Citrus-Gene interaction and melanoma risk in the UK Biobank.

High citrus consumption may increase melanoma risk; however, little is known about the biological mechanisms of this association, or whether it is modified by genetic variants. We conducted a genome-wide analysis of gene-citrus consumption interactions on melanoma risk among 1563 melanoma cases and 193 296 controls from the UK Biobank. Both the 2-degrees-of-freedom (df) joint test of genetic main effect and gene-environment (G-E) interaction and the standard 1-df G-E interaction test were performed. Three index SNPs (lowest P-value SNP among highly correlated variants [r2 > .6]) were identified from among the 365 genome-wide significant 2-df test results (rs183783391 on chromosome 3 [MITF], rs869329 on chromosome 9 [MTAP] and rs11446223 on chromosome 16 [DEF8]). Although all three were statistically significant for the 2-df test (4.25e-08, 1.98e-10 and 4.93e-13, respectively), none showed evidence of interaction according to the 1-df test (P = .73, .24 and .12, respectively). Eight nonindex, 2-df test significant SNPs on chromosome 16 were significant (P < .05) according to the 1-df test, providing evidence of citrus-gene interaction. Seven of these SNPs were mapped to AFG3L1P (rs199600347, rs111822773, rs113178244, rs3803683, rs73283867, rs78800020, rs73283871), and one SNP was mapped to GAS8 (rs74583214). We identified several genetic loci that may elucidate the association between citrus consumption and melanoma risk. Further studies are needed to confirm these findings.

Safety Assessment of Citrus Flower- and Leaf-Derived Ingredients as Used in Cosmetics.

The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) assessed the safety of 33 Citrus flower- and leaf-derived ingredients, which are most frequently reported to function in cosmetics as fragrances and/or skin-conditioning agents. The Panel reviewed the available data to determine the safety of these ingredients. Because final product formulations may contain multiple botanicals, each containing similar constituents of concern, formulators are advised to be aware of these constituents and to avoid reaching levels that may be hazardous to consumers. With Citrus flower- and leaf-derived ingredients, the Panel was concerned about the presence of the hydroperoxides of limonene and linalool in cosmetics. Industry should use good manufacturing practices to limit impurities that could be present in botanical ingredients. The Panel concluded that these ingredients are safe in the present practices of use and concentration when formulated to be non-irritating and non-sensitizing.

Safety Assessment of Citrus Fruit-Derived Ingredients as Used in Cosmetics.

The Expert Panel for Cosmetic Ingredient Safety (Panel) assessed the safety of 80 Citrus fruit-derived ingredients, which are most frequently reported to function in cosmetics as fragrances and/or skin-conditioning agents. The Panel reviewed the available data to determine the safety of these ingredients. Because final product formulations may contain multiple botanicals, each containing similar constituents of concern, formulators are advised to be aware of these constituents and to avoid reaching levels that may be hazardous to consumers. Industry should use good manufacturing practices to limit impurities that could be present in botanical ingredients. The Panel concluded that these ingredients are safe for use in both rinse-off and leave-on cosmetic products when formulated to be non-sensitizing and non-irritating, provided that leave-on products do not contain more than 0.0015% (15 ppm) 5-methoxypsoralen (5-MOP).

Safety Assessment of Citrus Plant- and Seed-Derived Ingredients as Used in Cosmetics.

The Expert Panel for Cosmetic Ingredient Safety (Panel) assessed the safety of 30 Citrus plant- and seed-derived ingredients, which are most frequently reported to function in cosmetics as fragrances and/or skin conditioning agents. Because final product formulations may contain multiple botanicals, each containing similar constituents of concern, formulators are advised to be aware of these constituents and to avoid reaching levels that may be hazardous to consumers. With Citrus plant- and seed-derived ingredients, the Panel was concerned about the presence of the hydroperoxides of limonene and linalool in cosmetics. Industry should use good manufacturing practices to limit impurities. The Panel reviewed the available data presented and concluded that 18 of these ingredients are safe in the present practices of use and concentration when formulated to be non-irritating and non-sensitizing. The data for the remaining 12 ingredients are insufficient to determine safety.

Safety Assessment of Citrus Peel-Derived Ingredients as Used in Cosmetics.

The Expert Panel for Cosmetic Ingredient Safety (Panel) assessed the safety of 47 Citrus peel-derived ingredients, which are most frequently reported to function in cosmetics as skin conditioning agents. The Panel reviewed the available data to determine the safety of these ingredients. Because final product formulations may contain multiple botanical ingredients, each containing similar constituents of concern, formulators are advised to be aware of these constituents and to avoid reaching levels that may be hazardous to consumers. Industry should use good manufacturing practices to limit impurities that could be present in botanical ingredients. The Panel concluded that Citrus peel-derived ingredients are safe in the present practices of use and concentration in both rinse-off and leave-on cosmetic products when formulated to be non-sensitizing and non-irritating, provided that leave-on products do not contain more than 0.0015% (15 ppm) 5-methoxypsoralen (5-MOP).

Alcohol-Related Dermatitis: A Review.

: Wine, beer, liquor, and spirits are widely consumed in many cultures across the globe, and for some individuals, ingestion, cutaneous contact, or other exposure can lead to dermatologic findings. However, there currently exist no comprehensive reviews on alcohol-related dermatitis. Herein, we will provide an overview of alcohol-related dermatitis and contact urticaria, including the epidemiology and clinical manifestations, potential allergens found in alcoholic beverages, testing approaches, and strategies for allergen avoidance.

Citrus fruits induced swallow syncope with atrioventricular block or sinus arrest.

Swallow syncope is a relatively rare syndrome and caused by various foods and drinks. A 76-year-old man was admitted with frequent syncope while eating. Holter electrocardiogram revealed frequent occurrence of atrioventricular block during meals. Both atrioventricular block and sinus arrest were induced by only eating citrus fruits, citrus jelly, and acidic foods but not by other drinks and foods. These arrhythmias were suppressed after administration of atropine. No further episodes of syncope recurred after the implantation of a DDD pacemaker. This case indicated that acidic stimulation of citrus induced a vasovagal reflex via esophageal nociceptors leading to syncope.

Dietary citrate and plasma ionized calcium: Implications for platelet donors.

BACKGROUND: Platelet donors receive 40 mmol or more of IV citrate anion during donation. When plasma ionized calcium ([Ca2+ ]) falls by ∼20%, half of the donors report symptoms of hypocalcemic toxicity. Citrus juices contain clinically relevant amounts of citrate anion. We asked whether citrus juice can lower [Ca2+ ] thus potentially contributing to hypocalcemic toxicity. METHOD: Six volunteers were given 20.4 mmol of citrate anion as grapefruit juice or orange juice. Capillary blood obtained by fingerstick was analyzed for [Ca2+ ] using an iSTAT point-of-care blood analyzer. [Ca2+ ] was measured at baseline and then 30, 60, 120, and 180 minutes after drinking juice. Subjects were tested with the alternative juice on a subsequent day. The outcome measure was the percent change in plasma [Ca2+ ] from baseline. RESULTS: [Ca2+ ] fell -2.2% to -11.5% in four of six subjects 30 minutes after drinking grapefruit juice. The effect persisted up to 3 hours. [Ca2+ ] fell -2.1% to -12.2% in four of six subjects 30-60 minutes after drinking orange juice. The effect abated after 2 hours. We could not correlate gender or body surface area to these findings. SUMMARY AND CONCLUSIONS: Citrus juice may lower [Ca2+ ] for 2-3 hours. This could add to the effect of IV citrate infusion during platelet donation, thus worsening the expected fall in [Ca2+ ]. This, in turn, would likely increase the rate and severity of hypocalcemic toxicity. It is prudent to advise platelet donors to avoid high citrate anion beverages, such as citrus juice, for at least 4 hours prior to donation.

Essential oils from Citrus x aurantium and Citrus x latifolia (Rutaceae) have anesthetic activity and are effective in reducing ion loss in silver catfish ( Rhamdia quelen )

This study investigated the anesthetic effect of the essential oils (EOs) from the peel of Citrus x aurantium (EOCA) and Citrus x latifolia (EOCL) on silver catfish Rhamdia quelen. Fish were exposed to different concentrations of EOCA and EOCL to determine time of anesthesia induction and recovery. Induction of anesthesia was observed in all fish exposed to 400, 600 or 800 µL L−1 EOCA and 300, 400 or 500 µL L−1 EOCL. Another group of fish were exposed for 8 h to 50, 100, or 200 µL L−1 of either EOs. Overall, fish exposed to ethanol and both EOs presented higher ventilatory frequencies (VF) than the control group throughout the 8 h of exposure. Net ion (Na+, K+ and Cl−) effluxes and ammonia excretion were significantly lower in fish exposed to 50, 100 or 200 µL L−1 of either EOs compared to control fish. Mortality was 37% in fish exposed to 200 µL L−1 of either EOs after 8 h. These findings suggest that EOCA and EOCL are useful anesthetics and sedatives for Rhamdia quelen, but their usefulness as alternatives to reduce stress in fish transportation at the lower concentrations tested (50-100 µL L−1) deserves further study.(AU)

O efeito anestésico dos óleos essenciais (OEs) da casca de Citrus x aurantium (OECA) e Citrus x latifolia (OECL) em jundiá Rhamdia quelen foi investigado. Os peixes foram expostos a diferentes concentrações de OECA e OECL para determinar o tempo de indução e recuperação da anestesia. Todos peixes expostos a 400, 600 ou 800 µL L−1 OECA e 300, 400 ou 500 µL L−1 OECL foram anestesiados. Outro grupo de peixes foi exposto aos OEs durante 8 h a 50, 100 ou 200 µL L−1. Peixes expostos ao etanol e aos OEs apresentaram VF maior que o grupo controle durante as 8 h de exposição. Os efluxos líquidos de Na+, K+, Cl− e a excreção de amônia foram significativamente menores nos peixes expostos a 50, 100 ou 200 µL L−1 dos OEs em comparação com o grupo controle. A mortalidade foi de 37% nos peixes expostos a 200 µL L−1 de ambos os OEs após 8 h. Os resultados sugerem que OECA e OECL são anestésicos e sedativos úteis para o jundiá, mas sua utilidade como alternativa para reduzir o estresse no transporte de peixes nas concentrações mais baixas testadas (50-100 µL L−1) necessita de estudos adicionais.(AU)

FOOD-DEPENDENT EXERCISE-INDUCED ANAPHYLAXIS DUE TO INGESTION OF MIKAN (CITRUS UNSHIU).

A 12-year-old girl was referred to our hospital owing to repeated anaphylactic reactions induced by exercise after meals. Food-dependent exercise-induced anaphylaxis (FDEIAn) was suspected. However, sequential tests of typical foods, including egg, milk, soy, and wheat, in combination with exercise, were all negative.The results of the skin prick test (SPT) for Citrus unshiu and specific IgE test for orange and grapefruit were positive. Although no symptoms were noted after an exercise challenge combined with the ingestion of only Citrus unshiu, an anaphylactic reaction was induced by additional acetyl-salicylic acid. From these results, she was diagnosed with FDEIAn due to the ingestion of Citrus unshiu. Because the SPT results for other citrus fruits (including orange, grapefruit, lemon, yuzu, sudachi, ponkan, and iyokan) were all positive, it was suggested that these fruits demonstrate cross-reactivity with each other. Since the girl eliminated citrus fruits from her diet, she has not developed any anaphylactic symptoms. Citrus fruits are not known to cause FDEIAn, but the findings of this case suggest that it is necessary to recognize them as a causative allergen of FDEIAn.

Fruit and vegetable intake and prostate cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Several dietary factors have been studied in relation to prostate cancer; however, most studies have not reported on subtypes of fruit and vegetables or tumor characteristics, and results obtained so far are inconclusive. This study aimed to examine the prospective association of total and subtypes of fruit and vegetable intake with the incidence of prostate cancer overall, by grade and stage of disease, and prostate cancer death. Lifestyle information for 142,239 men participating in the European Prospective Investigation into Cancer and Nutrition from 8 European countries was collected at baseline. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average follow-up time of 13.9 years, 7,036 prostate cancer cases were identified. Compared with the lowest fifth, those in the highest fifth of total fruit intake had a significantly reduced prostate cancer risk (HR = 0.91; 95% CI = 0.83-0.99; p-trend = 0.01). No associations between fruit subtypes and prostate cancer risk were observed, except for citrus fruits, where a significant trend was found (HR = 0.94; 95% CI = 0.86-1.02; p-trend = 0.01). No associations between total and subtypes of vegetables and prostate cancer risk were observed. We found no evidence of heterogeneity in these associations by tumor grade and stage, with the exception of significant heterogeneity by tumor grade (pheterogeneity <0.001) for leafy vegetables. No significant associations with prostate cancer death were observed. The main finding of this prospective study was that a higher fruit intake was associated with a small reduction in prostate cancer risk. Whether this association is causal remains unclear.

Effect of exclusion of frequently consumed dietary triggers in a cohort of children with chronic primary headache.

BACKGROUND: Although dietary factors are known to trigger headaches, the relationship between food and headache in children remains unclear. This prospective, observational case series aimed to evaluate the effect of exclusion of frequently-consumed foods in a cohort of children with headache. METHODS: One hundred and fifteen children aged 3-15 (mean 10.5) years with primary headache were followed in a paediatric outpatient clinic. Patients who frequently consumed foods or food additives known to trigger headaches were advised to exclude them for six weeks and to return for follow-up with headache and food diary. RESULTS: One hundred patients attended follow-up. Of these 13 (13%) did not respond to dietary exclusion; 87 (87%) achieved complete resolution of headaches by exclusion of 1-3 of the identified food(s). Caffeine was the most common implicated trigger (28), followed by monosodium glutamate (25), cocoa (22), aspartame (13), cheese (13), citrus (10) and nitrites (six). One patient was sensitive to tomatoes. CONCLUSIONS: This study demonstrates the potential scale and significance of seven frequently consumed foods or food additives as triggers for primary headache in children. Also this is the first study to show that headaches can be triggered by the cumulative effect of a food that is frequently consumed, rather than by single time ingestion.

100% citrus juice: Nutritional contribution, dietary benefits, and association with anthropometric measures.

Citrus juices such as 100% orange (OJ) and grapefruit juice (GJ) are commonly consumed throughout the world. This review examines the contributions of OJ and GJ to nutrient intake, diet quality, and fruit intake, and supports citrus juices as nutrient-dense beverages. This review also explores the research examining associations between OJ and GJ intake and anthropometric measures. Citrus juices are excellent sources of vitamin C and contribute other key nutrients such as potassium, folate, magnesium, and vitamin A. OJ intake has been associated with better diet quality in children and adults. OJ intake has not been associated with adverse effects on weight or other body measures in observational studies in children and adults. In adults, some observational studies report more favorable body mass index or body measure parameters in OJ consumers compared to nonconsumers. Intervention studies in adults report no negative impacts of OJ or GJ consumption on anthropometric measures, although these measures were typically not the primary outcomes examined in the studies. Moderate consumption of citrus juices may provide meaningful nutritional and dietary benefits and do not appear to negatively impact body weight, body composition, or other anthropometric measures in children and adults.

Dietary and Nondietary Triggers of Oral Ulcer Recurrences in Behçet's Disease.

OBJECTIVE: The nature and impact of food and other external triggers in recurrences of Behçet's disease (BD)-related oral ulcers (OUs) remain unknown. This survey investigated dietary and nondietary triggers of BD-related OU recurrences. METHODS: Patients with BD who were followed in 7 French hospital departments completed a self-administered patient questionnaire. General and specific dietary triggering factors were sought in open questions. The questionnaire also included closed questions, notably to evaluate the effect of 6 general triggering situations and 24 selected foods. The results were expressed as number (percentage) of positive responses. RESULTS: Among the 101 questionnaires distributed, 81 were usable. Among the 81 patients, 96% fulfilled the International Criteria for Behçet's Disease classification criteria, and 53% qualified their OU recurrences during the previous 12 months as very discomforting or discomforting. For the 6 general situations suggested, 50 patients (62%) declared ≥1 as a "sure" trigger of OU recurrences. In both open and closed questions, the most frequent triggers were fatigue/stress (37-47% of patients) and food (32-35%). Among the 24 suggested foods, nuts (48%), pineapple (42%), peanuts (32%), Emmental cheese (30%), almonds (23%), lemons (22%), and other cheeses (21%) were the most frequently reported. The corresponding open question gave consistent findings but with lower frequencies. CONCLUSION: Most patients can identify triggers of recurring BD-related OUs, with fatigue/stress and food representing the most frequent triggers. The management of OU must consider such external factors. The histamine-rich or -liberating properties of the commonly cited OU-triggering foods suggest a hyperreactivity mechanism.

Clinical features and factors associated with non-carious cervical lesions and dentin hypersensitivity.

Determining the factors associated with NCCLs and DH in populations could guide the implementation of specific preventive measures. This study evaluated the clinical features and factors associated with non-carious cervical lesions (NCCLs) and dentin hypersensitivity (DH) in a Brazilian population. The participants were 118 patients at the Dentistry Clinic of our dental school. They completed an interview to obtain personal information and determine the possible factors associated with NCCLs and DH. Clinical examination was undertaken to record the NCCLs, shape of the lesion and certain occlusal factors. DH was diagnosed by air and probe tests. Data were analysed with the multilevel Poisson regression and prevalence ratios, and the respective 95% confidence intervals were calculated. The prevalence of NCCLs and DH among patients was 67·8% and 51·7%, respectively. Of a total number of 2902 teeth examined, 9·65% had NCCLs and 5·82% were sensitive to air. The most affected teeth for both conditions were the premolars. Most of the NCCLs were wedge-shaped and located in the maxilla. The factors associated with NCCLs and DH were age and presence of premature occlusal contacts. NCCLs were also significantly associated with consumption of wine and alcoholic beverages, and DH with consumption of acidic fruits and juices. NCCLs were a common finding, with higher frequency in more advanced age groups, the maxilla and premolars. A significant association occurred between NCCLs, premature contacts and consumption of wine and alcoholic beverages. DH was associated with NCCLs, premature contacts and with the consumption of acidic fruits and juices.

Lemons in the Arizona Sunshine: The Effects of Furocoumarins Leading to Phytophotodermatitis and Burn-like Injuries.

INTRODUCTION: Phytophototoxic dermatitis is a strong phototoxic reaction to ultraviolet A (UV-A) radiation exposure after cutaneous contact with citrus fruit containing furocoumarins, leading to skin injury. At the Arizona Burn Center (Phoenix, AZ), the majority of these injuries are managed in the outpatient setting. CASE REPORT: The authors present a pediatric admission for burn-like injuries following prolonged cutaneous exposure to lemons while playing in the Arizona sunshine. A 7-year-old girl playing in her backyard squeezed lemon juice onto her skin while in the hot Arizona sunshine; within 24 hours, the child experienced pain, erythema, and blistering to multiple areas of her skin. She was admitted to the authors' burn center for wound care and pain control. She had scattered first-degree and second-degree burn-like lesions to her face, neck, and chest as well as bilateral forearms, hands, lower extremities, and feet. After blister debridement, appropriate dressing care, and pain medication, the patient was discharged home after 4 days of hospitalization with appropriate clinical follow-up. CONCLUSIONS: Burn-like lesions caused by furocoumarins after cutaneous absorption and UV-A exposure are known clinical entities in Arizona. The sequential progression from erythema to blisters equivalent to second-degree burn-like lesions to cutaneous hyperpigmentation is a well-described clinical triad. Meticulous wound care and pain control for the treatment of these burn-like lesions are essential as is the need for the wound care specialist to be well versed on this topic to quickly identify the etiology of the injury, thereby avoiding misdiagnosing the patient with nonaccidental traumatic injuries.