Clinical Experience
IgE-mediated reactions
Lime may induce symptoms of food allergy in sensitised individuals, though this is not common. Allergic reactions are similar to those seen with other citrus fruit,.and consist mainly of contact dermatitis and contact urticaria. (2)
In a study aimed at characterising allergens from raspberry, sera from 8 female patients were assessed. A 25-year-old with periorbital oedema and rhinitis from lemon and other citrus fruits was described, who was prick-to-prick positive to peach, lemon, sweet lime, orange, banana, blueberry, tomato, grape and bell pepper. (3)
An instance has been reported of a bartender with hand dermatitis who developed allergic contact sensitivity to the skin of lemon, lime, and orange, but not to their juices. Although most reported cases of citrus peel allergy are due to d-limonene, in this instance reactions to patch tests for geraniol and citral (2 minor components of citrus peel oil) were positive, whereas those for d-limonene were negative. (4)
Similarly, a 52-year-old woman presented with an eczematous rash at the side of her mouth and lips. She had been sucking the lime from her gin and tonic for up to 1 minute after finishing her drink. Patch tests were positive for geraniol 2%, geranium oil and lime peel. Citrus oil is made up of 90% limonene, and the remaining 10% consists of citral, gerraniol and bergapten. (5)
Other reactions
Non-allergic phytophotodermatitis, a phototoxic reaction occurring in skin exposed to sunlight after contact with plants containing furanocoumarins, has been reported. (6,7) Ninety-seven (16%) of 622 children and 7 (7%) of 104 counsellors at a camp developed a phototoxic dermatitis. The eruptions were confined to the hands, wrists, and forearms, and appeared as discrete and confluent polymorphous patches and linear streaks. The cause was thought to be the making of pomander balls (sachets). The makers punctured the skin of limes (the principal component) with scissors, releasing oils known to contain photoreactive furocoumarin (psoralen) compounds. (8)
A 6-year-old boy presented with marked, symmetric, painful erythema and oedema of both hands that rapidly developed into dramatic bullae covering the entire dorsum of the hands. The history revealed that the hands had been bathed in lime juice for a prolonged period during the preparation of limeade. This resulted in phytophotodermatitis. The rind contains 6- to 182-fold greater concentrations of all furanocoumarins measured, compared to pulp. Bergapten was the most abundant substance in the rind. (9)
In a group of Thai patients with contact dermatitis, patch-test reactions to extracts of fragrance raw materials, traditionally used in Indonesian cosmetics, were evaluated. Positive reactions to extracts of Citrus aurantifolia Swingle were observed. Specimens taken directly from the citrus fruits (the unconcentrated sources of the fragrance raw materials) were less antigenic. (10)
Sensitisation to pollen from the lime tree may occur. (11)