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.
Mal d 3 is a Lipid Transfer Protein (LTP), which is considered a panallergen - if allergic to this particular allergen you may have reactions to other foods containing LTPs.
Mal d 2 is a is a thaumatin protein, this is made by plants to inhibit fungal growth.
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.
If sensitised to Alder pollen you may have Pollen Food Allergy Syndrome and may also react to cherry, peach, pear, parsley, celery, almonds and hazelnuts.
If sensitised to Birch pollen you may have Pollen Food Allergy Syndrome and may also react to kiwi, pear, peach, plum, nectarine, apricots, cherries, tomato, celery, carrot, potato, parsnip, pepper, dill, cumin, peas, coriander, fennel, hazelnut, walnut, almonds, peanuts, lentils and green beans.
If sensited to Mugwort pollen you may have Pollen Food Allergy Syndrome and may also react to celery, carrots, dill, parsley, fennel, coriander, cumin and sunflower seeds.
Proteins with similar protein structures are strawberry, raspberry, asparagus and mango.
Other foods containing thaumatin proteins are kiwi, chilli, peppers, apple, banana, cherry and peach.
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.
Thermofisher - Apple Allergens
Allergy information for: Apple (Malus domestica)
Allergy UK - Oral Allergy Syndrome Factsheet
Patient (UK) - Oral Allergy Syndrome
Articles and Journals
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
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