In what may be the first case of a severe allergic reaction to oranges, a toddler in Pennsylvania was rushed to the emergency room as she went into anaphylactic shock. In a report describing the case, Dr. Sigrid DaVeiga of the Children’s Hospital of Philadelphia discusses the 31-month-old toddler’s reaction.

DaVeiga’s report was presented over the weekend at the annual meeting of the American College of Allergy, Asthma, and Immunology (ACAAI) in Atlanta, Georgia.

The child was shopping with her parents in a store when she ate a mandarin orange. She began coughing and her face began swelling and itching, so her parents purchased an over-the-counter liquid ephedrine for her. She kept coughing, however, and her breathing became more labored so her parents rushed her to the ER.

There, the child was given two epinephrine shots, which helped alleviate some symptoms, but did not stop her breathing problems, leading them to intubate her and connect her to a ventilator. She was then flown to the Children’s Hospital of Philadelphia where Dr. DaVeiga first encountered the allergy.

After 48 hours, the child recovered and returned home. Skin prick and other tests confirmed her allergy to oranges and an underlying asthma, previously undiagnosed and likely the reason she did not recover her breathing quickly.

This is the first known case of an extreme anaphylactic reaction to oranges. DaViega says this is not likely an epidemic or a growing new allergy and will likely remain very rare.

You can read an interview with Dr. DaViega in Newsweek.

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