Could I Have an Apple Allergy?

Food allergies and oral allergy syndrome are linked to apples

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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.

However, if you experience an allergic reaction with symptoms that only affect the mouth, it could be a condition known as oral allergy syndrome (OAS), also called pollen food allergy syndrome.

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

Types of Apple Allergy

There are two types of allergies some people have when eating apples. One is a true allergy to apples, which is uncommon. Another is related to an allergy to birch pollen.

Apple Allergy

If someone is allergic to apples, they have a reaction to a protein in apples. This protein is specific to fruit. (A similar protein is found in peaches.)

The severity of the allergic reaction after eating an apple or foods with apples in them varies from person to person, depending on the type of allergy they have. For example, people who have a fruit allergy tend to have a more severe reaction than people who have a pollen allergy.

A true allergy involves a strong immune response by the body. It can cause symptoms throughout the whole body and sometimes, the allergic reaction is severe or even life-threatening. 

Oral Allergy Syndrome 

People who have symptoms of an allergic reaction that only affect their mouth (e.g., lip and mouth itching, tingling, stinging, or swelling) after eating an apple probably do not have a true fruit allergy. Instead, they are more likely to be reacting to the protein related to pollen. This protein is actually very similar to birch pollen, so instead of being a fruit allergy, it's more like a pollen allergy.

Oral allergy syndrome (OAS) is triggered by these proteins. This type of allergy usually leads to mild symptoms.

How Common Is It to Be Allergic to Apples?

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

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.

What Causes Apple Allergies?

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

A true apple allergy happens when your immune system overreacts to the proteins and starts making chemicals that attack the “threat." The attack causes a response in the body that looks and feels like allergy symptoms.

The body may react to apple proteins specifically, or it may “flag” apple proteins because they are similar to the proteins that you are actually allergic to. 

Oral Allergy Syndrome vs. True Allergy

Very few people with OAS have a true allergy. This can be confusing since oral allergy syndrome is considered a type of food allergy. The key difference is that OAS only causes mouth-related symptoms.

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, not just when you eat them.

OAS is more common in people with hay fever or asthma that’s triggered by tree pollen. All plants have pollen, which they use to reproduce. Each pollen has its own unique set of proteins.

Oral allergy syndrome (OAS) is triggered by those proteins. Unlike a true allergy, OAS is more a case of “mistaken identity.” In OAS, the immune system "reads" the apple proteins as if they are tree pollen proteins, and reacts to them as if they were.

This kind of response is called cross-reactivity. It may not happen all the time or be as severe every time it happens—another way it’s different from a true allergy.

For example, people with OAS often have worse allergy symptoms during the seasons when their bodies are already overwhelmed by airborne pollens. If you can usually 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

Many fruits, vegetables, spices, and nuts have similar cross-reactivity with certain types of pollens:

  • 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 eat one of these foods, you may have an allergic response—though it might be milder and shorter-lasting than the one you’d get when you’re exposed to the specific pollen that’s problematic for you.

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 and/or celery.

Apple Cider Vinegar

If you are allergic to apple cider or apple cider vinegar but not raw apples, you may have an allergy to brewer’s yeast, a byproduct of fermentation.

Symptoms of Apple Allergy

Apple allergy symptoms vary, depending on if you're having a true allergic reaction to apples or if you are experiencing OAS. Symptoms of OAS are usually mild and only felt in 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

It’s not common, but more widespread symptoms are possible. Nausea or stomach upset happen in about 10% of people with OAS.

Symptoms of Oral Allergy Syndrome
Verywell / Jiaqi Zhou

OAS symptoms tend to be more surprising than irritating. Usually, they only last a few seconds or minutes—however long it takes for the enzymes in the saliva to break the proteins down.

True apple allergy symptoms affect more than the mouth. The symptoms of an apple allergy range from mild irritation or itchiness to a whole-body, potentially life-threatening allergic reaction.

People with a true apple or a peach allergy are more likely to have pronounced allergy 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 people with true apple allergies. Anaphylaxis is a medical emergency that requires urgent care.

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

When to Call 911

Call 911 or seek emergency medical care if you develop any symptoms of anaphylaxis:

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

Treatment for Apple Allergy

If you have an unexpected food allergy, you need to be monitored for a few hours on the off-chance a more severe reaction follows—especially if it’s the first time you've had a reaction.

In many cases of OAS, medication is not necessary since the symptoms will usually get better within minutes.

If the symptoms are bothering you, allergic reactions that just affect your mouth and lips can be treated with an over-the-counter (OTC) antihistamine, such as Benadryl (diphenhydramine). These medicines block the actions of a chemical released in response to an allergen that contributes to allergy symptoms (histamine).

However, it’s not recommended that you regularly use antihistamines to be able to eat food that gives you a reaction. 

If you have an apple allergy and have more severe symptoms, your healthcare provider will give you a medication called epinephrine that will relax your airways and reverse the effects of a severe allergic reaction in case it happens. 

They will ask you to carry an EpiPen (epinephrine auto-injector) so you’ll be ready if you are accidentally exposed and have a severe reaction. 

Foods to Avoid If You Have an Apple Allergy

The most important way to avoid apple allergy symptoms is to avoid apples and other foods that could trigger symptoms.

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

How Food Preparation Can Help

People who have OAS symptoms when eating apples should avoid eating raw fruit, as this form tends to trigger symptoms. For some people, the allergic reaction can be avoided if they eat the food in a certain way that has changed the proteins. 

For example, some people with OAS only react to raw apples but can eat them cooked (like in apple pie) because the proteins are changed by heating. Cooked or processed forms of the fruit (e.g., baked, boiled, dried) are usually fine because the proteins get broken down enough for your body not to react to them.

You might be able to eat apples or other fruits if you wash them thoroughly, heat them, or peel the skin off first. The proteins that cause the reaction are usually concentrated in the skin of the fruit.

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" from 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.

Some people react to apples whether they are cooked or not. Being allergic to apples no matter how they’re prepared is more likely if you are also allergic to peaches or other foods with proteins that are like those in apples that trigger an allergy. 

Coping With Apple Allergies

Products like apple pie, apple juice, and apple sauce are easy to identify and avoid. However, you should know that apples can also show up in other foods or drinks that you might not expect, like fruit and veggie blends, smoothies, and baked goods. 

Always check food labels to make sure a product does not have apples in it. You may want to look for other fruits and foods that could cause a cross-reaction, like peaches. 

If you have an EpiPen, carry it with you at all times and educate the people around you (e.g., family, friends, coworkers) on how to use it, if needed. 

When to See a Provider

If you think you’re having an allergic reaction to apples, talk to your provider. If the symptoms are just in your mouth, it’s likely you have OAS, but you’ll need to see a provider to find out for sure. 

You may need to see an allergist to learn how to manage your allergy symptoms effectively and learn when and how to use an Epi-Pen if needed. 

If you ever have symptoms of anaphylaxis, get emergency medical care right away. 

Summary

If you think you are having an allergic reaction after eating apples, you likely have oral allergy syndrome (OAS), especially if the symptoms are mild, don’t last long, and only affect your mouth. This reaction is not like a true apple allergy and is more similar to a pollen allergy.

You should see a provider if you have symptoms after eating apples and you don’t know what's causing them.

Whether you have a true allergy or OAS, you can learn to manage your symptoms by preparing foods in a certain way, avoiding foods that trigger a reaction, and taking medication to treat your allergy symptoms and prevent serious allergic reactions. 

7 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.
  1. University of Manchester. Allergy information for: apple (malus domestica).

  2. Allergy & Asthma Network. Oral allergy syndrome (OAS).

  3. Popescu FD. Cross-reactivity between aeroallergens and food allergensWJM. 2015;5(2):31. doi:10.5662/wjm.v5.i2.31

  4. American Academy of Allergy Asthma & Immunology. Oral allergy syndrome (OAS) or pollen fruit syndrome (PFS). Updated September 28, 2020.

  5. UpToDate. Patient education: oral allergy syndrome (beyond the basics). Updated August 23, 2021.

  6. Children's Hospital of Philadelphia. Oral Allergy Syndrome.

  7. American College of Allergy, Asthma & Immunology. Oral allergy syndrome.

By Jeanette Bradley
Jeanette Bradley is a noted food allergy advocate and author of the cookbook, "Food Allergy Kitchen Wizardry: 125 Recipes for People with Allergies"