Today we’re going to talk about all things apple allergy. Managing an apple allergy sounds easy on the surface, however, it’s actually a lot harder than you’d think. The biggest reason it’s hard to manage: apples can be used as part of natural flavors, a natural sweetener, and much more. It has a range of uses in sweet foods, savory foods, and even non-food products.
By the time you’re done with this article, you’ll feel well equipped to manage your apple allergy, and live your best apple free life, unless of course you have an iPhone.
Now, let’s take a deeper look at food allergy basics, how you can avoid apples, how they’re used in food, as well as cross reactive allergenic conditions.
This article covers a lot of ground so be sure to use the table of contents to jump around as you see fit.
What is an Apple
An apple is an edible fruit, made by an apple tree. They’ve been grown for thousands of years, and there are countless varieties available across the globe.
Apples are a round fruit with a stem and a few small seeds inside the core, and it’s part of the Rosaceae family. Other famous members of this family include apricot, pear, almond, and strawberries.
Apples have culinary uses in both sweet and savory recipes, plus, there are many ways to use apples including vinegar and sparkling beverages.
What is a Food Allergy?
A food allergy is a response by your immune system that’s triggered by a protein that your body sees as a threat. This is not the same thing as a food intolerance (sometimes called a food sensitivity) or an autoimmune disease.
If you suspect you have a food allergy, ask your healthcare provider/primary MD to refer you to an allergist for allergy testing where blood tests and/or a skin prick test can be ordered to determine if you have an allergy. Know that tests are not 100% accurate, but are still a good diagnostic tool.
A “true” food allergy is IgE mediated, and the immune system usually elicits a reaction within immediate ingestion to four hours. Outside of that window, it’s usually suspected that you have a food intolerance. In addition to immunoglobulin e, there are 4 other Igs that play a role in food intolerance and histamine reactions.
There are some types of allergenic diseases that are “true” food allergies and the reactions happen outside of the four hour window. Additionally, a person can have a more rare or complex case and suffer from delayed reactions (which can still be “true” food allergies).
Contact & Airborne Reactions
In some patients, they have what’s called contact or airborne allergy as well. This tends to be more common in those with a tree nut allergy or peanut allergy, and is very rare in those with an apple allergy.
In their case, a reaction can be triggered by touching apples, or by breathing in its particles (like when cooking or baking).
Food allergies can be life threatening and should always be taken seriously. Work with your allergist and healthcare providers to create an action plan that will meet your needs.
Apple Allergy Symptoms
Food allergy reactions can vary among patients, as no two people are the same. Some allergy symptoms of an apple allergy include:
- Swelling of the Lips
- Swelling of the Tongue
- Swelling of the Throat
- Itchy Mouth and/or Throat
- Tingling of the Mouth, Lips, or Throat
- Shortness of Breath
- Difficulty Breathing or Asthma Symptoms
- Wheezing
- Skin Rash and/or Severe Redness of the Skin
- Itching
- Hives
- Racing Heart Rate
- Decreased Blood Pressure
- Impending Doom/Dread
- Dizziness
- Fainting/Loss of Consciousness
- Severe Stomach Pain
- GI Distress or Abdominal Pain
- Nausea
- Vomiting (including projectile vomiting)
- Diarrhea
- Blood in Stool
These symptoms are more the more severe symptoms of the allergic reaction spectrum, and can indicate anaphylaxis. It’s critical that if you see these apple allergy symptoms, you recognize that this is a medical emergency and you need to seek immediate medical help.
If you have a known allergy, follow your action plan including the use of an epipen if you have one, or prescribed antihistamines.
Milder reactions can include a persistent cough, runny nose and/or sneezing, eczema, persistent congestion, allergic rhinitis (inflammation of the nose membrane), and more. However, milder symptoms don’t mean you should let your guard down, or take your allergy less seriously.
Three Critical Points
There are hundreds of symptoms a person can experience during an allergic reaction, but it’s important to know three things about apple allergy symptoms and allergic reactions:
- Not every reaction is anaphylaxis. People can have a “non-traditional” apple allergy reaction to food (or have mild symptoms) and still be allergic to apples.
- Should a person experience anaphylaxis, or you see signs of anaphylaxis, it’s important to seek immediate medical treatment (use your epinephrine auto-injector if you have one). When left untreated, anaphylaxis can lead to anaphylactic shock, which can cause death.
- Previous allergic reactions don’t predict future reactions (or the severity of future reactions). In some patients, continued exposure to known allergens can cause more severe reactions each time. This is why strict avoidance of allergens is so important.
How Kids May Talk About Food Allergies
A child may talk about a food allergy differently than adults. Many children will say things like “my mouth is spicy” or “there’s a frog in my throat”.
They’re trying to express what the reactions feel like to them with language or experiences that are familiar to them. Always take note of these types of statements from a child, as they can indicate a serious medical situation.
If needed, don’t hesitate to seek medical treatment, and be sure to ask your doctor for a referral to an allergy specialist.
You May be Asked to Do an Oral Food Challenge
A food challenge, sometimes called an oral challenge, is when an allergy patient eats a food they’ve tested as allergic to, or for a food where the results were inconclusive, under the supervision of their doctor and/or medical team. The goal of the challenge is to confirm the positive results or to determine if the patient isn’t allergic to the food.
There are several steps involved with a proper oral food challenge, including raising the patient’s heart rate to make sure a reaction doesn’t happen. If you’ve been tested for an apple allergy, or other food allergy, you may be offered an in-office oral food challenge to ensure the test results are accurate. A lot of people wonder, is this a good idea, or a really bad idea.
Honestly, it depends. Let’s say you had a severe reaction to apples in the last year, and that’s what prompted you to get tested. Since a reaction is already known, in that case, an oral food challenge would be a bad idea. On the flip side, let’s say you were diagnosed as allergic to almonds, cherries, or peaches after a panel was run alongside other foods.
Perhaps your allergist was concerned about potential reactions to other members of the Rosaceae plant family due to your unique medical history, and feels it’s in your best interest to challenge related foods. In that case, an oral food challenge could be very helpful.
How Challenges Can Help
Food challenges are also used to confirm if someone has outgrown an allergy (this is a lot more common in kids). For some kids, they’re diagnosed at an early age with really high numbers on their test results and the food(s) will be avoided for years.
During a checkup, their allergist may note that their numbers have decreased dramatically, and it would be safe to do a food challenge. Many food allergy parents are understandably nervous, and some choose to move forward with the challenge whilst others decide they’ll continue to avoid the food(s).
In some cases, an allergic individual may not be offered an oral food challenge by their allergist, even with a reduction in numbers, and that’s because of other risk factors (including a history of severe allergic reactions).
Know that food challenges are completely voluntary, and you don’t have to do anything you’re uncomfortable doing, nor do you have to subject your children to them. At the end of the day, do what’s best for you and your children.
How to Grocery Shop When Managing an Apple Allergy
When it comes to shopping with an apple allergy, know that food labels on products will always be your first line of defense. Apples can hide in a lot of foods, which I’ll cover further down in this article.
You’ll want to grab a product and turn it over to the nutritional panel and usually near that, you’ll see a list of ingredients. Read them carefully and look for apple. When there are are a lot of ingredients, use a finger to trace under the lines, which drags your eyes along, and ensures you don’t accidentally skip over a line.
If you see natural flavors, or other questionable ingredients, take a picture of the product. When you get home, email companies and find out about the products before purchasing them.
The Biggest Tips I Can Give You
When you’re new, stick to basic foods (raw meat, seeds, fresh fruits & vegetables, basic grains like rice, legumes, etc.). The more basic the food, the less likely you’ll run into apples.
The best advice I can give you: learn to cook and bake at home. Develop a passion for nourishing yourself and find joy in the kitchen. You can create a wide range of safe and delicious foods at home.
The 30% Group
The one thing you’ll want to know about yourself when it comes to shopping is if you can tolerate traces of apples in your food. About 30% of people with food allergies self-report that they’re unable to eat foods that have been made on shared equipment with what they’re allergic to, due to these traces of allergens.
No matter what country you reside in, if shared equipment is an issue, you need to contact companies before purchasing pre-made items.
Apple Labeling Information
Most regulating bodies require food companies to use plain language on the food labels (this is especially helpful with an egg allergy which we can talk about another time). What this means is that in the ingredient statement, you won’t see “Malus domestica” on the label (the scientific name for apples) but instead you’ll see “apple”, “apple cider vinegar”, “apple juice”, or something along those lines.
Apple seed oil and apple extract have some use in bath, body, and cosmetic products (in addition to some food products). You’ll want to contact brands if you manage a contact allergy, or have concerns about applying apple to your skin.
Apple Free Diet Types
There are a few diet types that are free from apples:
- Alder Pollen Free Diet
- Birch Pollen Free Diet
- Mugwort Pollen Free Diet
- Latex Free Diet (apple is in the moderate cross-reactive group)
- Low FODMAP Diet
- Nickel Allergy Diet
You’ll be able to find recipes online for these diet types, but you’ll be very hard pressed to find restaurants or pre-made foods for these diet types. There are some options for the Low FODMAP diet, but not a tonne.
If you manage an apple allergy, along with other dietary restrictions, be sure to check out the Advanced Recipe Search on RAISE. You can mix and match over 100 filters for food allergens, food families, special diets, and much more.
Cross Reactivity
When it comes to apples, they fall into several other categories of allergenic diseases. I won’t go into all of them, but the two I want to highlight are oral allergy syndrome, and a latex allergy.
In simple terms, this is how cross-reactions work:
- You’re allergic to apples, almonds, carrots, and peanuts.
- Your immune system knows what those proteins look like.
- You eat something that has proteins that “look similar”, your immune system is “confused”, and you have a reaction.
- The food with similar proteins is something you’re not allergic to, however, because the proteins looked similar enough, your immune system readied the troops.
Another way to think about this is a case of mistaken identity. It’s almost like when you glance and see someone you think you know, only to do a double take and realize you have no idea who they are.
Oral Allergy Syndrome Connection
Oral allergy syndrome, now called pollen food allergy syndrome, is a special type of food allergy. As the name implies, the allergic reactions happen in the mouth (oral). In easy to understand terms, here’s how it works:
A person has a birch pollen allergy and needs to avoid a specific list of foods because the proteins in said foods “look similar enough to the birch pollen” to their immune system that it causes a reaction.
This is cross-reactivity, however, not every person with pollen allergies manages pollen-food allergy syndrome.
In almost every OAS/PFAS patient, all allergic reactions occur above the collar bone, and mainly in the mouth and throat. In some rare cases, the reaction happens outside of this scope, but it’s still OAS.
Many OAS/PFAS patients are able to tolerate the cross-reactive foods if they’re well cooked first, as this denatures the protein so their immune system can “clearly see” that this isn’t the environmental pollen, but something else.
Know the Pollens
There are five major pollens at play where OAS is concerned: Alder Pollen, Birch Pollen, Grass Pollen, Mugwort Pollen, and Ragweed Pollen.
In the case of apple, it’s cross-reactive with alder, birch, and mugwort. If you’re allergic to those pollens, and seem to have allergy-like symptoms to apples and other “random” foods, you may have OAS and should schedule an appointment with your doctor.
If you’d like to read more about OAS and see cross-reactive fruits and vegetables, check out this article here on my website.
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Latex Allergy Connection
Many patients with a latex allergy have to eliminate foods that are cross reactive with latex. Foods all into three categories: low cross reactivity, moderate cross reactivity, and high cross reactivity.
Apple falls into the moderate cross reactive category. If you manage a latex allergy, and need to eliminate moderate and high cross reactive foods, apples are off the menu until your medical team can help you determine which foods might be good for an oral challenge.
If you’d like to learn more about a latex allergy and cross reactive foods, read this article.
Different Names and Parts of Apples
There are a lot of usable parts of apples, along with different forms of apple, and you may see them on food packages. These are the names to be aware of:
- Apples
- Applesauce
- Apple Butter
- Apple Cider Vinegar
- Apple Extract
- Apple Jelly
- Apple Juice
- Apple Peels
- Apple Powder
- Apple Seed Oil
- Apple Syrup (a modern day sweetener)
- Crinkle Cut Apples
- Diced Apples
- Matchstick Apples
- Shredded Apples
Apple peels are an apple part some chefs don’t like to waste, and they’re used as a garnish. Apple seed oil is used mostly in cosmetics.
List of Popular Apple Varieties
There are over 7,000 apple varieties grown in most countries around the world. Each variety will have its own taste, however, a good amount of apple varieties aren’t designed for mass production. I’ll keep this list brief, and share apple varieties that are pretty popular.
- Ambrosia Apples
- Arkansas Black Apples
- Autumn Glory Apples
- Bareburn Apples
- Belle de Boskoop Apples
- Cameo Apples
- Cortland Apples
- Cosmic Crisp Apples
- Cox’s Orange Pippin Apples
- Dazzle Apples
- Elstar Apples
- Empire Apples
- Envy Apples
- Fuji Apples
- Gala Apples
- Gala Guo (Black Diamond Apples)
- Gold Delicious Apples
- Golden Nugget Apples
- Granny Smith Apples
- Hawaii Apples
- Hokuto Apples
- Honeycrisp Apples
- Jazz Apples
- Jonagold Apple
- Jonathan Apples
- Juici Applies
- Juliet Apples
- Lady Apples
- Liberty Apples
- Macoun Apples
- McIntosh Apples
- Opal Apples
- Orin Apples
- Ozark Gold Apples
- Pacific Rose Apples
- Pink Lady Apples (also called Cripps Pink)
- Pink Pearl Apples
- Queen Apples
- Red Delicious Apples
- Red Prince Apples
- Smitten Apples
- Snapdragon Apples
- Sonya Apples (this apple variety has such a beautiful & unique shape)
- Spartan Apples
- Sugarbee Apples
- SweeTango Apples
- Topaz Apples
Apple Allergy: List of Foods to Avoid
When you’re managing an apple allergy, know that there are foods that naturally contain apple products. When you see these food products, you’ll know right away that apples are most likely present.
- Apple Cake
- Apple Chips (dried apples)
- Apple Cider
- Apple Cobbler
- Apple Crisp
- Apple Crumble
- Apple Dumplings
- Apple Fritter
- Apple Pie
- Apple Turnover
- Calvados (French apple brandy [alcohol])
- Caramel Apples
- Stuffed Apples
Hidden Sources of Apples: List of Foods That Can Contain Apple
This is not an exhaustive list. Apples can be used in a wide range of applications, especially in both sweet and savory foods.
I’d love to tell you that you won’t find apples in certain types of products, however, their use as a natural flavour means you can find them across all product categories (with the exception of raw meat and raw produce).
Just because a product type is on this list doesn’t guarantee the presence of apples (or the opposite). It means that you need to really, really, really read ingredient labels carefully and reach out to companies if there’s any doubt.
- Any processed food with a label buzzword/claim of “added fruits & veggies”
- Baby Food
- Baked Goods (breads, buns, desserts, etc.)
- Bath & Body Products (makeup, toothpaste, soap, shampoo, etc.)
- BBQ Sauce
- Breakfast Cookies
- Candy (not nearly as present in chocolate, but present in other styles)
- Chewing Gum (natural flavours will be the top issue)
- Chicken Dishes
- Cider
- Cold Pressed Juices (single ingredient such as cucumber is fine, but blends often contain apples)
- Cole Slaw
- Desserts (all types including cake, cookies, hand pies, pastry, and everything else in between)
- Drinks (soda, kombucha, smoothies, flavoured water, etc.)
- Fall Desserts & Fall Themed Beverages
- Fermented Foods & Drinks
- Fried Foods (very common in sweets)
- Fritters
- Fruit Juice Concentrate (will be listed as such on labels, often for colour, can be derived from any fruit, you have to contact the brand)
- Fruit Leather (even if it’s not apple flavoured, it can contain apple for sweetness)
- Fruit Snacks (often as a juice to boost the sweetness)
- Health & Wellness Focused Products (apple cider vinegar is a popular ingredient in this category)
- Ice Cream & Frozen Desserts
- Jam & Jelly
- Ketchup
- Meat Marinades
- Meatballs
- Muffins
- Natural Flavors
- Packaged Snacks
- Pectin (usually from apple, and it’s in a lot of jams & jellies)
- Popsicles & Other Frozen Desserts
- Pork Dishes
- Pouches (convenient snack of puréed fruits & veggies)
- Refined Sugar Free Baked Goods (applesauce is a common sweetener)
- Salad Dressings & Vinaigrettes
- Salads (shredded apple or apple chips as a topping)
- Snack Bars
- Sandwiches & Wraps
- Sauces
- Sausages
- Soups
- Spice Cake or other “Spiced” Foods
- Stews
- Stock Cubes (also called Bouillon Cubes)
- Supplements (especially vitamins with a “fruit and/or vegetable blend” added to boost the nutritional value)
- Tarte Tatin (traditionally made from apples, but other fruits are used these days)
- Vegan & Vegetarian Foods (including meat alternatives)
- Vegetable Juice
- Veggie Chips & Veggie Straws
- Waffles
- Yogurt (flavoured yogurt)
Natural Flavors Warning
Since apple isn’t a major allergen, companies don’t need to disclose on packaging if it’s present in an ingredient such as natural flavors. Unfortunately, this term encompasses thousands of individual ingredients and compounds.
The only way to find out if apples are present is to call the company and request the details. Explain that you have an apple allergy and you need to know about each of the ingredients in their natural flavours.
Some brands will say things like “it’s proprietary”. If you run into that, walk away. Companies that can’t be transparent don’t deserve our support.
Bath & Body Warning
Apple is commonly found in makeup and a random assortment of bath and body products. If you have a contact allergy, or you’re not comfortable applying apples to your skin, you’ll need to take your time to find safe options.
In the meantime, you can start with a basic olive oil soap that’s only 3 ingredients and it gets the job done (yup, you can even use it as a shampoo). It’s not fancy, but it’s safe.
Eating Out at Restaurants with an Apple Allergy
If you’d like to eat at a restaurant whilst managing an apple allergy, you’ll have to do a lot of investigating before choosing to dine out. The biggest issue you’re going to run into: the hidden sources of apples.
Apple isn’t a spice like thyme, paprika, or marjoram, so it won’t be in a lot of places. However, it can easily be in drinks, baked goods, foods made offsite, and so much more.
Even foods that don’t sound like they would contain apples absolutely can, because if you’re at a low quality or mid range quality establishment, they’re not using top of the line, super clean ingredients. They’re using pre-made components that can contain natural flavors and so on. See the problem?
Now, that’s not to say that you can’t or won’t find an apple free meal. You will absolutely find one. In fact, basic meat dishes will be your best bet because the raw meat will be free from apples. However, you may need to get used to piecing together a meal from the menu such as simply seasoned steak + steamed rice + a side dish of steamed veg.
Types of Restaurants to Explore
The absolute safest option will be an expensive farm-to-table restaurant directly on a farm where everything is made from scratch. In those environments, they control a lot of moving parts, and have so much control over the ingredients and can accommodate individuals with food allergies.
Outside of that, there isn’t a single cuisine that will be naturally apple free. Paleo restaurants might be able to serve you a little easier, but apples will still be present (especially in sauces).
Steak houses are another good option, as they should be able to season a basic piece of meat and cook it in a clean pan for you. I’d be on the lookout for restaurants that advertise clean ingredients, and organic ingredients. That’s not to say they don’t use apples, but your chance of success is simply higher because they won’t have as many products that contain natural flavors etc. to work around.
Mexican restaurants are a great option, since basic Mexican foods are naturally apple free. However, you’ll still have to account for natural flavours and other hidden ingredients. The same is true of Mediterranean and Japanese restaurants.
I’d suggest avoiding high-end restaurants that have rotating seasonal dishes that frequently change. Whilst they can make some minor adjustments, they really aren’t able to accommodate food allergy folks as easily since the ingredients are pretty set and the menu isn’t super flexible.
Cross Contact and Cross Contamination
Cross-contact and cross-contamination are not the same thing. When talking with food professionals, it’s important that you use the correct terminology. Cross-contamination refers to pathogens (e. coli, etc.), and cross-contact refers to allergens.
Please read the article on this page to learn more about cross-contact, and how you can work towards preventing it.
Apple Substitutes & Apple Alternatives
The great news about removing apples from your diet is that you won’t run into too much trouble finding great substitutions. Here are a few options to get you started. This article on apple substitutes will dive in a lot deeper.
Apple Juice Substitute: Pear Juice, Quince Juice, Star Fruit Juice. In case you need to make these at home, this is the juicer that I’m currently loving.
Apple Pie Substitute: Peaches, Nectarines, Quince
Applesauce Substitute: Quince, Pears
Answering Your Apple Allergy Questions
If I have apple and peach allergies. Should I avoid other fruits?
On the surface, if someone ONLY has an apple allergy and peach allergy, then no, you don’t need to avoid other fruits. You can work with your allergist and talk about cross reactivity concerns that you have.
However, if you have other medical conditions, manage seasonal allergies (and might have OAS), or have test results that imply you may be more prone to cross reactivity, you may need to avoid fruits and nuts in the Rosaceae family.
You should also find out if you have a latex allergy, so you can plan accordingly. Remember though, not all individuals with an apple and/or peach allergy manage cross-reactivity.
You’ll want to work with your medical team, as they can order allergy tests (blood tests and skin prick tests), supervise an oral challenge, and give you great guidance based on your case history and test results.
During this time, make sure you’re keeping a detailed food journal, that way, should symptoms develop, you’ll know what you’ve eaten and what the cause may be.
Is an apple intolerance the same thing as an apple allergy?
No, an allergy and an intolerance are two different medical conditions that have different pathways that elicit the responses. However, both will have the same approach in avoiding eating apples.
A food allergy is IgE mediated, and can cause severe reactions, including death, if not treated. FYI, death is very rare in the grand scheme, as almost all allergy patients respond well to treatment for their food allergy symptoms.
A food intolerance on the other hand is a condition that can have a whole range of symptoms, not mediated by IgE antibodies, including skin irritation, GI & digestive distress (cramping, bloating, diarrhoea, etc.), headaches, and more. What’s even more interesting is that in some patients, food intolerance symptoms can last up to 28 days (where food allergy symptoms are usually completely cleared after treatment, with some recovery time).
For your overall health, well-being, and safety, when managing a food allergy, you’ll want to make sure your meals are free from apples, apple juice, apple extract, apple cider vinegar, and all varieties of apples.
If you have a food intolerance (sometimes called a food sensitization or food sensitivity), talk with your doctor about the consumption of apples via the form of natural flavours, apple extract, and apple cider vinegar. You may not need to avoid apples down to that degree since you’re not managing an allergy diagnosis.
If I’m allergic to birch trees, can I still eat apples?
There’s a good chance that you’ll still be able to eat apples, even with a birch tree allergy. Not all individuals with pollen allergies experience cross-reactivity.
However, if you find that you have any kind of itchiness in your mouth or throat, digestion discomfort/issues, or any other symptom when eating apples, stop eating them and work with your medical team.
In addition to apples, if you have any symptoms when eating cherry, hazelnut, carrot, celery, peach, and other foods cross-reactive with birch pollen, work with your medical team. There’s a good chance you’re dealing with cross-reactivity, and they can help you determine the best path forward.
This article here on my site dives a lot deeper into oral allergy syndrome. You can also browse this section on allergy information where I cover a range of foods and food groups that may be of interest to you.
I have banana and apple allergies. What types of fruits would taste good as pudding and pie?
Managing these particular fruit allergies can be tough when it comes to making dessert. However, have hope! There are so many other delicious fruits you can pull from.
For pudding, I’d suggest strawberries. I’m assuming you’re asking about classic banana pudding with cookies and custard. In that scenario, strawberries are an awesome substitute. After that, I’d go with blackberries or peaches.
For apple pie, pear is an epic stand in. Whilst there are quite a few differences between apples and pears, they can be swapped 1:1 for each other in recipes and you’ll still have great results.
After pear, quince is a FABULOUS stand in for apples in both pie and applesauce.
