Citrus allergy is a type of food allergy in which the allergens are components of citrus fruits and substances used to process these fruits. Manifestations of this syndrome include skin reactions, reactions of the mucous membranes, disorders of the respiratory, cardiovascular and digestive systems. Diagnosis is carried out on the basis of anamnesis, as well as by setting skin tests outside the period of exacerbation. As a treatment, modern allergology suggests using the method of specific immunotherapy. Symptomatic treatment includes taking antihistamines and hormonal drugs, enterosorbents.
ICD 10
T78.1 Other manifestations of a pathological reaction to food
General information
Citrus allergy is considered in modern allergology as a kind of food allergy – a specific hypersensitivity to an external foreign irritant that enters the body with food. The substances that trigger such an allergic reaction, in this case, are the components of citrus fruits. Many allergists and immunologists believe that chemicals that process fruits to preserve an attractive appearance for buyers play a significant role in the development of allergies to citrus fruits. Most often, diphenyl is used for these purposes – an active compound without color, taste and odor, and fungicides and sulfur gas are used to protect against insects and other pests. It should also be noted that the human enzyme system usually adapts to food that is common for the area in which he was born and grew up, which increases the risk of food allergies when eating foods that are exotic for this geographical region, which citrus fruits are for us.
The prevalence of this pathology in our country is associated with the deterioration of the overall environmental well-being, coupled with the increased level of citrus imports from China, South Africa, Egypt and Morocco over the past decades. A person who had previously eaten, for example, a couple of slices of orange for the New Year, could not even guess that his body would respond to regular consumption of this fruit with a pathological hypersensitivity reaction. Most often, such an allergy is acquired.
Causes
Citrus fruits are classified as products of a high degree of allergenic activity. If an allergy to citrus occurs, the allergen may be a high-molecular component of citrus – usually a protein compound with antigenic activity. As well as foreign ones, the body can perceive special chemicals that are used to process fruits to preserve their presentation, extend the shelf life, and make them more attractive to the buyer. Of no small importance is the high content of liquid and sugar in citrus fruits – because of this, if stored incorrectly, the fruits quickly become covered with mold, which, in turn, is also a strong allergen. Storing citrus fruits next to other moldy food contributes to cross-contamination – fungal particles can end up on the fruit, even if the storage conditions are fully met.
Additional factors for the occurrence of allergies to citrus fruits may be a genetic tendency to allergic diseases or other immune pathologies, congenital or acquired decreased immunity, impaired functioning of the gastrointestinal tract, urinary system. The frequency and quantity of citrus fruits consumed in food, as well as the age of the initial intake of the antigen into the body – all this significantly affects the body’s susceptibility to the allergen.
Symptoms
An allergic reaction occurs almost immediately, usually 10-15 minutes are enough for the development of the first symptoms. External signs of allergy persist from forty minutes to several days. The spectrum of symptoms is quite wide, due to the fact that the disease affects various organs and systems of human organs.
Very often, especially in children’s patients, such an allergy is manifested by skin reactions, namely the development of an unpleasant rash, itching, redness, urticaria, eczema. The eye syndrome is expressed in the form of allergic conjunctivitis: there is swelling, itching, redness of the mucous membrane of the eyes, lacrimation. Respiratory manifestations range from allergic rhinitis (nasal congestion, mucus discharge) to bronchospasm, accompanied by wheezing and attacks of suffocation. On the part of the digestive system, the following pathological reactions can be observed – stomach pain, diarrhea, flatulence, nausea, vomiting. Hearing impairment and dizziness are less common against the background of low blood pressure.
Complications
In severe forms of allergic reactions, life-threatening symptoms may appear, such as Quincke’s edema – pronounced, rapidly developing angioedema, asthmatic attack, anaphylactic shock. Without the immediate provision of specialized emergency medical care and further monitoring of the state of health by an allergist-immunologist, such complications can lead to death.
Diagnostics
Diagnosis is carried out on the basis of the collected anamnesis, the establishment by the attending physician of the connection of the fact of taking the product with the onset of symptoms. Since citrus allergy is a condition most often acquired, the diagnostician should pay attention to both the functioning of the digestive and excretory systems and the immune status of the patient. Since the genetic nature of the disease cannot be excluded, the doctor should request and analyze the family history of the patient. In the process of choosing a treatment regimen, it is important to distinguish citrus allergy from individual food intolerance of a particular product.
Hypersensitivity to citrus fruits is recognized with the help of skin samples delivered by the scarification method or by the prick test method. A few days before such a test, the patient should stop taking symptomatic treatment (antihistamines or hormonal drugs) in order to avoid false negative results. The test is carried out using water-salt solutions of protein-polysaccharide complexes isolated from the pulp of fruits. Droplets of liquid with allergen and test liquid are applied to the skin of the inner side of the forearm treated with a disinfectant composition to exclude false results. Through the applied drop with sterile individual instruments – a lancet or a needle – scratches or injections with a depth of about 1 mm are applied. In case of a positive result, the reaction is observed fifteen to twenty minutes after the start of the test, it lasts up to forty minutes. Since such a test is specific, it allows you to isolate a certain type of provoking allergen, and optimize the patient’s diet accordingly.
Treatment of citrus allergy
Symptomatic treatment is prescribed depending on the severity and severity of allergy signs. It can be antihistamines (loratadine, cetiriziine) or hormonal drugs (prednisone). Antihistamine ointments are used to relieve skin symptoms, vasoconstrictor sprays and drops are used to eliminate nasal congestion.
To remove traces of the allergen from the body, the doctor prescribes sorbents. The sorbent performs a detoxifying effect, adsorbs antigen residues and toxic metabolic products on its surface, prevents their absorption and reduces the intensity of external manifestations of allergic reactions.
Specific immunotherapy is carried out by sequential administration of an increasing dose of the allergen, starting from the minimum values. It is able to rid the patient of allergies for a long time. Since in the case of this type of allergy, the allergen is quite easy to exclude from the diet, a kind of etiotropic therapy is to avoid eating citrus fruits. A skin test will help determine which fruit causes a hypersensitivity reaction, in some cases it will be possible to exclude only it, not necessarily abstaining from all citrus fruits.
Prognosis and prevention
In order to avoid the appearance of repeated pathological reactions, it is enough to refrain from using an allergenic product. People suffering from allergies, and especially patients with a history of complicated allergic reactions, must have constant access to antihistamines, as well as an epinephrine solution for injection in case of development of Quincke’s edema or anaphylactic shock. Faced with an allergy episode in yourself or a loved one, it is better not to postpone going to an allergist-immunologist – the disease can threaten with life-threatening sudden complications.
