Special Foods – Orange Juice

Filed under: 4 - Atopic Dermatitis

Orange Juice.-It is common for the mother to notice that the baby “breaks out” if orange juice is given. It is probably best to remove it from the diet of most infants who have atopic dermatitis, for orange juice is of little or no value to a baby except as an antiscorbutic, and if he is taking any “multivitamin” drops he is getting an adequate amount of vitamin C. If he is not, it is a simple matter to give him some ascorbic acid.

Positive scratch tests to orange are uncommon: in 300 cases there were only four. In a series of twenty-three tested by the intracutaneous method, however, there were eight slightly posi­tive tests. Sensitivity to orange is almost always of low degree-I have seen one 4-year-old child, however, who was exquisitely sensitive to it, and who had an enormous positive scratch test.

There are in orange juice three sub­stances which may produce allergic symptoms:

  1. The  protein  of  the  juice
  2. The protein of the seed
  3. The peel oil

The relative importance of these is not entirely clear. In most commercially prepared orange juice there is plenty of chance for peel oil and seed protein to be present. Bib* canned orange juice contains no seed protein and no peel oil, and in five infants who had allergic symptoms from ordinary orange juice, Batner and his co-workers20 found that the Bib juice was

tolerated. They do not say what sort of allergic symptoms were present. I have had no personal experience with it.

In orange juice, as it is prepared at home, it is not likely that any seed protein is present, and the amount of peel oil must be very small, although possibly enough to produce symptoms. The oil of orange peel in addition to being a sensitizer (its active principle is dextrolimonene, which is closely allied to turpentine) is a primary irri­tant, and dermatitis of the fingers from it has been known for a long time and is common in adults whose work in­volves the cutting up of oranges. It seems likely that if sensitivity to orange peel oil existed in infants it would be epidermal rather than dermal, and would therefore not be demonstrated by scratch or intracutaneous tests. Sensitivity to the juice protein or to the seed protein is shown by urticarial type scratch or intracutaneous tests. Ratner and his co-workers-” in a painstaking study showed clearly that the protein of orange juice is not readily absorbed from the digestive tract in an unsplit antigenic condi­tion, and said, “What we call allergy to citrus fruit may in truth not be al­lergy in all instances, but irritation from the peel.” This seems likely.

*Bib Corporation,  Lakeland,  Fla.

20Ratner, Bret, Untracht, Samuel, Malone H. John, and Retsina, Mary: Allergenicity of Orange Studied in Man, J. pediat. 43: 421, 1953

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