Course of disease
The first contact with apple does not usually cause the typical allergic symptoms. Nevertheless, a reaction of the immune system already runs in the background. After the smallest structures of the apple have penetrated through the mucous membrane into the bloodstream and the immune system has mistakenly recognised them as harmful, T-lymphocytes are reactively formed, which belong to the white blood cells of the immune system.
These T-lymphocytes then recognize the next contact with apple, which immediately and as fast as lightning activates the immune system and the symptoms appear. As the allergy progresses, allergic reactions will occur again and again and no weakening can be expected. Therefore it is very important to avoid these triggers if possible.
In principle, people with apple allergy can develop an allergy to all apple varieties. However, it has been observed that old apple varieties are better tolerated by allergy sufferers. These apple varieties include Boskop, Gravensteiner, and Berlepsch.
Even of these more tolerable varieties, only a small piece should be eaten first to test whether a reaction occurs or not. It is also important to wash the apples thoroughly before eating them, so that no reaction against possible pesticides occurs. Peeling already removes many of the antigens, which makes the apples even more digestible.
As a rule, processed apple products are well tolerated by allergy sufferers. This includes not only apple juice, but also apple sauce or apple pie. By removing the peel and especially by heating, the antigens responsible for triggering the allergic reaction are rendered ineffective. Nevertheless, as a precautionary measure, a small amount of juice should be tested beforehand to see if a reaction is triggered.
Acute therapy depends on the severity of the allergic reaction. In general, the trigger of the allergy must be removed immediately. The severity of the allergic reaction can be assessed by a short conversation and an orienting examination.
A venous access is always necessary, as the drugs act faster through the vein. In case of a mild reaction, it is usually sufficient to administer an antihistamine such as dimetinden or clemastine in combination with a glucocorticoid via the vein. If there are also problems breathing through the swollen mucous membrane, the stress hormone adrenaline would be injected into the muscle and the patient would be given oxygen to breathe.
To open the airways, a spray can also be administered, which is also used in bronchial asthma. In the case of extreme reactions associated with anaphylactic shock, one would take all the above measures and additionally give fluid through the vein. In this case, constant monitoring of the vital parameters is important, as an anaphylactic shock can also lead to cardiovascular failure. The therapy is always focused on improving the symptoms and stabilizing the circulation. The allergy itself cannot yet be completely cured, so avoiding raw apples is the most effective preventive measure in this case to avoid further allergic reactions.