Key Allergens

Apples are in the Rosaceae family of plants. Other plants in this family are pears, apricots, plums, cherries, peaches, raspberries, strawberries and almonds.

87% of people suffering from this allergy are thought to be sensitised to the protein Mal d 1, this is a Bet v 1 protein. These proteins are panallergens which cause oral allergy type symptoms.

Apples also contain Lipid Transfer Proteins, which are considered to be panallergens - if allergic to this particular allergen you may have reactions to other foods containing LTPs.

They also contain profilin proteins, these are plant panallergens, proteins which have the potential to cause allergies across large groups of seemingly unrelated foods.

There is also a thaumatin-like protein, this is made by plants to inhibit fungal growth.

Apple cider vinegar is highly processed. Intolerance or allergy to vinegar is most likely a histamine sensitivity, a salicylate sensitivity or an intolerance to sulphites.

Food Intolerances

Food is low in histamine Food is medium in salicylates Food is high in FODMAP

Apples are a low food, apple cider vinegar is low in histamine in small amounts. Both of these foods are suitable for people following a low histamine diet.

The amount of salicylates in apples depend on the variety. Some apples are low in salicylates and others are high. Salicylates have the potential to cause worsening of asthma, swelling, itching and hives as well as food intolerance symptoms in people who are sensitive to salicylates.

Apples are a high FODMAP food. FODMAP stands for Fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Foods high in FODMAPs can cause symptoms of food intolerance, affecting the gastro intestinal system and this can be mistaken for a true IgE food allergy.

You can read more about Food Intolerances on the dedicated Food Intolerance Page.

Associated Syndromes

You may have Pollen-Food Allergy Syndrome if you suffer from apple allergy with oral allergy symptoms to 3 or more of the foods mentioned in cross reactivity section.

You may have LTP Syndrome if you react to multiple foods in the cross reactivity section.

Allergy to apple is sometimes linked to Celery-Mugwort-Spice Syndrome as the sensitising allergen is a profilin protein called Art v 4, these proteins are also sometimes also called Bet v 2 proteins.

There is a link between apple and Latex Food Syndrome. The plant involved in latex allergy Hevea brasiliensis, the rubber tree plant, has an allergen called Hev b 8 which is a profilin protein. Those very sensitised to latex may have a contact allergic reaction from other foods or plants containing profilin proteins, there is less evidence of this than sensitisation to other latex linked proteins like hevein and chitinases.

Cross Reactivity

Foods linked to Pollen Food Allergy Syndrome are almond, aniseed, apricot, carrot, celery, cherry, chestnut, cranberry, dill, edamae, fenugreek, fig, hazelnuts, jackfruit, kiwi, melon, mung beans, parslep, parsnip, peach, peanut, pear, persimmon, plum, poppy seed, raspberry, soya, strawberry, tomato and walnuts.

If sensitised to LTP proteins you may also react to kiwi, strawberries, sunflower seeds, walnut, apple, mulberry, banana, pea, apricot, cherry, plum, almond, peach pomegranate, raspberry, tomato, grape, celery, peanut, asparagus, cabbage, broccoli, chestnut, lemon, tangerine, orange, hazelnut, lettuce, lentils, lupin, green bean, pear, mustard, wheat and maize.

Apple is broadly linked to other fruit profilin allergies. Allergy to celery, peanut, lychee, soyabeans, walnut, lupin, almonds, mustard, hazelnut, kiwi, pineapple, chilli, melon, orange, strawberry, apple, banana, aubergine (eggplant), peach, pear, tomato, dates, cherry, carrot, barley and wheat. Allergic reactions to some of these foods may be considered a marker of profilin hypersensitivity.

Other foods containing thaumatin proteins are kiwi, chilli, peppers, apple, banana, cherry and peach.

Note that these food lists are not exhaustive. The most up to date lists of food can be found on the Cross Reactivity Tool page.



Thermofisher - Apple Allergens

Allergy information for: Apple (Malus domestica)

Allergy UK - Oral Allergy Syndrome Factsheet

Patient (UK) - Oral Allergy Syndrome

Histamine Food Intolerance List

ATP Science - Salicylate Food List

Healtline - FODMAP Foods

Articles and Journals

Allergen profiles in Japanese children with pollen-food allergy syndrome: Insights from a multicenter cross-sectional study, 2024

Lipid transfer protein syndrome in a Northern European patient: An unusual case report, 2023

Clinical Study of Pollen-food Allergy Syndrome Estimated by Double-blind, Placebo-controlled Food Challenges of Ten Apple Cultivars, 2023

Identification of apple cultivars hypoallergenic for birch pollen-allergic individuals by a multidisciplinary in vitro and in vivo approach, 2022

Oral birch pollen immunotherapy with apples: Results of a phase II clinical pilot study, 2021

Restriction polymorphism of Mal d 1 allergen promotor in apple varieties, 2021

Apple Allergy—Development of Tolerance Through Regular Consumption of Low-Allergen Apples. An Observational Study, 2020

The Effect of Birch Pollen Immunotherapy on Apple and rMal d 1 Challenges in Adults with Apple Allergy, 2020

Allergen‐specific immunotherapy with apples: selected cultivars could be a promising tool for birch pollen allergy, 2020

Possibilities of Interlinking the Genomic Data and Allergenic Potential of Apples, 2019

Allergenicity of apple allergen Mal d 1 as effected by polyphenols and polyphenol oxidase due to enzymatic browning, 2019

Immunological characterization of recombinant Mal d 1, the main allergen from apple (Malus x domestica L. Borkh), 2019

The EuroPrevall outpatient clinic study on food allergy: Background and methodology, 2015

Let me know if you found any of these interesting or useful. If you spot an article or research that you think is interesting you can message me or tag me on Facebook or Twitter - links at the bottom of the page.

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