Are there other allergens I could be sensitized to?*
Some people with apple allergy may also experience symptoms when eating other seemingly unrelated foods. This is called cross-reactivity and occurs when your body's immune system identifies the proteins, or components, in different substances as being structurally similar or biologically related, thus triggering a response. The most common cross-reactivities with apple include cherries, peaches, hazelnuts, peanuts, carrots, pears, raspberries, strawberries, and mulberries.3
If you experience an itchy mouth or throat after eating apples or other related fresh fruits or raw vegetables, you may suffer from Oral Allergy Syndrome (OAS), sometimes called Pollen Food Allergy Syndrome (PFAS). This condition is caused by your immune system's reaction to similar proteins, or components, found in plant foods and tree pollens.6 It is quite common, with up to 25 percent of children with allergic rhinitis (i.e., hay fever) also suffering from OAS when eating fruits or vegetables.7 Common pollen allergies that could cause OAS when eating apple include tree pollens such as birch, alder, and hazel.3
Do I need to avoid all forms of apple?
An apple consists of different types of proteins that all have different characteristics that may be associated with varying risk of causing severe allergic reactions. Some people with apple allergy may be able to eat apple if it is extensively heated (cooked), as high temperatures break down the causative proteins. Other proteins are mostly located in the peel, and apple may be tolerated if peeled. For other patients, apple may need to be avoided in all forms, it could potentially cause a severe event, also called anaphylaxis. Your specific risk profile depends on which proteins you are allergic to.3
Knowing the proteins, or components, within each allergen that are triggering your symptoms can help guide your management plan. With that in mind, and based on your symptom history, your healthcare provider may suggest something called a specific IgE component test, which can help reveal other pollens and foods you may react to.3
Already have your specific IgE component test results?
Your component test results will include the name of the components (a series of letters and numbers and/or name). Your healthcare provider will likely review the results with you, but here you'll find an at-a-glance breakdown you can use as a reference. Simply match the component names to the list below to see what they mean in terms of symptom management.3
rMal d 1
- Usually associated with mild symptoms, such as OAS, but sometimes also severe reactions.
- Present in all pollens and plant foods, associated with cross-reactions, typically to birch and grass pollen.
- Sensitive to heat and digestion, and cooked foods are often tolerated.
rMal d 3
- Usually associated with severe reactions as well as OAS.
- High concentration in the peel. Peeled apple may be tolerated.
- Stable to heat and digestion, cooked apples can also cause symptoms.
- Positive specific IgE for apple in combination with MUXF3 CCD (Cross-Reactive Carbohydrate Determinant) being the only positive component test indicates that the cause of symptoms may be something other than apple.
Test results should be interpreted by your healthcare provider in the context of your clinical history. Final diagnosis and decision on further management is made by your healthcare provider.
*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.