Could I Have an Apple Allergy?

It is possible to have an apple allergy, which is when your immune system launches a response to the fruit as if it is harmful to your body. You may experience a rash, stomach cramps, or diarrhea soon after consuming the fruit or any food or drink that contains it.

Those experience an allergic reaction with symptoms that only affect the mouth—like lip and mouth itching, tingling, stinging, or swelling—after eating an apple. This is a condition known as oral allergy syndrome (OAS), also called pollen food allergy syndrome.

This article explores apple allergy and OAS related to apples, common symptoms, treatments, and when to seek medical care.

What Is an Apple Allergy?

An apple allergy is when your immune system overreacts to apples. It produces chemicals aimed at attacking the perceived threat, which causes a negative 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 mild irritation or itchiness to a whole-body, potentially life-threatening emergency.

Some people with OAS only react to raw apples, while others may also react to the fruit whether it is cooked or not. This may be particularly likely if you are allergic to peaches or other foods with proteins similar to those in apples.

What Causes Apple Allergies?

An apple allergy is due to proteins in apples that confuse the immune system into thinking that it has to protect the body from something dangerous.

The body may take issue with the apple proteins themselves, or it may flag apple proteins as similar proteins that you are actually allergic to instead.

Oral Allergy Syndrome vs. True Allergy

Very few people with OAS have a true allergy to the fruits or vegetables they react to. This may be confusing, since oral allergy syndrome is considered a type of food allergy.

This may seem like medical semantics, but it matters to how you approach your diet. It all makes a lot more sense when you think about exactly what the body is reacting to in each condition.

All plants have pollen, which is how they reproduce. Every pollen you encounter has a unique set of proteins.

A true apple allergy is an immune reaction to the specific proteins in apples or closely related proteins in other fruits, such as peaches. The reaction occurs whenever you are in contact with these proteins.

On the other hand, OAS after eating an apple is more of a case of mistaken identity.

OAS is most common in people with hay fever or asthma triggered by tree pollen (in the case of apples, birch specifically). The immune system "reads" apple proteins as if they are tree pollen proteins, and reacts in kind.

This response is called cross-reactivity. It may occur at some times, but not others. 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 apples and then suddenly have a reaction to them, it might be because pollen counts are high.

These shared reactions can also be related to 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 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 foods, you may also have an allergic response, albeit a slighter and shorter-lasting one than you'd experience when exposed to the problematic pollen itself.

For a sense of how common cross-reactivity is, up to 50% to 75% of people with birch pollen allergies will react to raw apples or celery.

Symptoms of Apple Allergy

Symptoms can vary in type and severity, depending on if you're having a true allergic reaction to apples or you are experiencing OAS.

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

Oral allergy syndrome symptoms typically include:

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

However, more widespread symptoms are possible. For example, nausea or stomach upset happens in about 10% of people with OAS.

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.

True apply allergy symptoms affect more than the mouth. Those with a true apply allergy or a peach allergy are also more likely to experience more pronounced symptoms, such as:

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

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

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

Treatment for Apple Allergy

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.

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

If symptoms are bothering you, 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.

Taking the medication regularly before eating so that you can consume a food without issue is not recommended.

If you have an apple allergy and tend to have more severe symptoms, your healthcare provider will give you a medication called epinephrine to relax the airways and reverse the effects of severe allergic reactions.

They will ask you to carry an EpiPen (epinephrine auto-injector) in the event of a future emergency as well.

Foods to Avoid If You Have an Apple Allergy

Of course, watching what you eat is a key part of managing negative reactions to apples.

If you have a true apple allergy, you will need to avoid apples in all forms. Remember, too, that you may also have reactions to some other foods and may need to avoid them as well.

These may include:

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

People who experience OAS in response to eating apples should avoid eating the raw fruit, as it is what tends to trigger symptoms. Cooked or processed forms of the fruit (e.g., baked, boiled, dried) are usually fine, as the proteins often get broken down enough for your body not to react to them.

That said, you may find the need to avoid all forms of apples at times of the year when your immune system is already on "high alert" due to pollen allergies.

The same applies to any other fruits, vegetables, spices, or nuts with mild cross-reactivity. Whether or not a food is organic does not play into your risk.

Coping With Apple Allergies

Apple products like apple pie, apple juice, and apple sauce are easy to identify and avoid. However, apples are in a host of foods you may not expect.

Be sure to check food labels so you are sure that what you're choosing doesn't contain apple, if you need to strictly avoid it. Keep an eye out for peaches in particular, as well.

If you have an EpiPen, be sure to carry it with you at all times and educate those who are commonly around you (family, coworkers) on how to use it on you, if needed.

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.

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 that 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 have an allergy to brewer’s yeast, a byproduct of fermentation, as opposed to OAS.