Apple allergies are more common than you think, in a 2014 EuroPrevall study apples were categorised as a Priority One Allergen (read more about EuroPrevall studies here). Symptoms of apple allergy are most often non-anaphylactic with either Oral Allergy Syndrome symptoms or gastro-intestinal symptoms.
Blood tests are generally unreliable in allergy diagnosis and as a less common allergy with less severe symptoms your doctor or hospital may be unwilling to perform an allergy test.
As with most allergies it is recommended that elimination diets and avoidance are the safest, quickest and cheapest course of action.
If you think you may be allergic to apples and are interested in making a food diary to diagnose or manage your allergy, see my food diary download.
Look out for labels
Apple can be consumed as fresh, as a processed fruit and in juices and cider. Apple pectin is often used as a gelling agent in jams, jellies and relishes. It may be hard to avoid when apple is used as a natural flavouring in products in things like sweets.
Key Allergens/Proteins in Apple Allergy
The most studied proteins in apple allergy are called Mal d 1, Mal d 2, Mal d 3 and Mal d 4. 87% of people suffering from this allergy are thought to be sensitised to the protein Mal d 1, but may be allergic to other combinations of proteins.
Apple-allergic patients may display cross-reactivity with pollen or food containing allergens with a similar protein structure to Mal d 1.
There have been found to be links with
Fruits and Vegetables
- Bell Pepper
- Birch Tree Pollen
If you have two or more of these allergies there are links at the bottom of the page for Oral Allergy Syndrome.
The amount of allergens in apples are influenced by the apple variety, the ripeness of the fruit and the storage conditions. Over-ripe and freshly harvested fruits have high levels of one protein, but longer storage increases the levels of other apple allergens.
Mal d 1, the allergen most commonly causing allergic reactions is heat labile, which means the protein changes shape during cooking, which means it is no longer able to cause an allergic reaction (or in cases of extreme allergy, reduces the effects of any reaction). Patients still having allergic reactions to apple after cooking are likely to be allergic to the allergen Mal d 3, which would be important to mention to an allergist if you are looking to be tested.
In recent studies (listed below) red‐fleshed apples displayed the lowest reactivity, followed by older and then newer varieties as newer varieties of apple are bred to be more crisp and tasty, increasing the amount of the offending proteins. It was also noted that skin reactivity increased from the flesh of the apple to the peel and peel near the stalk.
This is a blog and should not be used for advice on diagnosis or treatments. If you think you may have a food allergy please contact your GP in the first instance to discuss treatment options.