Apple allergy
Apple allergy, often oral allergy syndrome with birch pollen.
About apple allergy
Apple allergy is common and, in the UK, is most often linked to birch-pollen hay fever. Many people who react to apple do so because of pollen-food syndrome (also called oral allergy syndrome): the immune system makes IgE antibodies to birch pollen, and these cross-react with a similar, fragile protein in raw apple. A smaller group, more common in southern Europe, react to a sturdier apple protein and can have more serious symptoms. Both are IgE-mediated allergies.
In the pollen-related form, symptoms usually start within minutes of eating raw apple and are typically mild and short-lived: itching or tingling of the lips, mouth and throat, sometimes with mild swelling. Because the protein involved is easily broken down by heat and digestion, cooked apple in pies, sauce or juice is often tolerated. The less common protein type can cause hives, stomach upset and, rarely, more severe whole-body reactions. Symptoms tend to appear quickly, within minutes to a couple of hours of eating.
Diagnosis is usually based on the typical story alongside skin-prick testing (sometimes with fresh apple) or specific-IgE blood tests, and component testing can help tell the mild pollen-related form from the more serious type. Management centres on avoiding the trigger, and many people manage well by choosing cooked apple or peeling the fruit. If reactions ever involve the throat tightening, breathing difficulty or faintness, treat it as a medical emergency and call 999.
Common triggers
- Apple and products containing it
Symptoms
- Itching or tingling in the mouth
- Hives, itching or eczema
- Swelling of the lips, face, tongue or throat
- Stomach cramps, nausea, vomiting or diarrhoea
- Wheezing or trouble breathing
- In severe cases, anaphylaxis
Avoidance & management
- Read ingredient labels every time
- Ask about ingredients and cross-contamination when eating out
- Keep the food out of shared cooking areas
- Carry prescribed antihistamines or an adrenaline auto-injector
- Seek emergency help for any severe reaction
Sources & references
Allergy safety: what everyone should know
Mild-to-moderate reaction signs
- Itching, hives or a raised rash
- Swelling of lips, face or eyes
- Tingling mouth, sneezing, runny nose
- Stomach pain, nausea or vomiting
Anaphylaxis — call 999 (UK) or 112 (EU) immediately
- Difficult or noisy breathing, wheeze, persistent cough
- Swelling of the tongue or tightness in the throat
- Dizziness, collapse, pale and floppy (young children)
- Use an adrenaline auto-injector (e.g. EpiPen) at once if prescribed, then call an ambulance even if symptoms improve
Allergy or intolerance? A true allergy involves the immune system and can escalate quickly; an intolerance (e.g. lactose intolerance) is unpleasant but not life-threatening. The symptoms overlap, so self-diagnosis is unreliable.
Getting tested: home-testing kits based on IgG are not diagnostically valid. If you suspect an allergy, ask a GP for referral to an allergy clinic for skin-prick or specific-IgE testing and a supervised food challenge where appropriate.