Could I Have an Apple Allergy?

Oral allergy syndrome is linked to apples and other fruit

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If you’ve ever bitten into an apple and felt your lips and mouth itching, tingling, stinging, or swelling, you may have a condition known as oral allergy syndrome (OAS), also called pollen food allergy syndrome.

OAS is the result of an allergic reaction to a protein in apples that's similar to a type of pollen found in birch trees. Therefore, if you are allergic to birch pollen you may also be allergic to apples.

There are also apple allergies that are connected to peach allergies and other foods due to similar proteins.

This article will explore the different types of apple allergies, common symptoms, treatments, and when to seek medical care.

Symptoms of Oral Allergy Syndrome
Verywell / Jiaqi Zhou

What Is an Apple Allergy?

An apple allergy is when your immune system overreacts to apples and causes a reaction.

The severity of the reaction after eating an apple or foods with apples in them can vary widely from person to person. Symptoms can range from a mild irritation or itchiness to a potentially life-threatening emergency.

Some people with OAS only react to raw apples while others, particularly those with apple allergies tied to peach allergies, may also react to all forms of cooked apples.

What Causes Apple Allergies

An apple allergy is due to proteins in apples that confuse the immune system.

It can be a direct response to the apple proteins or a shared allergic response in which the immune system mistakes the apple proteins for pollen.

All plants have pollen, which is how they reproduce. Every pollen you encounter is different; it has a unique set of proteins. If you are allergic to a particular protein in birch pollen, you may have an allergic reaction to apples. This shared allergic response is called cross reactivity.

In all types of apple allergies, the immune system responds as if the proteins in apples are a threat.

Oral Allergy Syndrome

Oral allergy syndrome (OAS) is not usually a true allergy but rather the body’s response to apple proteins it mistakenly believes are pollen.

These shared reactions can also be related to other fruit and nut allergies.

Very few people with OAS have a true allergy to the fruits or vegetables they eat.

Up to 50% to 75% of people with birch pollen allergies will react to raw apples or celery.

Apple Allergy and Other Fruit and Nut Allergies

In addition to apples, other fruits, vegetables, spices, and nuts have similar cross-reactivity issues involving types of pollens, such as:

  • Birch: Apple, almond, carrot, celery, cherry, garlic, hazelnut, kiwi, peach, pear, plum
  • Ragweed: Banana, cucumber, melons, sunflower seeds, zucchini
  • Mugwort: Celery, melons, oranges, peaches, tomato

If you bite into one of these, you may also have an allergic response (albeit slighter and shorter-lasting than the pollen allergy).

Another type of allergic reaction to apples is a true allergy to a protein in apples that is also closely related to a protein found in peaches.

These allergies tend to result in more serious symptoms, such as hives, or even potentially life-threatening emergencies, such as difficulty breathing.

The proteins for this type of allergy and OAS are also similar to other fruits and nuts, such as almonds or walnuts.

Recap

Apple allergies are usually connected to birch pollen allergies and other food allergies due to similar proteins that confuse the immune system. People with a severe allergy to peaches may also have a severe allergy to apples.

Symptoms of Apple Allergy

Symptoms of OAS are usually mild and confined to the mouth, lips, or tongue.

Symptoms of OAS often include:

  • Itchy, irritated mouth, tongue, or throat
  • Red and slightly swollen lips, tongue, or throat

OAS symptoms tend to be more surprising than irritating, and last only a few seconds or minutes until the enzymes in the saliva break the proteins down.

People with OAS often have worse symptoms during allergy seasons when their bodies are already struggling with airborne pollens.

For this reason, if you can otherwise tolerate raw fruits and vegetables and then suddenly you have a reaction, it might be because pollen counts are high.

Those with an allergy connected to peach allergy are more likely experience more pronounced symptoms of apple allergy such as:

  • Nausea or stomach upset
  • Abdominal cramps
  • Diarrhea
  • Rash
  • Hives

Although, these symptoms can also sometimes occur in those with OAS. For example, nausea or stomach upset happens in about 10% of people with OAS.

In severe cases, anaphylaxis, a potentially life-threatening allergic reaction, can occur those with apple allergies. It is a medical emergency that requires urgent care.

If left untreated, anaphylaxis can lead to respiratory asphyxiation (lack of oxygen), shock, coma, and even death.

When to Call 911

Call 911 or seek emergency medical care if you develop any of these symptoms of anaphylaxis, a potentially life-threatening allergic reaction:

  • Swelling of the face, tongue, or throat
  • Wheezing
  • Shortness of breath
  • Vomiting
  • Rapid heartbeat
  • Trouble swallowing
  • Slurred speech

Treatment

In many cases of OAS, medication isn't necessary since the OAS symptoms typically subside within minutes.

Allergic reactions limited to your mouth and lips can be treated with an over-the-counter antihistamine, such as Benadryl (diphenhydramine).

Antihistamines block the actions of histamine, a chemical released in response to an allergen that contributes to allergy symptoms.

Antihistamines can be used once the food is eaten. However, it is not recommended that antihistamines be regularly used as premedication to eat these fruits.

People who have symptoms of OAS should opt for cooked or processed forms of the food—which usually do not cause symptoms—instead of relying on antihistamines.

If you experience an unexpected food allergy, you should be monitored for a few hours on the off-chance a more severe reaction follows. This is especially true if it’s the first time you've had a reaction.

If you have an apple allergy and severe hypersensitivity, your healthcare provider will likely ask you to carry an EpiPen (epinephrine auto-injector) in the event of an emergency. An EpiPen can relax the airways and reverse the effects of severe allergic reactions.

Recap

OAS often leads to mild symptoms in the throat and mouth that resolve quickly and may not require treatment. Sometimes an antihistamine is recommended.

Those with severe apple allergies should always carry an EpiPen with them in case of accidental ingestion.

Foods to Avoid If You Have an Apple Allergy

If you are allergic to apples you may also have reactions to some other fruits and nuts and may need to avoid them.

The ones that lead to reactions can vary from person to person and may include:

  • Peach
  • Pear
  • Cherry
  • Apricots
  • Plum
  • Strawberry
  • Nectarine
  • Banana
  • Melons
  • Celery
  • Carrots
  • Hazelnuts
  • Almonds
  • Walnuts
  • Soybeans

If you have OAS and cook or process apples by baking, boiling, or drying, the proteins often get broken down and your body may no longer react to them.

The same applies to any other fruits, vegetables, spices, or nuts with mild cross-reactivity. However, it doesn't matter if you choose an organic or non-organic product, an allergy will occur either way.

Coping with Apple Allergies

Managing an apple allergy may just require avoiding apples. Sometimes this is just raw apples and other times it is apple in any raw, processed, or cooked form.

When to See a Doctor

If you think you have an apple allergy or you have OAS that seems to be getting worse, consult your medical provider.

They can help you figure out next steps and if it's necessary to carry medication for any time you accidentally eat apple or other trigger foods.

If you ever experience any symptoms of anaphylaxis, seek urgent medical care.

Outlook and Prevention

The best preventive measure for avoiding symptoms is avoiding the trigger foods.

If your allergy is severe, always carry an EpiPen with you and check ingredients, such as in baked goods and snacks, for apples (and peaches, if you are allergic to both).

Summary

If you have an apple allergy, your immune system reacts to proteins in apples as a threat. Symptoms vary widely from person to person and can be mild to severe.

Oral allergy syndrome commonly 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 for pollen.

There are also proteins in both apples and peaches that your immune system may identify as an allergen. These apple allergies tend to lead to more serious or even potentially life-threatening symptoms after eating any form of raw or cooked apples.

A Word From Verywell

If you've experienced oral allergy symptoms, you should know that pollen is not the only allergen connected to OAS. Latex allergies, which affect about 5% of people, are associated with allergies to avocados, bananas, chestnuts, kiwis, and papayas.

If you are allergic to apple cider or cider vinegar but not to raw apples themselves, you may be allergic to brewer’s yeast, a byproduct of fermentation, as opposed to having OAS. 

Frequently Asked Questions

  • Which fruits are safe to eat with oral allergy syndrome?

    Even if you have oral allergy syndrome, you may be able to eat any fruit of your choosing if you wash it thoroughly, heat it, or peel the skin off before eating. The proteins that cause the reaction are usually very concentrated in the skin of the fruit.

  • How common is oral allergy syndrome?

    OAS is very common, with an estimated 1 in 3 people with seasonal allergies experiencing symptoms from it. The numbers could be even higher as the condition usually goes undiagnosed.

  • Why am I suddenly allergic to apples?

    It's possible to develop a food allergy at any point in your life.

  • How common is apple allergy?

    It's unknown but some studies estimate that up to 5% of people may have food allergies connected to pollen allergies, especially a cross reaction of birch pollen and apple.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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