Question: I have a sensitivity or allergy to tomatoes. My mouth and esophagus get itchy and sore when I eat them. Is there any way to make tomatoes less irritating? Is there a good substitute for tomatoes in recipes?

Answer: You may suffer from oral allergy syndrome (OAS), a relatively common reaction to plant foods, including tomatoes. People who have pollen allergies are more likely to have OAS (Asero 2013) because they react to similar proteins in vegetables, fruits and/or nuts.

“People with tomato allergy also tend to be allergic to latex,” said Margie Woch, a registered dietitian/nutritionist at Stanford University’s Center for Allergy and Asthma Research, in an email interview. Because the responsible proteins are easily broken down, OAS symptoms are usually mild and localized—like itching and swelling in the mouth—as opposed to the more severe symptoms of other food allergies, such as difficulty breathing or reduced blood pressure (ACAAI 2018). The good news is, “Most people (but not all) who react to a raw fruit or vegetable do not react if that food is cooked,” Woch said. “A great example is having a reaction to raw apple, but no reaction to applesauce or apple pie.”

Scientists are working on growing hypoallergenic tomatoes (Paulus et al. 2012). In the meantime, if cooking tomatoes doesn’t prevent your symptoms, you can recreate the flavor and texture of tomatoes in some recipes. Tomatoes add bright acidity to food, so you can often replace their flavor with lemon juice, vinegar, citrus or other fruit. If you are craving a tomato and mozzarella Caprese salad, for example, try peaches or nectarines in place of tomato, as they have similar texture and acidity.

To find out more about preventing your reactions, be sure to consult an allergist. Shots that treat pollen allergies may also help prevent OAS.