Apple Allergies

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 Pollen-Food 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.

Linked Allergies

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

  • Cherry
  • Apricot
  • Pear
  • Celery
  • Carrot
  • Peach
  • Strawberry
  • Raspberry
  • Parsley
  • Asparagus
  • Bell Pepper
  • Potato
  • Melon
  • Mango


  • Hazelnuts
  • Almonds
  • Peanuts


  • Birch Tree Pollen

If you have two or more of these allergies there are links at the bottom of the page for Pollen-Food Allergy Syndrome.

Protein Changes

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.

Apple Varieties

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.

References and Further Reading


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


Unusual Allergies – Potato

This was previously posted to my old blog, Itch, Swell, Ooze, Wheeze in May 2014. This is an updated version for 2020.

Allergy to potato is relatively uncommon but the symptoms can be quite severe.  The main protein is patatin (or sol t 1) which is thought to be the allergen which causes the majority of allergic reactions.  There are several case studies available which show anaphylactic reactions to potato, especially in its raw form.  In older research from the sixties potato allergy was referred to as a “housewives allergy”, as the raw potato would cause an eczema reaction on the skin, cause allergic rhinitis or bring on asthma attacks from peeling potatoes.

Potato is not one of the EUs top 14 allergens, so is harder to cater for those suffering from this allergy as it is not only a common food source in Western countries, but it is also added to processed food in various forms in things that you wouldn’t expect.

Look at labels

For those suffering with severe symptoms look for labels which state potato starch, potato flour, dried or powdered potato and as an ingredient in alcohol (like vodka).  They will not be labelled as an allergen on packaging, so make sure you check very carefully if you suffer from a potato allergy.

Other Linked Allergies

Potato is part of the Nightshade family and has similar proteins in common with other members of this family such as tomatoes, aubergines (egg plant) and peppers.  With the severest form of the allergy a person may experience allergic responses to other vegetables in the Nightshade family.

Protein Changes

With some food proteins, like those found in egg, cooking can sometimes break down the proteins and cause either less of a reaction or none at all, these proteins are called heat labile. 

The main potato protein, patatin (sol t 1) is heat labile and may be less effective in causing an allergic reaction when cooked.  Unfortunately, other proteins found in potato (sol t 2, sol t 3 and sol t4) are thermostabile – which means they are not broken down by normal cooking temperatures, so may still cause allergic reactions in different forms.  

Roasting, boiling, baking and mashing potatoes may make no difference to some people suffering with a potato allergy and then for others a certain way of preparing the vegetable may ease symptoms.

Potato varieties

Different varieties of potato will have different levels of different proteins in, so depending on which protein you are reacting to there may be some types of potato that you would be able to tolerate, it may be a case of trial and error as to which you can eat.  Sweet potato is a very distant relative of the potato and is not a member of the Nightshade family, so should be OK to eat as an alternative in most cases as it does not contain the problem protein patatin.

Birch Pollen and Latex Links

Potato allergy has been linked to birch pollen allergy and latex due to similar protein shapes.  You may want to be careful with bandages and condoms as this is a common allergy which can cause swelling at the point of contact or in severe cases anaphylaxis. You can read more about Pollen Food Allergy Syndrome here.

Birch pollen in the United Kingdom is generally high between March and June.  Anti-histamines can reduce the symptoms of hayfever.



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.

References and Further Reading


Research Papers

Cross-reactivity syndromes in food allergy, 2013

Allergy to vegetables belonging to the Solanaceae family, 2019

Anaphylaxis in an infant to raw potato, 2011

Aubergine and Potato Sensitivity with Latex Sensitisation and Oral Allergy Syndrome, 2013

Anaphylaxis to hidden potato allergens in a peach and egg allergic boy, 2017

Prevalence of sensitization and allergy to potato in a large population, 2017

Children with food allergies: How to build self-confidence

This is a guest post written by AllergyAbroad

Many children who suffer from food allergies go through their childhood and later, their teenage years, unable to be completely self-sufficient with their allergies. There are many reasons why this happens, but it stems from parents not knowing how best to teach ownership skills to their children. The good news is there are ways for parents to build confidence in their children so that they can manage their allergies without their parent’s supervision. 

Always try to prepare them from an early age. The following section shows four essential methods on how to build confidence in your children so they can be self-sufficient from an early age.

1-    Take ownership

Firstly, teach your child to take pride in who they are, and that includes their food allergy. There is no shame and embarrassment to be had, just emphasising the extra clarity needed when telling other people about their allergy. They will come across thousands of these conversations in their lifetime, but by giving them a headstart on this reframes how they see themselves from an early age. They are not the ones with a problem, they are now in position to educate other people when needed.

 2-    Honesty is the best policy

The second thing to remember is to always discuss this issue openly with your children and create a mutual respect when talking about allergies. They will want to ask questions and should use you as a sound board, creating a quick feedback loop. You will be surprised by how young an age a child can take charge of their lives; they deserve more credit than we give them. I would definitely recommend reading this NPR on children as young as 7 learning how to look after themselves

3-    Practice, practice practice

Teaching your child to advocate for themselves is key and it goes hand in hand with self confidence. Building confidence is no different to learning how to play the guitar: one string at a time. Parents should teach their kids how to ask questions about anything; there is no shame in that. Rather than feel like it’s a taboo of some sort, let your kids take pride when it comes to expressing their condition to others. You can then move to their allergy and use roleplay to practice different scenarios where your child can practice explaining their allergy. 

Child Mind Institute has some great tips – If your child is fully confident in asking for a bottle of ketchup at a restaurant, then expressing their allergic condition shouldn’t be any different!

4-    Step up

There is never any shame in objecting to something. Teaching your kids to say no from an early age broadens and strengthens their character. If your child doubts whatever it is they’re about to eat or drink, then they should know they always have the option to say no.

It’s also vital for a parent to teach their child that even adults can sometimes make mistakes. Your children must be comfortable in saying “no” in the case that an adult unknowingly said food is safe when it isn’t. Most kids are programmed to think that they should always listen to adults (teachers included). Still, when it comes to food allergies, children should be supported to make their own decisions when their parents are not around.

Confidence is an underpinning principle when it comes to allergies. By teaching your child how to own their allergy, you’re also empowering them in other areas of their life. I can’t think of a more fitting quote than that from Andrew Solomon to bear in mind when it comes to allergies; “The experience of diversity is more illuminating, more transformative, more powerful, and more important.”

This blog piece was contributed by AllergyAboard (find them here on Twitter). It was started on the belief that allergy translation does not need to be expensive or restricted to single phrases. The site started with 2 allergies and now has over 300 translations online available for free. Find the translation that’s right for you.

April – Articles of Interest

Another month in lockdown here in the UK, I have lost all track of time and have no idea what week we are in! I only just remembered this morning to look at what was published last month with regards to allergy. As we are on a global go-slow there hasn’t been much that caught my eye, but I did enjoy these!

Lemon seed allergy: a case presentation

Mechanisms of eosinophilic inflammation

A Day in the life of an Allergist: Food Allergies

This is a really nice read, by Claudia Gray who is a Paediatric Allergy Consultant in Cape Town

Novel Cross-Reactivity Syndrome: Severe Allergy to Ingested Quorn (Mycoprotein) in a Mould-Allergic Adolescent

Apple Allergy—Development of Tolerance Through Regular Consumption of Low-Allergen Apples. An Observational Study – This is just an abstract, but I have seen apple allergy pop up more and more, you can read more about it here from information compiled by the University of Manchester.

If you spot an article or research that you think would interest me you can message my Facebook page or tag me in a Tweet.


March – Articles of Interest

Well this has been a weird month! Our family are in week 4 of self isolation as we were unlucky enough to get the COVID-19 virus early before the UK schools shut down. We are in our second week of attempting to home school a 10 and 8 year old as well as hold down a couple of jobs. We are exhausted, but have all recovered well from the virus (including the 10 year old with asthma).

I hope you are coping as best you can wherever you are in the world.

I haven’t had an in depth look at the published articles this month as I am multi-multi-tasking, but thought I would get them out there as something different for you to read. I guess that some of you, like me, have spent way too much time looking at articles about the pandemic and need a break from it.

Here is what caught my eye from last month.

If you spot an article or research that you think would interest me you can message my Facebook page or tag me in a Tweet.


February – Articles of Interest

Cetirizine use in childhood: an update of a friendly 30-year drug. This is the antihistamine my daughter uses on a regular basis during pollen season, so I found this to be an interesting read.

IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. This document covers skin prick tests, intradermal tests and patch testing as well as non-specific IgE testing, specific IgE testing and basophil activation tests (BAT). I found it to be very thorough and informative.

Food hypersensitivity reactions to seafish in atopic dermatitis patients older than 14 year of age – The evaluation of association with other allergic diseases and parameters. This paper suggested a higher occurrence of atopic dermatitis in fish allergic patients as well as sensitisation to fungi and reactions to celery

Nickel allergy to orthopaedic implants: A review and case series. I included a paper last month about titanium allergy after implant.

The role of nutritional factors and food allergy in the development of psoriasis. Just an abstract, but this was interest of me as my sister has suffered with psoriasis since she was a child and has recently given up dairy to try to improve her condition.

Pea (Pisum sativum) allergy in children: Pis s 1 is an immunodominant major pea allergen and presents IgE binding sites with potential diagnostic value. Abstract only, you don’t see many studies on peas.

Allergy to tree-of-heaven pollen in Germany: detection by positive nasal provocation

Association between fruit and vegetable allergies and pollen-food allergy syndrome in Japanese children: a multicenter cross-sectional case series. The most common allergies in children in this study were found to be apple, peach, and kiwi.

Let me know if you found any of these interesting or useful.

If you spot an article or research that you think would interest me you can message my Facebook page or tag me in a Tweet.


Sulphite (Sulfite) Allergies

This was previously posted to my old blog, Itch, Swell, Ooze, Wheeze in March 2015. This is an updated version for 2020.

This allergy makes the Food Standards Agency list of top 14 allergens which needs to be monitored, assessed and declared in food packaging and restaurants in the UK.

When I wrote about the Top 14 allergens last year I found it interesting that Sulphite is not an allergen included in most other countries lists and aside from the EU is only monitored in Canada and South Africa. 

Sulphites (or sulfites as they are known in most other countries) are different from other allergens in the top 14 as they are inorganic salts with preservative properties rather than food proteins.  Allergy UK estimates that this allergy only affects 2% of the population, but that this can rise in asthmatics up to 13%.  This is not usually a classic IgE allergy as the symptoms are usually either from contact in the form of rashes or exacerbating asthma symptoms, so are classed as a sensitivity.

Sufferers may find that they are able to tolerate a low sulphite diet rather than avoiding completely, but it is still important to read labels and be aware of foods which naturally contain sulphites.  In the EU Sulphites are to be labelled if they are present in the food at levels above 10mg per kg or 10mg per litre (or if one of its ingredients contains it).

Some wine producers incorrectly assume that their wine is “sulphite free” as they do no add treatments during the production of their wine.  Sulphites can be produced naturally during the normal fermentation process, so there is a chance that residual leves of suplhites will exceed to 10mg declaration threshold.


It has been suggested that the best way to diagnose this allergy is through an oral challenge, but it is unlikely that this will be undertaken in the UK.  It could be potentially dangerous to patients with a history of severe asthma.

Blood tests are generally unreliable in allergy diagnosis and as sulphite allergy is rarely IgE this is not recommended.  There has been some small-scale success with skin prick testing for sulphite sensitivity which is safer.  

As with most allergies it is recommended that elimination diets and avoidance are the safest, quickest and cheapest course of action.

It is very difficult to get that initial diagnosis of sulphite allergy, so it’s important to make a note of food which contain it. If you are interested in making a food diary to diagnose or manage your allergy, see my food diary download.

Diet Management

Looking at labels is more difficult with this allergy than it is for the other top 14 as they are hidden in places you wouldn’t expect.


E220Sulphur dioxide
E221Sodium sulphite
E222Sodium hydrogen sulphite
E223Sodium metabisulphite
E224Potassium metabisulphite
E226Calcium sulphite
E227Calcium hydrogen sulphite
E228Potassium hydrogen sulphite
E150bCaustic sulphite caramel
E150dSulphite ammonia caramel

Other Foods

  • Dried fruit
  • Jams and Preserves
  • Bottled Sauces
  • Peeled or dehydrated potatoes
  • Pickled Food
  • Gravies
  • Gelatin
  • Naturally occurring in onions and garlic


  • Cider
  • Wine
  • Tea
  • Fruit Juices

Cosmetics/Cleaning products

  • Bleach
  • Hair Dyes
  • Fake Tan products
  • Skin lighteners

Prescription Drugs/Anaesthetics

  • Epinephrine
  • Local Anaesthetics
  • Eye Drops

Did you spot that in the last section? Epinephrine. Sodium metabisulphite is used as a preservative in EpiPen and Jext pens – you can read more about that on the Anaphylaxis Campaign website.



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.

References and Further Readings


Allergy UK Factsheet on Sulphites

Food Allergy Canada Factsheet on Sulphites

Sulphites in Adrenaline Injectors – Anaphylaxis Campaign

Research Papers

Contact allergy to sodium sulfite and its relationship to sodium metabisulfite, 2012

Considerations for the diagnosis and management of sulphite sensitivity, 2012

Adverse Reactions to the Sulphite Additives, 2012

Sulfites, The MAK Collection for Occupational Health and Safety, online 2014

Food Standards Agency – Food Labelling for Wine, 2016

Contact Allergy & Intolerance to Sulphite Compounds: Clinical and Occupational Relevance, 2017

Hidden Occupational Allergens such as Additives, 2018

January – Articles of Interest

Differences in omega-5-gliadin allergy: East versus West. This is a full paper, omega-5-gliadin allergy is also known as wheat-dependent exercise-induced anaphylaxis.  If you want an intro to what this is you can read about it on my previous blog here.

Association Between Folate Metabolites and the Development of Food Allergy in Children. It was found that higher concentrations of unmetabolised folic acid at birth were associated with the development of Food Allergy.  The cause of which was not determined, but may be due to increased exposure to synthetic folic acid in utero or underlying genetic differences in synthetic folic acid metabolism.

Peptide-glycodendrimers As Potential Vaccines for Olive Pollen Allergy. Just an abstract for this one, but I found it of interest.

Clinical Management of Seafood Allergy. Full article, very informative.

Does Allergy Break Bones? Osteoporosis and Its Connection to Allergy. Another full article – a very click-baity title it’s a good read, but please note the conclusion.  “Allergy and bone metabolism have common mediators and pathways, the available data are heterogeneous and sometimes conflicting… it is a matter of extreme complexity still in an embryonic phase of study that requires further targeted and in-depth studies”.

Transplant induced food sensitization without allergy—mechanisms of tolerance. Abstract only, case study of a man who had a stem cell transplant from a relative with a peanut allergy.

Cinnamon extract inhibits allergen‐specific immune responses in human and murine allergy models. Abstract only, this may only be of interest to me as I looked at the microbial effects of cinnamon as part of my dissertation.

Suspected allergy to titanium after anterior cervical discectomy and fusion using a Zero-P device: a case report. Abstract only, unusual case study of an allergic reaction to small screws and titanium plate which led to removal of the whole device.

Let me know if you found any of these interesting or useful.

If you spot an article or research that you think would interest me you can message my Facebook page or tag me in a Tweet.


How do I make a food diary for allergies?

I still see this question pop up every now and then . If you are already feeling overwhelmed by your symptoms (or your child’s symptoms) it’s hard to know where to start if you want to document what you are eating and what reactions you are getting to show to your healthcare provider.

Our Diagnosis Story

My daughter exhibited signs of food allergy from just a few weeks old, it was obvious as she ate her first solid food that it was dairy causing the problem. We were lucky that we were able to get a blood test at 5 months old as she had such a bad reaction that we ended up in hospital.

After cutting dairy from both of our diets (as I was still breastfeeding) the eczema which covered her head improved by about 90%, but I felt that she was still not doing as well as she should. My doctor and health visitor were very unhelpful, they both felt that milk allergies were not a real concern, but I found a lot of support in a Facebook group where I read that milk allergies were often linked with soya and egg allergies. I have always eaten a lot of eggs, so I cut them out of my diet on a trial basis and voila – we worked it out, she has an allergy to dairy and egg!

Did I use a food diary?

To work out the main food allergies, no, we didn’t have to. Why do I still think food diaries are a great diagnostic tool and recommend them in my social media groups?

By now I had a lot of experience as an allergy mom (I’m a Brummie, we say mom ) and I knew what all the main allergens were, but from my experience in the Facebook allergy group I knew that there were hundreds of children (and adults) who were allergic to all sorts of foods, dander and pollens.

My daughter was still ill on a regular basis and it seemed more like a reaction than illness as it eased quickly with anti-histamines. These reactions weren’t huge and didn’t require a hospital visit, but it was frustrating to be missing a small piece of a bigger puzzle. At this time A was 3 years old and I had another baby to look after, I was fed up with these reactions that would appear from time to time and decided to take action and make a food diary.

I wasn’t able to find one that fit my needs exactly, so at the time I wrote it all down in a normal blank notebook. After just 1 week I had a main suspect, pineapple. This is definitely not one of the main allergies and quite uncommon. I cut it from her diet and she no longer had the frequent digestive reactions.

I did not tell my doctor at the time, he was still convinced that the milk and egg allergies were really a problem with my anxiety (you will be happy to know that I am registered with a new, better practice now). On a visit to the allergist with A aged 7 I told the doctor about my food diary and she added pineapple to the list of allergens to be tested, she was very excited to try something different – and there it was a weak positive! FOOD DIARIES DO WORK!

How do food diaries work?

We were lucky (if you can see it that way), we started with an extreme allergic reaction on weaning and she was ultimately only allergic to 3 things. People often find that it is harder to gather evidence as to what is actually causing the problem when the reactions are less severe or when you are dealing with multiple allergies.

  1. Make a note of what you eat and it’s major components (e.g. weetabix is mostly wheat, note the fruits that were in the smoothie).
  2. Make a note of the time you ate something, after a week you may see a clear time period from when you ate a food to a reaction, which is why you may have missed it.
  3. Make a note of any medications you are taking and the time you took them, side effects from medication are not uncommon and could be mistaken for an allergic reaction to foods.
  4. Make a note of any reactions and the time so that you can try and make a link back to a certain type of food consumed.
  5. In the case of rashes and hives I would also take a picture on your phone to show your healthcare provider. I have also known people take nappy pics, which may also help you show a doctor the extent of your problems.
  6. Try to eat a varied diet in the time you are looking with as much variety as possible, this helped me in seeing the days my daughter did not have pineapple were days without reactions, had she eaten it every day I may have not noticed the pattern.

How do I use the completed food diary?

If you can see no obvious patterns from your diary you can take it along to see your doctor, I would recommend having at least 2 weeks of entries with a couple of reactions on to see if you are able to identify anything.

The most likely suspects for food allergy are going to be your top 14 allergens. I would also look at any relatives with allergies, we have a very distinct dairy allergy in our family, so it was the first thing I considered. I would also say, don’t discount a food just because you think you can’t be allergic to it – I have spoken to many people with melon, lettuce and carrot allergies. You can be allergic to anything!

If you are having no luck with your doctor and can’t figure it out on your own you should consider social media to try and guide you – there is a lot of experience in my allergy group on salicylate allergies and sugar intolerance and there is usually someone around who will have gone through the same thing you have.

Please be cautious

I was able to cut dairy from my diet when breastfeeding as I was able to get a source of calcium from fortified soya milk. I was able to cut eggs from my diet as I had other sources of protein available to me.

My daughter has a specialist soya milk which is supplemented with vitamins and minerals and has not affected her health or development. There were no consideration to be made when cutting pineapple from her diet as it does not affect any of the major food groups and she has no problems with other fruit and vegetables.

In the case of small children, especially those with multiple allergies, I would always recommend taking your findings to a doctor or health visitor and asking for help for a referral to a dietitian. We saw one every 18 months until the age of 9 and it was a great help, I would definitely recommend it to ensure you or your child are getting a fully balanced diet.

Where can I download a food diary?

I didn’t have a food diary specifically for identifying allergies when my children were little and certainly did not have time to put one together, so I have made a simple PDF daily sheet that you can download below.

It’s very simple, but I hope it can be of help to someone.

More Information

As always – I love to hear about your weird allergies – comment below or Tweet at me if you want to tell me all about them or tell me your struggles to get diagnosed properly.



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.

December – Articles of Interest

When I was writing my old blog (itch, swell, ooze, wheeze) I used to read lots of abstracts every month and list them for those that were interested. I really enjoyed doing it, so with work having calmed down I think I would like to go back to that.

I enjoy reading case studies of individuals with strange allergies and large cohort studies.

This is what caught my eye this month

Clinical and Laboratory findings of barley allergy in Korean children: a single hospital based retrospective study.  This is a small scale study, but I hadn’t seen one with barley before, so it caught my eye.

A case of twin results of allergic test in twin with atopic dermatitis. This is a rare find! Studies on twins are always very interesting and I don’t think I have seen any allergy studies with twins. This is important to consider as it shows that there may be genetic factors which play a part in allergic conditions as well as environmental factors.

The role of Caesarean section in childhood asthma.  Another interesting read. Both of my children were born by caesarean section (as was I), but only my daughter with allergies suffers from asthma.

Let me know if you found any of these interesting or useful!

If you spot an article or research that you think would interest me you can message my Facebook page or tag me in a Tweet.