A person with a citrus allergy experiences a reaction when they come into contact with fruits such as oranges, lemons, and limes.

While this 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.

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In this article, we describe ways to identify and treat a citrus allergy.

What are the symptoms?

Woman with a citrus allergy holding her mouth
Symptoms of a citrus allergy may include redness, swelling, and tingling sensations on the lips.

Symptoms may appear immediately after touching a citrus fruit, its juice, or products containing either. In other cases, symptoms can take hours to develop.

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Some people experience symptoms after inhaling airborne citrus particles.

However, symptoms are usually confined to the areas of skin that have touched citrus products. These often include the:

  • gums
  • lips
  • throat
  • tongue

Common symptoms include:

  • tingling sensations
  • itching
  • redness
  • swelling

Touching the peels of citrus fruits can cause a skin reaction called contact dermatitis. This may lead to:

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  • a burning sensation on the skin
  • blisters
  • dry and flaky skin
  • extreme itching
  • hives
  • redness
  • swelling

Citrus allergies can also cause digestive and respiratory problems, including:

  • coughing
  • diarrhea
  • nausea
  • a runny or stuffy nose
  • sneezing
  • stomach pain
  • vomiting
  • wheezing

In rare cases, a citrus allergy may induce anaphylaxis, a potentially fatal condition that should be treated as a medical emergency.

Anaphylaxis symptoms include:

  • confusion
  • difficulty breathing
  • flushed skin
  • a loss of consciousness
  • nausea, vomiting, and diarrhea
  • a sharp drop in blood pressure
  • swelling of the mouth and throat
  • a weak or rapid pulse

Causes

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. This is caused by cross-reactivity, which occurs when the proteins in one substance resemble those of an allergen and provoke a similar reaction.

Results of a study from 2013 suggest that people with grass pollen allergies may be vulnerable to citrus allergies. When given a skin prick test, 39 percent of participants with grass pollen allergies showed similar reactions to citrus. However, it is possible for a person to react to a test but have no allergy symptoms otherwise.

The citrus varieties tested were clementines, lemons, and oranges.

Foods to avoid

A variety of citrus fruits
Citrus fruits include limes, lemons, and oranges.

A person with a citrus allergy should refrain from touching the fruits and eliminate them from the diet.

Citrus fruits include:

  • kumquats
  • lemons
  • limes
  • mandarins
  • grapefruits
  • oranges

A surprising number of processed and 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
  • alcoholic and non-alcoholic cocktails
  • vitamin C supplements and bioflavonoid supplements
  • candies and confectionary, 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

Citric acid is commonly used as a preservative or firming agent, as well as for flavor. It can cause skin and oral irritation, but it rarely triggers an allergic reaction. However, some people with allergies choose to use a substitute.

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:

When to see a doctor

Anyone who experiences an allergic reaction should see a doctor for treatment recommendations. Further testing may be needed.

Seek emergency medical attention if symptoms of anaphylaxis occur.

Diagnosis

blood tests and analysis sheet
A blood test may be ordered to diagnose a citrus allergy.

A doctor will ask about a person’s diet and symptoms, and they may also perform a physical examination.

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

A skin prick test involves using a needle to apply a diluted allergen to the skin.

If within 15 minutes the skin becomes red and itchy or a bump appears, a person is likely to have an allergy to the substance.

An intradermal test may be used 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 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 are often less accurate.

What are the treatment options?

There is no cure for a citrus allergy, though symptoms may diminish over time. If a person can eliminate contact with the fruits, symptoms should disappear.

When it is impossible to avoid contact with citrus completely, the following treatments can reduce allergy symptoms:

Medication

Several types of prescription and over-the-counter (OTC) medication can treat allergic reactions. Depending on the symptoms, a doctor may recommend:

  • antihistamines
  • inhalers
  • ointments or lotions

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 treated with another form of immunotherapy, which involves tablets placed under the tongue, rather than shots.

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 or Auvi-Q, with them at all times.

Takeaway

A citrus allergy is a rare and potentially severe condition. A person can reduce or eliminate symptoms by cutting citrus fruits out of their diet and avoiding 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 pens to treat anaphylaxis, a potentially fatal event.