Mouth Itchiness After Eating Fresh Apples

Oral Allergy Syndrome and Fresh Apples

woman picking out fruit at a fruit stand
Do you ever get itching in your mouth when you eat fresh apples?.

Why does my mouth itch when eating fresh apples, but not with applesauce?

Apples and Mouth Itching

If you've noticed that your mouth and lips itch after eating fresh apples—but have never had a problem with, say, applesauce, you might feel a little stymied. Worse yet, your family and friends may think you're imagining your symptoms. Yet these symptoms aren't that uncommon and even have a name: oral allergy syndrome

Oral Allergy Syndrome (OAS)

The symptoms we just spoke of—itching only after eating fresh apples—are due to something known as oral allergy syndrome, caused by apples. Oral allergy syndrome (OAS) is a form of food allergy that is caused by a person having an allergy to a particular pollen. The pollen, in this case birch pollen, has similar proteins found in a certain fruit, in this case apple, which causes a person to be allergic to both.

When a fresh apple is eaten, a person may experience itching, burning, or stinging sensations of the mouth, throat and tongue. The symptoms generally last only a few seconds or minutes, as the proteins that cause the symptoms are broken down quickly by saliva. Since cooking, baking or processing the food (as is the case with applesauce) breaks down these proteins as well, a person with OAS to a fresh apple can eat applesauce without symptoms.

Cross Reactivity Between Airborne Antigens and Foods

You may be familiar with cross reactions between different foods.

In fact, the increase in allergic sensitization causing sensitivity to multiple foods is a significant problem at this time.

Yet, as illustrated with our birth-pollen apple example here, airborne allergens may also cause cross-reactivity with some foods. In these cases, the respiratory allergy is usually much more obvious, as the allergens in food are usually broken down during digestion (as with the apples above.) Examples include:

  • Birch and apple
  • Cypress and peach
  • Celery, mugwort, and spice syndrome
  • Mugwort and peach
  • Mugwort and chamomile
  • Mugwwort and mustard
  • Ragweed, melon, and banana

Foods may also be contaminated by mites or fungi resulting in these cross-reactivity reactions.

Birch-Apple Cross Reactivity

There are a few different ways in which cross-reactivity occurs at molecular level, which can give risk to different associations. Around 70 percent of people who have an allergy to birch pollen will also develop symptoms of food allergies. In addition to apples, cross-reactivity may occur with nuts (especially hazelnuts), and vegetables (usually celery and carrot.) In one immune type of cross-reactivity (not that mentioned above) people may have an allergy that is cross-reactive between birch pollen, apples, and carrots. In contrast to oral allergy syndrome, this allergy may occur with cooked apples and carrots as well.

Will Organic Apples Make a Difference?

Oral allergy syndrome is caused by pollen in the apple. Some people have wrongly believed that their symptoms are related to pesticide residual on the skin of the apple and decided to try organically grown apples instead.

Unfortunately, the pollen is present in organic apples just as it is in non-organic apples, and you're likely to have the same symptoms regardless of your choice.

Can Oral Allergy Syndrome Be Dangerous?

Most commonly, oral allergy symptoms are usually confined to the mouth, lips and throat and are of short duration. Medications such as Benadryl (diphenhydramine) may be helpful if your symptoms are bothersome. It's important to monitor your symptoms for a few hours to make sure more serious symptoms or an anaphylactic reaction doesn't develop. If you note swelling of your throat, any difficulty breathing or wheezing, or feel lightheaded you should use your Epi-Pen if you have one and call 911 immediately.

Sources:

Florin-Dan, P. Cross-Reactivity Between Aeroallergens and Food Allergens. World Journal of Methodology. 2015. 5(2):31-50.

McKenna, O., Asam, C., Araujo, G. et al. How Relevant is Panallergen Sensitization in the Development of Allergies?. Pediatric Allergy and Immunology. 2016. 27(6):560-568.

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