This article discusses the symptoms, causes, diagnosis, treatment, and alternatives of citrus allergy.
Symptoms
Those who have an allergy to citrus may experience a wide variety of symptoms. They can range from mild symptoms to anaphylaxis.
Possible symptoms include:
Runny noseSneezingProblems with the eyes, including itching, tearing, and rednessItching of the throatMild swelling in the throatRedness of the lips, tongue, soft palate, ears, or inside of the mouthItching of the lips, tongue, soft palate, ears, or inside of the mouthMild swelling in the lips, tongue, soft palate, ears, or inside of the mouthAbdominal painVomitingNauseaFlushing of the skinHivesSwollen skin on any part of the bodyWelts
Complications
In some cases, more serious symptoms can occur as a result of a citrus allergy.
These can include:
WheezingThroat swelling to the point it restricts breathingDifficulty swallowingBreathing problemsDrop in blood pressureCollapse
Those with a severe allergy may also experience anaphylaxis.
Anaphylaxis is a severe allergic reaction that can be life-threatening. Being able to identify symptoms of anaphylaxis is essential.
Symptoms of anaphylaxis may come on suddenly and rapidly worsen.
They may include:
WheezingRash that is often itchyHivesWeltsTightness in the chestCoughVomitingDiarrheaHoarse voiceLoss of consciousnessSwelling in the throatSwelling of other parts of the bodyPale face or bodyAbdominal crampingDifficulty swallowingSense of impending doomBreathing difficultiesRedness to face or body
If you or someone near you has an anaphylactic reaction, administer the epinephrine auto-injector (EpiPen) immediately and call 911.
Causes
As with other allergies to fruit, a citrus allergy has many possible causes. Many people with an allergy to citrus may also have an allergy to pollen.
Pollen-Food Syndrome
Those with an allergy to citrus fruits may be experiencing a cross-reactivity with pollen (having an immune reaction to certain proteins).
People with pollen-food syndrome often already have a pollen allergy and may have hay fever symptoms. These people will also experience allergy symptoms when eating certain fruits and vegetables.
Citrus fruits are one of the fruits that may cause this reaction.
This is because the proteins in pollen are similar to the proteins in some fruits and vegetables, like citrus.
Other Causes
Those with an immediate family member who has an allergic condition like eczema, asthma, or a food allergy may have a slightly increased risk of also developing a food allergy. The food they are allergic to will not necessarily be the same as that of their family member.
Citrus Allergy In Infants
Food allergies are more common in children and infants. About 5% of children under the age of 5 have a food allergy.
Children who have eczema when they are very young are more likely to develop a food allergy.
However, 90% of food allergies are caused by just eight foods. These foods are:
EggsMilkWheatSoyTree nutsPeanutsFishShellfish
Although possible, a citrus allergy is uncommon.
Diagnosis
An allergist will typically make a diagnosis of food allergy after conducting tests.
These are outlined below.
Skin Prick Test
During a skin prick test, an allergist will place a small drop of liquid that contains a food allergen on the skin on either the back or arm. If testing a fruit like citrus, fresh fruit may be used.
The allergist then pricks or scratches the skin using a needle or plastic probe to break the skin and allow a small amount of the allergen to enter the area below the skin’s surface.
The person having the test is then observed. If positive, the skin where the test was given will often have a raised bump and a circle of red and itchy skin.
In addition to testing the suspected food allergens, allergists need to perform a negative control test (no allergen included) to be sure that the skin is not overly sensitive to the prick itself and to achieve a positive control test using histamine to be sure that the skin is responsive to histamine release (what causes the red bump to form in an allergic reaction).
Blood Test
In many cases of possible food allergy, a blood test is preferred.
An IgE (immunoglobulin E) blood test measures the number of specific antibodies in the blood. If there are high levels, the body may overreact if exposed to those allergens.
However, false positives can occur in both skin and blood tests, and food allergy testing is only recommended in cases where clinical history is concerning for food allergy.
Treatment
A food allergy can’t be cured, but people with an allergy to citrus should do all they can to avoid consuming or coming into contact with that allergen.
This means reading food labels thoroughly when buying food or asking questions about food when dining out.
Medications
Antihistamines can be used to treat mild symptoms of allergy. These work by blocking the effects of histamine in the body. Histamine is what triggers the symptoms of an allergic reaction.
Antihistamines are available over the counter at the pharmacy.
Those with a severe allergy should always carry their EpiPen with them to be prepared in the case of anaphylaxis.
What to Avoid
People with an allergy to food like citrus should avoid consuming citrus fruits and any food, beverage, or product that may contain them.
Reading labels is essential for managing food allergies, as sometimes what you’re allergic to may be an unexpected ingredient.
If a person with a citrus allergy also has a pollen allergy, they may also be advised to avoid certain other vegetables and fruits. A healthcare provider will be able to advise what should and shouldn’t be consumed.
Food Alternatives
Citrus fruits contain a high level of vitamin C, which is typically healthy for you, but people with an allergy should still avoid eating citrus fruits.
Alternative foods that are also high in vitamin C include:
PotatoesBroccoliStrawberriesPeppersBrussels sproutsBlack currants
When to See a Healthcare Provider
If you suspect you have an allergy to food like citrus, consider making an appointment with your healthcare provider.
If you or someone you know is experiencing symptoms of anaphylaxis, call 911 immediately.
Summary
A citrus allergy is rare but has been reported to some citrus fruits like grapefruit and oranges. Symptoms may include a rash, swelling, itching, nausea, and vomiting, among other symptoms. A citrus allergy is not the same as an allergy to citric acid.
There is no treatment or cure for food allergies, but management strategies like reading labels and carrying an EpiPen are helpful. Those who can’t have citrus fruits usually can eat other foods high in vitamin C like strawberries or broccoli.
A Word From Verywell
A citrus allergy is rare, but if you are experiencing symptoms after consuming citrus, consider making an appointment with a healthcare provider for help. They may advise you to get tested to determine if you have allergies to citrus or other foods.
Those who had eczema in their early years are more likely to develop a food allergy.
There have been reports of a delayed inflammatory response from manufactured citric acid. However, this is not the same as an allergy.
There is limited information on allergies to citric acid, and there is no evidence to suggest citric acid can cause an immune response like an allergic reaction.
