Pineapple allergy is not commonly reported, but it can cause adverse reactions. Hypersensitivity reactions to other fruits are commonly reported, particularly apples, stone fruits and bananas. Pineapple (Ananas comosus) is known for its sweet and tangy taste, but its anti-inflammatory properties and enzymatic activity have been used for centuries. Pineapple has been implicated in an array of adverse reactions, including uncomfortable mucosal irritation due to acidic pH and bromelain, oral allergy syndrome and anaphylaxis.
Types of Reactions to Pineapple:
- Mucosal irritation-involves the acidic pH of the fruit as well as the proteolytic activity of Bromelain, which is a combination of multiple enzymes. Bromelain has been used as a meat tenderizer and a wound debridement agent. It is naturally found in pineapple and concentrated in the pineapple stem. Bromelain can cause burning, soreness of the oral mucosa and tongue. Bromelain denatures when heated, which explains symptoms occurring with fresh but not heated pineapple products. Symptoms can be helped by pairing pineapple with dairy or sprinkling it with salt.
- Oral Allergy Syndrome-symptoms typically occur with mouth itching and swelling of lips and tongue. Patients allergic to birch tree (Bet v 2) can describe symptoms of oral allergy syndrome to pineapple. This is not a true pineapple allergy, but a cross reactivity of the proteins to the birch tree pollen. Treatment is heating the fruit or just avoiding it.
- Anaphylaxis-symptoms that occur are hives, swelling, wheezing, coughing, vomiting, diarrhea and low blood pressure. Bromelain has been implicated as well as pineapple specific proteins, this leads to IgE mast cell degranulation. Allergy skin testing, specific IgE lab testing and fresh food skin testing with pineapple all can be used to test for pineapple allergy.
Reactions to pineapple can thus come in different forms. An allergy doctor can help decipher what type of reaction one is having to pineapple and to do the appropriate tests for establishing or ruling out a diagnosis of clinical allergy.