Citrus Allergy: Diagnosis, Treatment, and Foods to Avoid

Wyndly Care Team
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What are the symptoms of a citrus allergy?

Symptoms of a citrus allergy include skin reactions like hives or eczema, breathing difficulties, digestive problems like vomiting, diarrhea, or stomach cramps, and severe reactions like anaphylaxis. These symptoms usually occur within two hours of consuming citrus fruits. Always seek medical advice for suspected allergies.

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What Causes a Citrus Allergy?

Citrus allergy is primarily triggered by an immune system reaction to proteins found in citrus fruits. This reaction can be influenced by genetic and environmental factors, which vary between individuals.

Genetic Factors

Genetic factors play a significant role in the development of citrus allergy. If your parents or siblings have food allergies, you are more likely to develop one. This genetic predisposition can make you susceptible to citrus allergy, among others.

Environmental Factors

Environmental factors also contribute to the development of citrus allergies. For instance, residing in areas with high citrus pollen count, like Orange, CA or Irvine, CA, can increase your exposure to citrus allergens. Also, cross-reactivity with other allergens, such as cypress tree, palm tree, or maple tree pollen, can trigger or exacerbate citrus allergies due to a phenomenon called Oral Allergy Syndrome (OAS).

What Are the Symptoms of a Citrus Allergy?

Citrus allergy symptoms often appear within minutes to hours after eating or touching citrus fruits. They can affect the skin, digestive, and respiratory systems.

Skin Reactions

Skin reactions are quite common with citrus allergies. These may include hives, itchiness, or eczema. In some cases, individuals may experience contact dermatitis, which presents as red, itchy, and scaly skin, especially if they touch citrus fruits or their juices.

Digestive Symptoms

Digestive symptoms of citrus allergy can include nausea, stomach cramps, vomiting, and diarrhea. These symptoms often appear shortly after eating citrus fruits.

Respiratory Symptoms

Respiratory symptoms can also occur with a citrus allergy. These may include wheezing, coughing, nasal congestion, and difficulty breathing. In severe cases, an allergic reaction to citrus can lead to anaphylaxis, a life-threatening reaction that requires immediate medical attention. If you experience difficulty breathing or other severe symptoms after eating citrus, seek immediate medical help.

How Do Doctors Diagnose a Citrus Allergy?

Diagnosing a citrus allergy involves several steps, including a medical history review, physical examination, and specific allergy tests. These tests aim to identify the specific allergen causing the allergic reactions.

Skin Prick Test

A skin prick test is the most common method for diagnosing citrus allergies. In this test, a small amount of citrus extract is pricked into the skin, and any reaction, such as a raised bump or redness, is observed. The test is relatively quick and provides immediate results.

Blood Test

A blood test, also known as a specific IgE test, measures the amount of allergy-causing antibodies in the blood. A blood sample is taken and sent to a laboratory, where it is tested for a reaction to citrus allergens. This test can be particularly helpful for those who can't undergo skin tests due to certain skin conditions or medications.

Oral Food Challenge

An oral food challenge might be done under strictly supervised medical conditions. This involves consuming small amounts of citrus, with the dose gradually increased, to observe for any reactions. This is the most accurate test for diagnosing food allergies, including citrus allergy. However, it's only conducted when other tests are inconclusive due to the risk of severe reactions. If you'OAS symptoms after eating citrus fruits, your doctor might consider this test.

What Foods Should Individuals with a Citrus Allergy Avoid?

Individuals diagnosed with a citrus allergy should avoid foods and drinks containing citrus or citrus-derived ingredients. The degree of sensitivity varies among individuals; some may react to all citrus fruits, while others might only react to specific types.

Citrus Fruits

Citrus fruits such as oranges, lemons, limes, grapefruits, mandarins, and tangerines should be avoided. This also extends to any products made from these fruits like juices, jams, and marmalades. Allergenic proteins are present in the fruit pulp, seeds, peel, and juice, making all parts of the fruit a potential allergen.

Citrus-Flavored Foods and Drinks

Many processed foods and drinks are flavored with citrus or contain citrus derivatives. These include candies, sodas, bakery items, salad dressings, and sauces. It's important to check food labels for citrus-related ingredients, as even small amounts can trigger allergic reactions.

Foods with Citrus as a Hidden Ingredient

Citrus can also be a hidden ingredient in certain foods. Some vitamins, dietary supplements, and medications may contain citrus bioflavonoids. Certain skincare products might also contain citrus extracts. Reading labels can help identify these hidden sources of citrus, ensuring a safer environment for those with citrus allergies. If you experience symptoms of an oral allergy after consuming certain foods, it's crucial to check the ingredients for hidden citrus.

Can Infants Develop a Citrus Allergy?

Yes, infants can develop a citrus allergy. Citrus allergies in infants can manifest as skin reactions, digestive issues, or respiratory symptoms. It is crucial for parents to introduce new foods one at a time and monitor their child for allergic reactions.

Infants with citrus allergies may develop skin reactions like hives, redness, or eczema after consuming citrus fruits or touching citrus peels. Digestive symptoms, such as vomiting, diarrhea, or abdominal pain, may also occur. Respiratory symptoms, like wheezing, coughing, or difficulty breathing, although less common, can be severe.

If your infant shows signs of a citrus allergy, it's critical to seek medical attention. A healthcare provider can confirm the allergy through tests like a skin prick test or a blood test. In the meantime, avoid feeding your child citrus fruits or foods containing citrus. Remember, even though your child might be allergic to one citrus fruit, they might tolerate others.

It'OAS, a condition that causes an itchy mouth or throat after eating certain raw fruits or vegetables. If your child has been diagnosed with a pollen allergy and experiences these symptoms after eating citrus, it could be OAS. This condition is related to pollen allergies, so addressing the underlying pollen allergy can often help manage OAS symptoms.

What Are the Treatment Options for a Citrus Allergy?

Treatment options for a citrus allergy include avoidance, medication, and sublingual immunotherapy. Identifying what works best for you is crucial and may rely on a combination of these treatments.


The most effective strategy for managing a citrus allergy is avoidance. This means not consuming citrus fruits and avoiding products with citrus as an ingredient. This can be challenging, as many processed foods, cosmetics, and household products contain citrus extracts. Therefore, it's critical to read labels carefully.


In case of accidental exposure, over-the-counter (OTC) antihistamines can help manage mild to moderate symptoms. For severe reactions, an epinephrine auto-injector may be necessary. Always consult your healthcare provider before starting any new medication.

Sublingual Immunotherapy

For some, sublingual immunotherapy, or allergy drops, may be an option. This treatment involves placing drops of allergen extracts under the tongue to help the immune system build tolerance. This therapy should only be taken under the supervision of a healthcare provider.

It's crucial to understand that while these treatments can help manage symptoms, they do not cure the allergy. Preventive strategies and a plan for managing accidental exposure are essential components of living with a citrus allergy.

In certain regions, such as Orange, CA, where citrus fruits are prevalent, individuals with citrus allergy may also have to manage cross-reactivity with other allergens like cypress tree, palm tree, or orchard grass pollen. Understanding the local allergy trends can help in better managing the condition.

When Should You Consult a Doctor for a Citrus Allergy?

It's advisable to consult a doctor for a citrus allergy if you experience persistent or severe symptoms after consuming citrus fruits or products containing citrus. Early diagnosis and appropriate treatment are crucial in managing allergy symptoms and preventing severe reactions.

Consult a healthcare provider if you experience symptoms such as hives, itching, swelling, difficulty swallowing, or shortness of breath after consuming citrus. These can be signs of a serious allergic reaction. Even mild symptoms like an itchy mouth could indicate Oral Allergy Syndrome, which can lead to more severe symptoms in the future.

Living in citrus-dense regions like Orange, CA or Corona, CA can present additional challenges due to the high prevalence of citrus pollen. In such cases, consulting a local allergist can provide insights into managing allergies effectively.

If OTC medications do not alleviate your symptoms, or if they become more frequent or severe, seek medical attention. Unmanaged allergies can lead to complications like asthma or sinusitis. It's essential to get a professional diagnosis and personalized treatment plan.

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Frequently Asked Questions

What are the four types of allergic reactions?

The four types of allergic reactions, based on Gell and Coombs classification, are: Type I (Immediate Hypersensitivity), which includes reactions like hay fever and asthma; Type II (Cytotoxic Reaction); Type III (Immune Complex Reaction), and Type IV (Delayed-Type Hypersensitivity), often seen in contact dermatitis.

How do you manage a citrus allergy?

Managing a citrus allergy primarily involves avoiding citrus fruits, such as oranges, lemons, and grapefruits, along with products containing citrus. Read food labels carefully. Carry an epinephrine auto-injector for emergencies if you have a severe allergy. Consult a healthcare provider for personalized advice.

What should you avoid with a citrus allergy?

If you have a citrus allergy, you should avoid all citrus fruits and their juices, including oranges, lemons, limes, grapefruits, and tangerines. Be aware of citrus ingredients in food, drinks, and even skincare or cleaning products. Always check labels for potential citrus-derived ingredients.

Who should avoid citrus fruits?

Citrus fruits should be avoided by individuals who have a known allergy to them. Symptoms of a citrus allergy include itching, rash, and difficulty breathing. People with gastroesophageal reflux disease (GERD) or mouth ulcers may also need to avoid citrus due to their acidity.

Is citric acid safe for those with a citrus allergy?

Yes, citric acid is safe for those with a citrus allergy. Citric acid, commonly used as a food preservative, is derived from a mold, not citrus fruits. Therefore, it doesn't contain the proteins that trigger a citrus allergy and can be safely consumed.

What happens when you have a citrus allergy?

A citrus allergy triggers an immune response in your body. Common symptoms include itching, redness, and swelling of the mouth, lips, and throat. In severe cases, you may experience hives, difficulty breathing, or anaphylaxis. Symptoms typically occur shortly after consuming citrus fruits.

How do you know if you are allergic to citrate?

Citrate allergy symptoms include skin rash, itching, hives, shortness of breath, wheezing, or swelling of the lips, tongue, or throat. Severe reactions may cause anaphylaxis. To confirm a citrate allergy, an allergist can perform a skin prick test or a blood test.

What are three signs of an allergic reaction?

Three signs of an allergic reaction are hives, characterized by red, itchy welts on the skin; difficulty breathing due to swelling in the throat or airways; and gastrointestinal symptoms, such as nausea, vomiting, or diarrhea. Allergic reactions vary in severity and require immediate medical attention.

What remedies help with a citrus allergy?

Citrus allergy can be managed by avoiding citrus fruits and products containing citrus. In case of accidental ingestion, antihistamines can alleviate symptoms. For severe reactions, an EpiPen may be required. Immunotherapy could also be recommended by a healthcare professional for long-term management.

What is the orange allergy medicine?

The orange allergy medicine most likely refers to Allegra (generic name Fexofenadine), which is an antihistamine used to relieve allergy symptoms such as runny nose, itchy or watery eyes, sneezing, and itching of the nose or throat. It's recognized by its orange packaging.

How rare is a citrus allergy?

Citrus allergies are relatively rare, affecting a small percentage of the population. The exact prevalence is unknown due to underreporting. Symptoms can range from mild (like itching or hives) to severe, including anaphylaxis. If you suspect a citrus allergy, seek medical advice immediately.

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