it’s important to how you handle your diet. It all makes more sense when you think carefully about how your body responds in each situation.
All plants have pollen, and that’s how they reproduce. Every pollen you come across has a unique set of proteins.
A true apple allergy is an immune response to a specific protein in apples or a closely related protein in other fruits such as peaches. Whenever you come into contact with these proteins, a reaction occurs.
On the other hand, OAS after eating an apple is more of a case of wrong identity.
OAS is most commonly seen in people with hay fever or asthma triggered by tree pollen (in apples, especially birches). The immune system “reads” apple proteins as if they were tree pollen proteins and responds accordingly.
This reaction is called a cross-reaction. It might happen some times, but not other times. People with OAS often experience more severe symptoms during allergy season because their bodies are already battling airborne pollen.
For this reason, if you can live with raw apples and then suddenly react to them, it’s probably because of the high pollen count.
These common reactions may also be associated with other fruit and nut allergies.
other fruit and nut allergies
In addition to apples, other fruits, vegetables, spices, and nuts have similar cross-reactivity issues involving pollen types, such as:
- Birch: Apple, Almond, Carrot, Celery, Cherry, Garlic, Hazelnut, Kiwi, Peach, Pear, Plum
- Ragweed: Bananas, cucumbers, melons, sunflower seeds, zucchini
- Mugwort: celery, melons, oranges, peaches, tomatoes
If you bite into one of these foods, you may also have an allergic reaction, although this reaction is milder and less lasting than what you experience when you are exposed to the pollen in question itself.
To understand how common cross-reactions are, as many as 50 to 75 percent of people with birch pollen allergies will react to raw apples or celery.
Apple allergies are often linked to birch pollen allergies and other food allergies because similar proteins confuse the immune system. People who are severely allergic to peaches may also be severely allergic to apples.
Symptoms of an apple allergy
The type and severity of symptoms may vary depending on whether you have a true allergic reaction to apples or are experiencing OAS.
Symptoms of OAS are usually mild and limited to the mouth, lips, or tongue.
Symptoms of oral allergy syndrome often include:
- Itchy, inflamed mouth, tongue, or throat
- Redness and slight swelling of the lips, tongue, or throat
However, broader symptoms are possible. For example, about 10% of people with OAS experience nausea or upset stomach.
OAS symptoms tend to be more surprising than irritation, and last only a few seconds or minutes until enzymes in the saliva break down the protein.
Real application allergy symptoms affect more than the mouth. Those who were truly allergic to the app or were allergic to peaches were also more likely to have more pronounced symptoms, such as:
- nausea or upset stomach
- abdominal cramps
In severe cases, anaphylaxis — a potentially life-threatening allergic reaction — can occur in people with an apple allergy. This is a medical emergency that requires urgent care.
If left untreated, allergic reactions can lead to hypoxia, shock, coma and even death.
When to call 911
Call 911 or seek emergency medical care if you experience any of the following symptoms of an allergic reaction:
- swelling of the face, tongue, or throat
- shortness of breath
- hard to swallow
- slurred speech
apple allergy treatment
If you experience an unexpected food allergy, you should be monitored for a few hours for a more severe reaction. This is especially true if this is your first time reacting.
In many cases of OAS, medical treatment is not required because OAS symptoms usually resolve within minutes.
If symptoms bother you, an over-the-counter antihistamine (such as benadrine (diphenhydramine)) can be used to treat a reaction limited to the mouth and lips. Antihistamines block the effects of histamine, a chemical that is released in response to allergens that cause allergic symptoms.
It is not recommended to take the medicine regularly before eating so that you can eat food without problems.
If you are allergic to apples and tend to have more severe symptoms, your healthcare provider will give you a drug called epinephrine to relax your airways and reverse the effects of a severe allergic reaction.
They will also ask you to bring an EpiPen (adrenaline auto-injector) in case of future emergencies.
OAS usually causes mild symptoms in the throat and mouth that resolve quickly and may not require treatment. Antihistamines are sometimes recommended. Those with an apple allergy should carry an EpiPen with them in case of accidental ingestion.
Foods to avoid if you are allergic to apples
Of course, watching what you eat is a key part of managing a negative reaction to apples.
If you are allergic to apples, you need to avoid apples in all their forms. Keep in mind that you may also react to some other foods and may need to avoid them as well.
These may include:
People who experience OAS from eating apples should avoid eating the raw fruit, as it tends to trigger symptoms. Cooked or processed forms of fruit (eg, roasted, boiled, dried) are usually fine because the proteins are usually broken down enough that your body doesn’t react to them.
That said, you may find yourself avoiding all forms of apples at certain times of the year when your immune system is on “high alert” due to pollen allergies.
The same applies to any other fruit, vegetable, spice or nut that is mildly cross-reactive. Whether or not the food is organic does not affect your risk.
Dealing with Apple Allergies
Apple products like apple pie, apple juice, and applesauce are easy to identify and avoid. However, apples are found in many foods you might not expect.
If you need to strictly avoid eating it, be sure to check food labels to make sure the foods you choose do not contain apples. Also pay special attention to peaches.
If you have an EpiPen, be sure to take it with you and educate those around you (family, colleagues) how to use it on you when needed.
when to see a doctor
Talk to your healthcare provider if you think you are allergic to apples or if your OAS seems to be getting worse.
They can help you determine your next steps and whether it’s necessary to carry your medication with you if you accidentally eat an apple or other trigger food.
Seek emergency medical care if you experience any symptoms of an allergic reaction.
If you are allergic to apples, your immune system reacts to the proteins in apples, which is a threat. Symptoms vary from person to person and can range from mild to severe.
Oral allergy syndrome usually causes mild symptoms in the throat and mouth that resolve quickly. If you are allergic to birch tree pollen, you may experience OAS because your immune system confuses a protein in raw apples with this pollen.
The proteins in apples and peaches may also be recognized by your immune system as allergens. These apple allergies tend to lead to more severe and potentially life-threatening symptoms after eating raw or cooked apples in any form.
If you’ve experienced oral allergy symptoms, you should know that pollen isn’t the only allergen associated with OAS. About 5 percent of people are allergic to latex, linked to allergies to avocado, banana, chestnut, kiwi, and papaya.
If you’re allergic to cider or apple cider vinegar, but not to raw apples themselves, you may be allergic to brewer’s yeast, which is a byproduct of fermentation, not OAS.
Frequently Asked Questions
Which fruits are safe for people with oral allergy syndrome?
Even if you have oral allergy syndrome, you can eat any fruit of your choice if you wash, heat or peel the skin thoroughly before eating. The protein that causes the reaction is usually very concentrated in the skin of the fruit.
How Common is Oral Allergy Syndrome?
OAS is common, with an estimated one-third of people with seasonal allergies experiencing symptoms. This number may be higher because the condition is often undiagnosed.
Why am I suddenly allergic to apples?
Food allergies can happen at any time in your life.
How common is apple allergy?
This is unknown, but some studies estimate that as many as 5% of people may have food allergies linked to pollen allergies, especially a cross-reactivity between birch pollen and apples.
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