Case Report Shows Child Developed Severe Allergic Reaction to Eating an Orange

Doctors in Pennsylvania made news with an unprecedented report that a few bites from an orange triggered severe anaphylaxis in a 31-month-old girl, but their analysis of the episode focuses more on the dangers of allergies than the dangers of citrus fruit.

Indeed, allergies to citrus fruit in general and oranges in particular are extremely rare and generally mild. The most common symptoms, by far, are runny noses and watery eyes. No one had ever documented a case of a child suffering orange-induced anaphylaxis until this year, when a single snack nearly killed the little girl.

“Her lips and tongue swelled, and she broke out in hives,” said allergist Sigrid DaVeiga, MD, who helped write the ensuing case study and present it at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI).

The girl’s parents, who were with her inside a Wal-Mart when the attack began, bought Benadryl and gave her a dose. The girl’s condition worsened, however. Her airways contracted, and she began to cough uncontrollably.

Rather than wait for an ambulance, the girl’s parents drove her directly to a local emergency room, where doctors diagnosed her with anaphylaxis and injected her with epinephrine. Still, despite receiving 2 shots, the girl kept struggling to breathe, so the emergency team intubated her and hooked her up to a ventilator. They then sent her by helicopter to Children’s Hospital in Philadelphia.

Physicians kept the girl in the hospital for 48-hours, treating her symptoms and looking for the trigger. The girl’s parents indentified the orange immediately, saying it was the only possible allergen, but the doctors who later wrote up the case study struggled to believe it. They kept asking the girl and her parents about possible exposure to other allergens.

Only later, after the girl reacted strongly to oranges used in a skin prick test, did they come to believe they’d worked on a case with no reported precedent.

The report generated news coverage, which tended to treat the story either as a curiosity or, in some cases, as a sign that orange allergies may be on the rise. The doctors who wrote the case study, on the other hand, think the true importance of the tale lies elsewhere.

During the girl’s stay at the hospital, doctors diagnosed her with both the allergy to oranges and a significant case of asthma, one that had escaped formal detection and thus gone untreated. That underlying condition, moreover, likely increased the severity of the girl’s breathing difficulties during her reaction to the orange and may well have put her life needlessly in jeopardy.

That girl, the study authors reported, is hardly alone. A large percentage of children suffer with asthma for years before receiving a proper diagnosis and beginning a proper treatment plan. This underlying condition frequently worsens allergic reaction, and asthmatic children suffer many such reactions. About 90% of all kids who have allergies have asthma as well, the study authors wrote.

In other words, the unprecedented story of a girl who nearly died because she ate an orange is also a very common story of a girl who suffered more than she had to because her asthma had gone untreated. Her doctors hope the spectacular nature of her experience raises awareness about the more common truth it illustrates.

As for the girl herself, she recovered fully.

“She was advised to avoid orange and peach, and also told to start asthma therapy,” said Sayantani Sindher, MD, another allergist who helped write the study, “both of which will keep future allergic reactions under control.”