Pineapple food allergy is reported but medical literature evidence is limited

Pineapple food allergy is uncommon but it is still reported occasionally. There is an old case series in PubMed from 1993: https://www.ncbi.nlm.nih.gov/pubmed/8511816

Pineapple allergy could be due the following:

- the fruit allergen itself
- pineapple extract bromelain, including exposure at factories producing the extract (https://www.ncbi.nlm.nih.gov/pubmed/498486). This is called occupational exposure.
- cross-sensitivity with pollen. This is called oral food allergy syndrome.

Intolerance to pineapple is commonly reported but food allergy is more difficult to prove. Localized symptoms such as mouth tingling could be caused by local irritation caused by the acidity or the texture of the fruit. This is a nonspecific reaction, not related to food allergy.

Table 4 here lists the self‐reported prevalence of secondary FHS (pollen related fruits and vegetables) in 141 participants, thus 141/192 with possible pollen allergy reported secondary FHS to different fruits and vegetables. Kiwi allergy was reported in 7.8% of the participants followed by hazelnut (6.6%), pineapple (4.4%), apple (4.3%), orange (4.2%), tomato (3.8%), peach (3.0%) and brazil nut (2.7%). Reference: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1399-3038.2008.00842.x

Cross-reactivity with latex was demonstrated in a study with latex-allergic patients, where 19% exhibited IgE antibodies to pineapple, as demonstrated by the Phadia ImmunoCAP® System. However, sensitization does not mean clinical allergy.

Cross-reactivity has been reported to occur between apricot, avocado, banana, cherry, chestnut, grape, kiwi, papaya, passion fruit, peach and pineapple. Kiwi fruit, papaya, avocado, pineapple, fig and banana may be associated with sensitisation to Ficus benjamina allergens.

The review of literature available as of 2018 does not provide solid evidence of food allergy to pineapple beyond the 1993 study and the self-reported symptoms. There is a paucity of case reports of pineapple allergy proven with sIgE, skin prick test and ingestion challenge.

Additional reading:

http://www.phadia.com/Products/Allergy-testing-products/ImmunoCAP-Allergen-Information/Food-of-Plant-Origin/Fruits/Pineapple/