Apples and Itchy Throats: What's the Connection?

Young woman eating apple, portrait, close-up
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They say "an apple a day keeps the doctor away" but for some people this might be quite the opposite.  For those who find that biting into an apple may cause tingling, itching or swelling of the tongue or lips, this may very well indicate an allergy.  In fact most people that experience these symptoms do in fact have what is referred to as oral allergy syndrome (OAS).  Apples are a prime example of a fruit that is often associated with OAS however there are many other fruits, vegetables and nuts that can be the culprit.

 

OAS has been found to be related to pollen allergies, including birch pollen, grass pollen and weed pollen.  In fact the  proteins found in raw apples are similar to those found in birch pollen and mugwort pollen (a type of weed).  For this reason, the body reacts by treating this protein as an invader and starts to fight it off resulting in a reaction.  Between 50 and 80 percent of people with birch pollen allergies also react to raw apples.

Many people with OAS can in fact tolerate the fruit or vegetable in the cooked form, as the proteins are distorted when heated, no longer causing a reaction.  The proteins in apples generally break down when cooked, so they are often tolerated as applesauce or baked apples.  It is the raw apples that cause the reaction. 

What Are Apple Allergy Symptoms?

Symptoms of OAS are usually confined to a local reaction of the mouth or lips. There however are a very small number of people with a true apple allergy.

 While reactions are more often milk, there are some people have will experience more severe reactions that may include rashes, delayed gastrointestinal symptoms such as abdominal cramps and diarrhea, or, very rarely, anaphylaxis.

People with OAS tend to have worse symptoms during pollen season, when their bodies already are coping with reactions to the pollen.

For this reason some people are able to eat raw apples, as well as there other fruits, vegetables and nuts, at other times of year, but not when the pollen count is high.

If more severe symptoms develop, such as wheezing or difficulty breathing, you should seek emergency medical care. Anaphylaxis is rare but not impossible with OAS — know the symptoms and be prepared to treat it.

Over-the-Counter Antihistamines Can Treat OAS

Localized symptoms like itching or swelling of the mouth or lips can be treated with an over-the-counter antihistamine such as Benadryl. After taking an antihistamine, a person with OAS should be monitored for the next few hours to make sure that more serious allergic symptoms do not develop.

Immunotherapy for birch pollen may help some people with sensitivities to apples. If you think you have an allergy to apples, talk to your doctor or allergist. The type and severity of your symptoms may determine if you are eligible for immunotherapy, or if you need a prescription for an epinephrine auto-injector (commonly referred to by the brand name EpiPen.)

Managing any food allergy means to make dietary changes to avoid that food allergen, in this case  avoiding raw apples and being prepared in the event of future reactions.

Cross-Reactions with Other Foods

People with birch pollen allergies may also react to: apples, almonds, carrots, celery, cherry, hazelnuts, kiwi, peaches, pears and plums. People with grass pollen allergies may also react to: celery, melons, orange, peach, and tomato.  People with a ragweed pollen allergy may also react to: bananas, cucumber, melons, sunflower seeds and zucchini. 

Someone may never have had an allergic reactions to any food, and then suddenly develop OAS. And the reactions may vary depending on the severity of seasonal allergies. 

Apple Cider and Vinegar: Yes or No?

Some people find they are sensitive to apple cider or apple cider vinegar but not to raw apples. Both products are produced through a fermentation process. A sensitivity to apple cider, vinegar or alcoholic (hard) cider may be due to an allergy to brewer’s yeast and not to an apple allergy.  

It is important to note that consumption of large amounts of apple cider vinegar may cause damage to the stomach or esophagus even in people with no allergies, causing abdominal pain.

Updated by:  Marlo Mittler, MS RD

Sources:

NIAID-Sponsored Expert Panel. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. The Journal of Allergy and Clinical Immunology. Volume 126, Issue 6, Supplement , Pages S1-S58, December 2010

Webber, Christopher and Ronald W. England. Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge. Ann Allergy Asthma Immunol. 2010;104:101–108

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