Though it’s rare, some people have a citrus allergy. Symptoms are those of oral allergy syndrome (OAS), including things like tingling, itching, and swelling of the lips.
Allergies to citrus fruits are rare, but they do occur. Citrus fruits include:
You may have an allergic reaction to the fresh fruit and juice of citrus fruits or to the peels. Keep reading to learn more about what causes a citrus allergy and citrus allergy symptoms.
Most people who have a citrus allergy experience symptoms after eating food or a drink made with raw citrus fruit. The symptoms are often localized, which means that you feel them wherever the raw fruit touched your skin. Symptoms include:
- intense tingling and itching of the lips, tongue, and throat
- reddening and mild swelling of the lips and gums
These are the symptoms of oral allergy syndrome (OAS). Individuals with OAS who have reactions to citrus fruits can usually eat the fruits when they’re cooked. Symptoms may appear later in life, even if you’ve been eating the fruit for years with no problems.
People who are allergic to citrus fruit peels may experience symptoms of contact dermatitis if they come in contact with the peel of citrus fruit.
Allergic contact dermatitis is caused by your skin releasing inflammatory chemicals after coming into contact with an allergen. Symptoms include:
- skin redness
- skin that burns
- extreme itching
- dry, scaly, flaky skin
In rare cases, a citrus allergy can cause a systemic allergic reaction, also called anaphylaxis. Anaphylaxis is a medical emergency and can be life-threatening. Symptoms of anaphylaxis include:
- flushed skin
- swelling of the mouth and throat, which can make breathing difficult
- nausea, vomiting, or diarrhea
- drop in blood pressure, causing you to feel weak
Seek emergency medical help if you are experiencing any of the symptoms of anaphylaxis.
An allergic reaction is due to your immune system mistakenly defending your body against substances that typically don’t pose a threat to you. These substances are known as allergens. When your immune system reacts to an allergen, it causes an allergic reaction.
Allergic reactions to raw citrus fruits are sometimes seen in people who have pollen allergies, in a phenomenon known as cross-reactivity. Other people may experience an allergic reaction after coming in contact with the peels of citrus fruits.
There are also documented cases of some citrus fruits causing a severe allergic reaction known as anaphylaxis, although this is very rare.
Citric acid that’s found naturally in citrus fruit juice can cause irritation to your skin, mouth, and stomach. However, it does not trigger an immune system response, so is not likely to be responsible for an allergic reaction.
Another non-allergy reaction to citrus is called phytophotodermatitis. This is a rash that can appear if citrus juice gets on your skin and is then exposed to sunlight. The UV light causes substances in the juice to irritate your skin.
Many allergic reactions to citrus are due to OAS, which is caused by pollen allergies. This is known as cross-reactivity, which occurs because pollen and citrus fruits share certain proteins.
These shared proteins cause the body to react to a mouthful of fruit as if the bite delivered the allergy-causing pollen instead. This pollen-food cross-reactive allergy causes OAS.
People who are allergic to grasses in particular may experience OAS to citrus fruits. A 2013
They exposed participants to the fruit of fresh lemon, orange, and clementine with a prick test, and found that 39% of the participants who were allergic to pollen also had a positive prick test result for sensitivities to citrus.
However, a positive result on a skin test does not always mean you have a food allergy. Some people may appear to be sensitized to citrus in test results, but have no problems eating citrus. It’s also possible to have negative reactions to eating citrus, but show no sensitivity to citrus on a prick test.
People who are allergic to citrus fruit peels are often allergic to limonene, a chemical found in the peels of citrus fruits.
Just touching the outside of a citrus fruit can cause contact dermatitis symptoms for these people, but they may be able to drink fresh juice just fine. Limonene is also often used as a fragrance in cosmetics and perfumes.
There isn’t much information available about how many people experience a systemic allergy to citrus fruits, but there are documented cases of people having a severe, anaphylactic reaction to oranges and other citrus fruits.
There have also been cases of food-dependent exercise-induced anaphylaxis with oranges and grapefruits. This is a specific form of food allergy in which an allergic reaction occurs only after ingesting the allergen and then exercising soon after.
More research needs to be done to discover how many people have systemic allergies to citrus fruits.
If you or your child has food-related symptoms that could indicate an allergy, your doctor may suggest a skin-prick test.
A skin prick test involves a simple prick with a metal or plastic applicator. A doctor or nurse will firmly press the applicator onto your skin to apply a small amount of the suspected allergen. If you have a positive result, you’ll see a small swelling in the area in 15 to 20 minutes.
If your child is too young to tell you if they are bothered by some fruit, keep a close eye when trying new things and monitor any reactions.
Call for medical help right away if you suspect anaphylaxis. If your allergy is severe your doctor will recommend that you carry an EpiPen with you.
If you think you or someone in your family has had a severe allergic reaction to citrus, an elimination diet is the safest way to avoid future reactions.
A strict elimination diet is probably unnecessary for most people with mild citrus allergy or sensitivities to citrus.
Seeing an allergist can help you clarify which citrus fruits need to be avoided and what products you may be able to tolerate.
Foods to avoid
- Avoid anything from raw citrus fruit to citrus fruit juice. Check the label when buying other types of juices as well, as sometimes citrus juice will be mixed in for some extra punch.
- Avoid unripe or freshly picked citrus. Unripened citrus can be an irritant, more so than ripened fruit.
- Avoid citrus fruit seeds and rinds. People often add citrus zest rind to their baking and salads. Always ask about the ingredients when eating out or at someone else’s home.
- Avoid artificially-flavored sweets and vitamin C supplements, as they often use citrus flavoring.
Through citrus fruit can cause reactions when eaten raw, many people can safely consume them cooked. Cooking deactivates the allergic proteins in many cases. You can also try herbs like lemon verbena and sumac as substitutes for the tart citrus flavor, if a recipe calls for citrus fruit or zest.
My baby has some reactions to citrus fruits. Could they be allergic?Anonymous patient
Citrus fruits are acidic, which can irritate a baby’s sensitive skin. If your baby has a rash only where the fruit touched their skin, it’s likely a contact rash. A contact rash is bothersome, but not usually dangerous.
A true citrus allergy is very rare in babies, but it can happen. If the rash is spreading to areas that the food did not touch, or if your baby has other symptoms like itching, coughing, vomiting, breathing problems, or sleepiness, then this could be a serious type of allergic reaction that needs immediate medical attention.
If your baby has shown a reaction to citrus, talk with your doctor or an allergist to find out whether avoiding citrus is necessary.Elizabeth J. Feuille, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.