Apple Allergen Facts, Symptoms, and Treatment
Learn more about common allergic diseases, symptoms, management paradigms, and testing considerations.
Is your patient a candidate for specific IgE testing?
Get detailed information on whole allergens and allergen components.
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Learn more about common allergic diseases, symptoms, management paradigms, and testing considerations.
Is your patient a candidate for specific IgE testing?
Get detailed information on whole allergens and allergen components.
Ready to test a patient?
Access videos and webinars delivered by key experts in the field of allergy.
One of the most widely cultivated tree fruits, apples are available in thousands of varieties and are a source of carbohydrates, vitamins A and C, and dietary fiber. The vast majority of apples are produced in China, but throughout the world the fruit is eaten fresh and used to create foods such as vinegar, juice, jelly, apple butter, pie stock, applesauce, wine, and brandy.1 While apple allergy is caused by proteins in the fruit, the level of allergens in an apple is influenced by the apple variety, storage conditions, and degree of maturity.2 In a 2014 European study assessing fruit sensitization rates, apple ranked as the second most frequent inducer of sensitization (after peach) with a rate of 6.5 percent.3 While an average apple weighs 200 to 250 grams, as little as 5 grams of apple can generate a reaction.2
Apple trees are native to the temperate zones of both hemispheres, and apples are primarily eaten fresh as a whole fruit.1,2 However, in addition to being used to create items such as vinegar, juice, jelly, apple butter, pie stock, applesauce, wine, and brandy, apples are often ingredients in items such as breakfast cereals, candy bars, yogurt, deserts, cakes, pies, and pastries.1,2 Apples are also used in some hygiene products such as soap, shampoo, and shower gel; as a fruit extract in some biological cosmetics; and in pectin, which is employed as a gelling agent.2,3
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
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
rMal d 3
MUXF3 (CCD)
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.
Because there is no cure for food allergies, your healthcare provider may recommend a plan that includes the following.8-11
Your healthcare provider may direct you to take one of the following medications:
If you're with someone who's having an allergic reaction and shows signs of shock, act fast. Look for pale, cool, and clammy skin; a weak, rapid pulse; trouble breathing; confusion; and loss of consciousness. Do the following immediately:
Apple allergy can range from mild to severe and may vary over time, resulting in mild symptoms during one episode and severe symptoms in another. Although food allergy symptoms can start a few minutes to several hours after ingestion, most begin within two hours.3,4 Symptoms may involve the skin, gastrointestinal tract, cardiovascular system, and respiratory tract, and may include one or more of the following:4,5
Symptoms may also include the following, which are associated with Oral Allergy Syndrome (OAS), aka Pollen Food Allergy Syndrome (PFAS):6
Together with your symptom history, skin-prick testing or specific IgE blood testing can help determine if you are allergic to a particular allergen. If you are diagnosed with an allergy, your healthcare provider will work with you to create a management plan.
*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.
Because food allergic reactions are unpredictable and symptoms range from local to systemic, it is recommended that an epinephrine prescription be considered for any patient with an IgE-mediated food allergy.8