Extreme Orange Allergy Nearly Kills Toddler in First Recorded Case

Oranges do not often cause problematic allergic reactions. Daniel Munoz / Reuters

Fruits like oranges don't commonly cause allergic reactions, and even when they do, the symptoms are usually mild and involve irritation and itching of the mouth.

But in one recent case, an orange nearly proved fatal for a 31-month-old toddler.

While at Walmart in Pennsylvania, the child ate a mandarin orange. Her face began swelling and itching, so her parents bought and gave her some Benadryl, says Dr. Sigrid DaVeiga, an allergist at the Children's Hospital of Philadelphia.

But then she began coughing. Her breathing became more labored as her lungs spasmed, and her alarmed parents took her to a nearby emergency room.

There, she was given two shots of epinephrine to reverse the anaphylactic reaction, says DaVeiga, a co-author of a newly published report describing the case, to be presented this weekend at the annual meeting of the American College of Allergy, Asthma, and Immunology in Atlanta. Anaphylaxis is a life-threatening condition in which multiple organs react to an allergen; the face and mouth swell and airways constrict, hampering breathing, DaVeiga tells Newsweek. Typically, one epinephrine shot is enough to control anaphylaxis, but in this case the swelling was so severe. Epinephrine works by relaxing airway muscles and reducing swelling.

Even after the two epinephrine shots, the child still had enough trouble breathing that doctors intubated her and connected her to a ventilator. She was later taken via helicopter to the intensive care unit at Children's Hospital of Philadelphia.

She recovered and, after a 48-hour stay, returned home. She was prescribed two medications to treat her underlying asthma, which hadn't previously been recognized by the parents.

At first, doctors thought something besides an orange must have been to blame, because the fruit rarely causes allergic complications. "We kept asking about other things she might have been exposed to, but her parents were adamant" that it was just this one piece of fruit, DaVeiga says.

"Her reaction was pretty severe—we were all surprised it was ultimately an orange," she adds.

The diagnosis was confirmed when the physicians performed a skin-prick test with an extract of orange; the child's skin swelled up slightly in the spot where she was exposed to the orange extract.

Oranges and other fruits contain proteins that are chemically similar to pollen; eating these can cause itching and irritation of the mouth in certain people, many of whom also happen to be allergic to pollen, says Dr. James Sublett, an allergist in Louisville, Kentucky, who wasn't involved in the study.

But this case is the first known case of an extreme anaphylactic reaction, he says.

The fact that the child had asthma likely made the reaction worse than it otherwise would have been, since asthmatics often already have inflamed, narrowed airways, DaVeiga says.

This is not the only unusual food allergy DaVeiga has seen. She has also come across allergies to paprika, cinnamon and calamari, though "none as severe as this recent orange reaction," she says. She also seen "patients with a severe allergy to just pine nuts (not other nuts) that presented with anaphylaxis after eating pesto sauce." And another weird allergy that's gotten some press recently is a reaction to red meat after being bit by a Lone Star tick.

There's no saying exactly why the child reacted so strongly to this orange, although it likely has a genetic underpinning, like other allergies, Sublett says. Regardless, he doesn't recommend anybody stay away from these fruit.

"I don't think we'll see a surge of orange allergies or anything like that," DaVeiga says, laughing.