Reactions to fruit: Food intolerance or allergy?

With so many Internet resources available on salicylate sensitivity and histamine intolerance – where fruits are a big culprit – it is easy to get the impression that adverse reactions to fruit are signs of food intolerance and not food allergy. But even though fruit are not included in the Big 8 list of allergenic foods (except for nuts, which technically are fruit), it is still possible to develop fruit allergies and even suffer anaphylaxis from fruit. In fact, since most allergy symptoms overlap with food intolerance symptoms and both types of reactions can be delayed, you should not try to distinguish between the two conditions on your own.

Fruits, vegetables & allergy

The following fruits and vegetables are most often implicated in allergy. This list is not exhaustive – other fruits are possible.

Primary allergy

Cherry, pepper, kiwi, grape, apple, peach, celery, carrot

Oral allergy syndrome

Birch pollen – Apple, pear, cherry, peach, nectarine, apricot, plum, kiwi, hazelnut, other nuts, almond, celery, carrot, potato

Birch/mugwort pollen – Celery, carrot, spices, sunflower seed, honey

Grass pollen – Melon, watermelon, orange, tomato, potato, peanut, Swiss chard

Ragweed pollen – Watermelon and other melon, banana, zucchini, cucumber

Plane tree pollen – Hazelnut, peach, apple, melon, kiwi, peanuts, corn, chickpea, lettuce, green beans

Latex – Avocado, chestnut, banana, passion fruit, kiwi fruit, papaya, mango, tomato, pepper, potato, celery

Source: Skypala, p. 154

There are two types of fruit allergies:

  1. Primary fruit allergy is just like any other food allergy: specific proteins unique to fruits (lipid transfer proteins) bind to IgE antibodies and trigger the release of histamine and other chemicals. Symptoms are the same as classic allergy symptoms and develop along similar time frames.
  2. Oral allergy syndrome (OAS), also known as pollen-food syndrome, is most common food allergy in adults. In order to suffer from OAS, you must have an existing allergy to pollen or latex. OAS occurs because certain proteins in fruit are similar enough to plant proteins that they can also bind to pollen-specific IgE antibodies and trigger symptoms. Symptoms arise rapidly – between 15 minutes to 1 hour after eating fruit – and typically include itching or hives in the mouth and throat. However, gastrointestinal and systemic symptoms are also possible, and foods related to birch pollen can also cause or aggravate chronic eczema in children and adults.

The worldwide prevalences for primary fruit allergy and for OAS are both around 5%. The prevalence rates and predominant types of fruits and vegetables involved vary from country to country. OAS is often regarded as a mild condition, but about 2% of people with OAS could experience anaphylactic shock. Taking ACE inhibitors for hypertension or congestive heart failure amplifies OAS symptoms, and this could lead to facial swelling that stops you from being able to breathe.

If you do have a fruit allergy or OAS, a doctor can answer your questions about managing your condition: Should you completely avoid your trigger foods? How much could you safely eat? Should it be cooked or peeled? Which varieties of troublesome fruits should you shop for?

If your doctor tells you that you do not suffer from a fruit allergy or OAS, then you can probably pursue a diet investigation for food intolerance with a registered dietitian – get your doctor’s OK. Remember, if you are a person who experiences laryngeal edema (swelling of the throat or upper airways), food challenges for food intolerance should be done only in a clinical (inpatient or outpatient) setting.

© 2014 Anna (Laurie) Laforest. All rights reserved.
Photo © Can Stock Photo Inc. – Food intolerance resource with a scientific twist


American College of Allergy, Asthma and Immunology (ACAAI). Oral allergy syndrome, high blood pressure medications can create lethal cocktail. [Internet] ScienceDaily; 2013 November 13. Available from: [Accessed 2014 January 18] (Archived by WebCite® at

Breuer K, Wulf A, Constien A, Tetau D, Kapp A, Werfel T. Birch pollen-related food as a provocation factor of allergic symptoms in children with atopic eczema/dermatitis syndrome. Allergy. 2004;59(9):988–94. PubMed

Osterweil N. Foods That May Worsen Pollen Allergies. [Internet] WebMD. Available from: [Accessed 2014 January 18] (Archived by WebCite® at

Skypala I. Fruits and Vegetables. In: Skypala I, Venter C, editors. Food Hypersensitivity: Diagnosing and Managing Food Allergies and Intolerance. John Wiley & Sons; 2009. p. 147–65.