A person with a citrus allergy experiences a reaction, such as tingling or blisters, when they come into contact with fruits such as oranges, lemons, and limes.
While citrus allergy is uncommon, reactions can trigger severe symptoms. An individual with an allergy to grass may be more likely to develop an allergy to citrus.
Read on to learn more about the symptoms and causes of citrus allergy. This article also looks at foods to avoid, treatment options, and more.
Symptoms of citrus allergy can include:
- swelling or itching of the:
- tongue
- mouth
- lips
- soft palate
- ears
- throat
- abdominal pain
- nausea
- vomiting
- diarrhea
Symptoms may appear immediately after touching a citrus fruit, its juice, or products containing either. In other cases, symptoms can take hours or days to develop.
Touching the peels of citrus fruits
In rare cases, a citrus allergy may induce anaphylaxis, a potentially fatal allergic reaction that requires immediate medical attention.
Anaphylaxis: Symptoms and what to do
Anaphylaxis is a severe allergic reaction that can be life threatening. The symptoms develop suddenly and include:
- hives
- swelling of the face or mouth
- wheezing
- fast, shallow breathing
- a fast heart rate
- clammy skin
- anxiety or confusion
- dizziness
- vomiting
- blue or white lips
- fainting or loss of consciousness
If someone has these symptoms:
- Check whether they are carrying an epinephrine pen. If they are, follow the instructions on the side of the pen to use it.
- Dial 911 or the number of the nearest emergency department.
- Assist the person in moving from a sitting position to lying down. If they have vomited, turn them onto their side.
- Stay with them until the emergency services arrive.
Some people may need more than one epinephrine injection. If the symptoms do not improve in 5 to 15 minutes, or they come back, use a second pen if the person has one.
Allergic reactions occur when the immune system misidentifies a usually harmless substance as a threat. This substance is known as an allergen.
Some individuals with pollen allergies may also react to citrus fruits. Pollen-food syndrome (PFS), also known as oral allergy syndrome, is caused by cross-reactivity. This occurs when the proteins in one substance resemble those of an allergen and provoke a similar reaction.
If a person is allergic to tree or grass pollen, they may have an orange allergy.
A person with a citrus allergy should refrain from touching citrus fruits and eliminate them from the diet.
Citrus fruits to avoid include:
- kumquats
- lemons
- limes
- mandarins
- grapefruit
- oranges
Many prepared foods contain citrus. Carefully check the labels on products such as:
- juices, lemonades, and other beverages
- ice creams
- flavored yogurts
- jellies
- herbal teas
- sauces and dressings, including mayonnaise and sweet and sour sauces
- seafood and meat dishes, including prawn cocktails, baked fish, and duck dishes
- marinades
- pickles and chutneys
- alcohol and nonalcoholic cocktails
- vitamin C supplements and bioflavonoid supplements
- candies and confectionery, including candied peels, cheesecakes, and cookies
Citrus can also be found in personal care products such as toothpaste. Cosmetics and perfumes often contain limonene, a compound in citrus peels that can cause contact dermatitis.
Alternative foods
Some people can tolerate cooked citrus fruit because heat can deactivate the proteins that trigger an allergic reaction.
For those who cannot tolerate citrus but want to add a tart flavor to meals, popular citrus substitutes include:
- herbs such as lemon verbena and sumac
- vinegar
- white wine
Citrus fruits are a popular source of vitamin C, but plenty of other fruits and vegetables can help a person with an allergy meet their daily requirement.
Other foods rich in vitamin C include:
To assist with reaching an accurate diagnosis, a doctor will likely begin by performing a physical exam and asking questions about a person’s symptoms.
If they suspect a food allergy, they may also ask about a person’s diet. The doctor may request that a person record their meals and symptoms in a food diary. This will help to identify triggers.
A doctor may also perform an allergy test, but these often show false positive or negative results.
Common allergy tests include skin tests and blood tests.
Skin tests
A skin prick test involves using a needle to apply a diluted allergen to the skin.
If within about 20 minutes the skin becomes itchy or a bump appears, a person is likely to have an allergy to the substance.
An intradermal test may help to confirm results. In this test, the diluted allergen is injected just below the surface of the skin. A visible reaction indicates an allergy.
Blood tests
When diagnosing a citrus allergy, a doctor may order a blood test.
This will determine the amount of immunoglobulin E (IgE) antibodies in the bloodstream. A person with a high number of antibodies is likely to have an allergy to the substance tested.
Blood tests are more expensive than skin tests. Also, results take longer, and blood tests may be inaccurate.
There is no cure for a citrus allergy, though symptoms may diminish over time. If a person can eliminate contact with the fruits, the symptoms should disappear.
When it is impossible to avoid contact with citrus completely, some medical treatments may help.
Medication
Several types of prescription and over-the-counter (OTC) medication can treat allergic reactions.
Depending on the symptoms, a doctor may recommend antihistamines.
Immunotherapy
Immunotherapy can be used to treat severe allergies.
People receiving immunotherapy receive injections of the allergen, with the aim of decreasing the immune response and sensitivity over time.
Some pollen allergies are treatable with another form of immunotherapy, which involves placing a tablet under the tongue.
Emergency epinephrine
People with severe citrus allergies are at risk of anaphylaxis. They will likely need to keep an emergency epinephrine injector, such as an EpiPen, Auvi-Q, or Neffy, with them at all times.
A medical professional can provide more information about how to use an epinephrine injector.
Anyone who experiences a mild allergic reaction should contact a doctor for a diagnosis. Testing may be necessary to confirm citrus as the cause of the symptoms.
Seek emergency medical attention if symptoms of anaphylaxis occur.
A citrus allergy is a rare and potentially severe condition. After contact with citrus fruit such as oranges, lemons, or limes, a person may experience swelling or itching of the mouth, lips, tongue, or throat. Other symptoms may also develop.
A person can reduce or eliminate symptoms by avoiding citrus fruits and products that contain the fruits or extracts.
While there is no cure, medications and immunotherapy can help to alleviate symptoms. Those with severe citrus allergies should carry emergency epinephrine to treat anaphylaxis, a potentially fatal event.