Citrus fruit allergy: symptoms, causes & safer alternatives

A refreshing glass of orange juice or a splash of lemon in your tea—citrus fruits are part of everyday life for many people. But what if they cause symptoms such as itching, stomach problems, or respiratory reactions? These could be signs of an allergy or intolerance. Learn what symptoms may occur, how the diagnosis is made, and what treatment options are available. 

Table of Contents

• How does a citrus fruit allergy manifest?
• Why can’t I tolerate citrus fruits?
• Which foods should be avoided if you have a citrus fruit allergy?
• How is a citrus fruit allergy diagnosed?
• How can a citrus allergy be treated?
• Are there alternatives to citrus fruits for allergy sufferers?
• Can a citrus fruit allergy disappear over time?
• Are organic citrus fruits better tolerated by people with allergies?
• Summary

How does a citrus fruit allergy manifest?

A citrus allergy is a rare food allergy in which the immune system overreacts to components of citrus fruits such as oranges, lemons, or limes. An allergy to citrus fruits can cause a variety of symptoms. The following list provides an overview of possible complaints:

• Skin reactions – Itching, hives, eczema
• Gastrointestinal symptoms – Nausea, abdominal pain, diarrhea
• Respiratory problems – Sneezing, runny nose, asthma
• Oral symptoms – Tingling, swelling of the lips and tongue
• Severe reactions – Anaphylaxis (rare). Anaphylaxis is a severe, life-threatening allergic reaction that can affect the entire body. It occurs suddenly and often leads to symptoms such as shortness of breath, swelling, rash, low blood pressure, and loss of consciousness. Without immediate treatment with adrenaline, it can be fatal.

Source: Wyndly Care Team, 2024

Why can’t I tolerate citrus fruits?

A food allergy is an immune system reaction to certain foods. Even the smallest amounts can trigger an immediate immune response. In contrast, a food intolerance is caused by problems with processing or absorbing certain substances in the digestive tract and is not immunologically based.

Reasons for citrus fruit intolerance include:

• Allergic reaction: Some people are allergic to specific proteins in citrus fruits. Especially in people with pollen allergies (e.g. to grasses or mugwort), cross-reactions can occur because the immune system recognizes similarities between pollen and fruit proteins. This can lead to symptoms (Iorio, R. A., 2013).
• Histamine intolerance: Citrus fruits release histamine. Histamine is a naturally occurring substance in the body involved in immune responses, nerve signals, and stomach acid production. An excess—especially if it cannot be broken down properly—can lead to gastrointestinal symptoms, among others (Maintz, L., et al., 2007).
• Fructose sensitivity (fructose intolerance): Fructose, a simple sugar found in many fruits, can cause symptoms in people with fructose intolerance. Citrus fruits contain fructose; oranges, for example, are among the fruits with relatively low fructose content (Digestio, n.d.).

Which foods should be avoided if you have a citrus fruit allergy?

People with a citrus fruit allergy should avoid fresh fruits such as oranges, lemons, limes, clementines, and grapefruits. Caution is also advised with hidden citrus components in processed products. Fruit juices, jams, soft drinks, sweets, or ready-made meals containing citrus flavorings or acidifiers can also trigger symptoms. Spice blends or baking ingredients may contain hidden citrus elements that can cause reactions. Medications and cosmetics may also contain problematic extracts and provoke allergic reactions.

For example, look out for the following terms when shopping: citric acid (E330), citrus extract, orange or lemon oil, limonene, citral, ascorbic acid (E300), Citrus Limon (Lemon) Peel Extract, Citrus Sinensis Oil, Citrus Aurantium Dulcis (Orange) Extract, limonene, or citral.

Source: Nyacs, n.d.

How is a citrus fruit allergy diagnosed?

Diagnosis of a citrus allergy is based on medical history, skin prick tests, and specific IgE blood tests. To confirm the diagnosis, a provocation test may be performed under medical supervision. A provocation test is a medical procedure in which a specific substance is administered to determine whether a reaction occurs. In cases of intolerance without an immune response, a food diary can help identify links between symptoms and citrus fruit consumption (Yorktest, n.d.).

If you suspect that you may be allergic to citrus fruits, an allergy test can provide clarity. A home test offers the convenience of being performed at home—without waiting times or a doctor’s appointment. The extensive allergy test from Homed-IQ analyzes numerous allergens and is processed in ISO-certified laboratories, providing you with reliable and accurate results.

How can a citrus allergy be treated?

The best treatment for a citrus allergy is to avoid the relevant fruits and products. If symptoms do occur, antihistamines or corticosteroids can help relieve issues such as itching or swelling. In severe reactions, an epinephrine injection may be necessary. Specific immunotherapy is usually not an option, as citrus allergies are often combined with other allergies (Nyacs, n.d.).

Are there alternatives to citrus fruits for allergy sufferers?

There are many well-tolerated alternatives to citrus fruits for allergy sufferers that offer similar flavors or nutrients. Here are some options:

• Vitamin C sources: Bell peppers, broccoli, strawberries, blackcurrants
• Tart alternatives: Apples, pears, pomegranates, raspberries
• Lemon substitutes in cooking: Apple cider vinegar, white wine vinegar, tamarind
• Aromatic alternatives: Ginger, mint, lemon balm

Can a citrus fruit allergy disappear over time?

A citrus allergy can change over the course of a person’s life. Some people develop it in childhood and later outgrow it, while for others it persists. Mild intolerances may disappear over time, but true IgE-mediated allergies usually remain permanent.

Are organic citrus fruits better tolerated by people with allergies?

Organic citrus fruits are free from synthetic pesticides and wax coatings, which can be beneficial for some allergy sufferers. However, they contain the same natural allergens as conventionally grown fruits. People who react to proteins in citrus fruits will not benefit from the organic variants, as the allergy-triggering substances remain unchanged.

Summary

An allergy to citrus fruits can manifest as skin reactions, gastrointestinal complaints, or respiratory symptoms. Possible causes include a cross-reaction, histamine intolerance, or sensitivity to fruit sugar. Diagnosis is carried out through skin prick tests, blood tests, or provocation tests under medical supervision. The most effective treatment is the avoidance of citrus fruits and products containing hidden citrus components. Antihistamines can relieve acute symptoms, while an epinephrine injection may be necessary in severe cases. Allergy sufferers can turn to alternatives like bell peppers, berries, or apple cider vinegar to enjoy vitamin C and tart flavors without allergic reactions.