Apple Allergy

An apple a day keeps the doctor away, a saying that has been holding significance since time immemorial. It is apparent that apple is loaded with health benefits. In spite of its advantages, if one feels tingling sensation in and around mouth after having apple, it might be a case of apple allergy. A very small percentage of people are affected with apple allergy.

What is apple allergy?

Apple allergy is one of the most common forms of oral allergy syndrome (OAS) or pollen food syndrome (PFS). The proteins found in raw apples are quite similar to the ones found in mugwort pollens (a species of weed) and birch pollens. During pollinating season when the pollen count is high, apple allergy is at its peak with the worst kind of symptoms. In other words, apple allergy can be termed as an allergy associated with pollen allergy.


Like most other food allergies, apple allergy is an immune system response. It is a hypersensitivity reaction occurring from raw proteins. Same kind of reaction does not persist when apples are consumed in cooked or processed form because of inactivation of allergens. Apple allergy is primarily caused due to pollen-food cross-reactions. It is a seasonal allergy occurring in hay-fever sufferers and people with pollen allergy. The immune system produces antibodies against the raw proteins found in apples and trigger allergic reactions in the body.

Symptoms of Apple allergy

The symptoms of apple allergy are widespread and can occur within few minutes of raw apple intake. Those symptoms are cited below categorically:

Oral symptoms

  1. Tingling or itching sensation in and around lips, mouth and throat
  2. Formation of raised bumps inside mouth

Skin symptoms

  1. Itching of skin
  2. Redness of skin
  3. Patchy or flaky skin
  4. Hives
  5. Swelling of skin, face and eyelids
  6. A feeling of tenderness or pain on the areas of rash
  7. Rash of welts
  8. Bumps on skin
  9. Extreme swelling of eyelids leading to closure of eyes

Breathing problems

  1. Inflammation of respiratory tract tissue
  2. Difficulty to swallow due to swelling in throat leading to troubled breathing
  3. Inflammation of mucous membrane obstructing the airways
  4. Runny or stuffy nose
  5. Shortness of breath

Digestion problems

  1. Abdominal pain
  2. Nausea or vomiting
  3. Diarrhea

Emergency conditions

  1. Severe anaphylaxis reaction
  2. Weak or racing pulse
  3. Lightheadedness
  4. Abnormality in speech
  5. Loss of consciousness

Risk factors

The factors that put an individual at risk of developing apple allergy are discussed below:

Pollen allergy

People with pollen allergy are susceptible to apple allergy due to the similarity of birch pollen and mugwort pollen proteins with raw apple proteins.

Hay fever sufferers

People with hay fever are considered to be at risk of developing allergy to raw apple proteins due to the similar interference of immune system in both the cases.

Geographical location

Apple allergy puts people of the Mediterranean region at risk due to the prevalence of hypersensitivity to lipid transfer protein (LTP).


Fasting plays a significant role in the expression of allergy in people with hypersensitivity to LTP because the allergen is absorbed at a rapid rate when the gastrointestinal tract is empty.

Allergies associated with apple allergy

Since apple allergy is a type of pollen food syndrome, people with birch pollen allergy might as well suffer from the allergies associated with apple such as allergies to hazelnuts, peaches, kiwi, carrots, nectarines, pears, cherries, celery, plums and soybeans.

People with mugwort pollen allergy and apple allergy may suffer from allergies to chestnuts, carrots, celery, hazelnuts and melons.


Although apple allergy does not usually cause severe symptoms yet rare cases do experience the onset of life-threatening anaphylaxis reactions. Anaphylaxis can be complicated in terms of management and treatment. An anaphylaxis patient should be under a strict regimen advised by the allergist to manage the allergy in an apt manner and stay away from the abrupt complications.

Treatment of apple allergy

Minor symptoms like itching, swelling and rashes can be treated with over-the-counter antihistamines. After putting a patient of oral allergy syndrome on dosages of antihistamines, it is important to monitor the patient at least for the next few hours so as to ensure that there is no development of more severe symptoms.

Severe anaphylaxis symptoms are treated either with the help of immunotherapy or injections of epinephrine. EpiPen, an epinephrine auto-injector should be carried along by the people prone to anaphylaxis reactions. Depending upon the severity of allergic reaction, it is determined by an allergist whether the patient should go for immunotherapy or epinephrine injections.

Besides medications, preventive treatment is to avoid ingesting raw apples. If allergist asks a patient to avoid the processed form of apples as well, he should avoid them.

Dietary changes and caution

Elimination diet i.e. a diet without raw apples is compulsory for a patient of apple allergy. Caution should be taken if allergist asks an individual to avoid apple in any form. Reading food labels should be made a habit. Asking the restaurant or hotel staffs regarding the fruit ingredients involved in any preparation should be inevitably brought into habit so as to ensure that elimination diet therapy is strictly followed. In case of other associated allergies involving fruits, those fruits should be avoided as well after a consultation with the allergist. During pollinating season, an apple allergy patient should take extra care because pollen count is really high and they make the people suffer due to worsening of allergy symptoms.

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