Many people believe they are allergic to chocolate. However, true chocolate allergies, in which a person is allergic to cocoa, are very rare. Cocoa is made by fermenting, roasting and then grinding seeds from the cocoa tree. While they originated in Central America cocoa trees are now grown in tropical climates around the world.
Many reactions to chocolate are caused by an intolerance or allergy to one or more of the other ingredients or food additives in chocolate. These include soy lecithin, milk, corn syrup, gluten, nuts, flavorings and dyes. While they are not intentional additives, trace amounts of rat and mouse droppings, as well as cockroach and other insect parts, are occasionally found in some chocolates.
Chocolates from countries outside the United States often have less stringent regulations for listing trace ingredients in foods.
Food allergies to cocoa or other chocolate ingredients can cause a variety of different symptoms including:
- Rectal itching
- Skin Rashes
- Breathing problems
Chocolate allergies may also trigger asthma attacks in people with asthma who are sensitive to one or more chocolate ingredients.
Chocolate quality is a factor in the number and amount of additives. Generally the higher the quality of chocolate (indicated by the percentage of cocoa liquor and cocoa butter) the lower the chance of other additives. Mass–produced lower quality chocolate has less cocoa butter and more milk, soy lecithin, gluten and flavorings. The ingredients in chocolate will be displayed on the product label.
Some people are sensitive to naturally occurring chemicals in chocolate like caffeine, theobromine and phenylethylamine. These chemicals may cause mood swings and headaches in some people. The reactions to these naturally occurring chemicals in chocolate are not allergies.
A physician may perform a number of tests to determine if a person is allergic to chocolate. These may include skin tests and blood tests.
When treating a chocolate reaction, a physician will first determine whether the patient has a food allergy, food intolerance, or another condition producing similar symptoms. The physician may recommend dietary changes to reduce or eliminate reactions.
People sensitive to the chemicals or additives in chocolate can avoid unpleasant symptoms by eliminating chocolate and/or the specific additives from their diets. Medications, such as anti–diarrheals for gastrointestinal symptoms or creams to relieve skin rashes, may be prescribed.
People allergic to the ingredients in chocolate may experience breathing problems, or other symptoms related to asthma attacks or sever allergic reactions. These symptoms can be relieved through taking an antihistamine, corticosteroid or bronchodilator medications.
About chocolate allergiesVery few people are actually allergic to chocolate, as a true cocoa allergy is rare. More commonly, reactions to chocolate are the result of a food intolerance or allergy to an ingredient in chocolate. People may be allergic to one or more food additives used in some chocolate products. Much of the commercially available chocolate in the United States contains numerous additives.
Chocolate was first produced and consumed by indigenous peoples in Central America. It comes from a bean of the cocoa tree and was combined with chili peppers to make a drink. The chocolate bars common today evolved through 200 years of experimentation in Europe and North America.
There are three main forms of cocoa that may be used in chocolate:
- Cocoa liquor. The material that originates from the first processing of harvested cocoa beans (cocoa powder combined with cocoa butter).
- Cocoa butter. The solid fat component of chocolate. Cocoa butter is pressed from the cocoa liquor and separated into the butter and the powder./LI>
- Cocoa powder. Chocolate liquor without the cocoa butter.
The regulations for what defines chocolate and separates it from other forms of candy differ from country to country. They are based on the percentage of chocolate liquor in the product.
Minimum Percentages of Cocoa Liquor
| ||Dark chocolate||Milk chocolate|
|United States||15 percent ||10 percent|
|Europe ||35 percent||25 percent|
High quality chocolate contains only cocoa liquor, cocoa butter, sugar and sometimes vanilla. Mass produced chocolate contains much less cocoa (sometimes as low as 7 percent) and additives such as milk, soy lecithin, corn syrup, flavorings, dyes, and large amounts of sugar. There is a greater likelihood that people with allergies or intolerance to these common additives will react to chocolate. The ingredient label will indicate whether the chocolate contains additives. The price will also indicate the level of chocolate quality: Generally higher price means higher quality and lower chance of additives.
Food allergies are a group of closely related responses that involve an allergic reaction to a specific food (e.g., cocoa or other chocolate ingredient). An allergic response to a food or food ingredient involves the immune system’s inaccurate response to a food protein. The body perceives the protein to be harmful, and produces immunoglobulin E (IgE) antibodies to defend against the “invader.”
These IgE antibodies attach to the body’s mast cells, a type of white blood cell that contains chemicals called histamines and leukotrienes. When the IgE antibodies come in contact with the offending food molecule, these chemicals are released, causing the symptoms most people associate with allergies, including itchiness, rashes, hives, swelling, nausea, diarrhea and shortness of breath. More severe reactions to food may result in potentially life–threatening anaphylactic shock.
While it is possible to be allergic to the main ingredient in chocolate (cocoa), such allergies are rare. However, some foods more commonly associated with allergies may be used in chocolate products, such as milk, nuts and soy.Potential causes of chocolate allergy
Chocolate allergies are more commonly caused by sensitivity to another ingredient often found in chocolate. Some of the most common triggers of food allergies are common ingredients in chocolate products. They include:
- Cow’s milk (including components such as casein and whey). Milk is one of the common triggers of food allergies.
- Nuts. Nuts are one of the common triggers of food allergies and may cause a range of symptoms including anaphylaxis. Both peanuts and tree nuts are found in some chocolate bars. Chocolate may be made in a factory that also produces nut products and trace amounts of nuts can be present in the chocolate even if nuts are not listed in the ingredients. According to U.S. Food and Drug Administration (FDA) regulations, chocolate packages must indicate that the item was processed in a factory that also processes nuts.
- Wheat or gluten. Wheat and/or gluten are added to mass–produced chocolate–based products. These products are generally sold as “candies” and not as premium chocolate. Wheat is a common food allergen and gluten is a major source of food intolerance. According to FDA regulations foods containing these allergens must indicate their presence on food labels.
- Soybeans (including components such as soy lecithin). Soy is one of the common triggers of food allergies and intolerance and may cause a range of symptoms. Soy lecithin is an additive in many lower quality chocolates.
- Corn (including corn syrup). Corn is a common trigger of food allergies and corn syrup is commonly found in chocolate bars or other chocolate–containing products. FDA regulations require that foods containing corn indicate their presence on food labels.
In addition, people can have sensitivities to a particular food additive – substances added to foods that are not part of its basic raw ingredients. Additives are commonly used to achieve better preservation, taste, texture, nutrition or color. Additive sensitivities are less common than whole food allergies (see Additive Sensitivities). Food additives that are commonly used in chocolate products include:
- Butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT). Common preservatives that may be added to some chocolate products.
- Tartrazine. A yellow food coloring (also known as FD&C yellow number five) that may be added to some chocolate products.
- Nickel. Nickel is commonly found in chocolate, nuts, beer, tea, coffee and apricots. Nickel can cause contact dermatitis in sensitive people.
- Other additives. There are many other common chocolate additives including flavorings like mint, dyes for hard candy coating and other products that may cause reactions. FDA regulations do not require that flavorings, dyes or other additives are indicated on food labels.
There are also a number of chemicals commonly found in chocolate including: caffeine, theobromine, phenylethylamine, preservatives and dyes. Some of the commonly reported side effects of chocolate, like headaches, may be caused by a reaction to one or more of these chemicals and NOT due to an allergic reaction. Chemicals in chocolate that may cause reactions include:
- Caffeine. Caffeine can cause anxiety, sleep problems, difficulty concentrating, restlessness and heartburn. Withdrawal from caffeine may cause headaches and fatigue. Chocolate contains much less caffeine than coffee.
- Theobromine. An alkaloid with about one–tenth the stimulating effect of caffeine. Withdrawal from theobromine may cause headaches. Theobromine is toxic to dogs and other animals.
- Phenylethylamine. A chemical in the body that is similar to an amphetamine (a central nervous system stimulant). The amphetamine–like nature is responsible for mood swings and may cause blood vessels to dilate in the brain causing headaches in some people.
- Tyramine. This ingredient can trigger headaches in some individuals.
Related allergies and conditions
True cocoa allergies are rare. Therefore most allergic reactions associated with chocolate are caused by allergies to other ingredients, such as milk, soy or nuts.
It is important to note that not all reactions to food are allergic reactions. While symptoms are often the same, many people actually suffer from food intolerances, which are much more common and usually not as severe. A food allergy often results in a more generalized reaction that occurs as histamines travel throughout the bloodstream. Food intolerance is usually the result of an individual’s lack of a specific enzyme that is required to digest a certain food. Food intolerances and other conditions related to chocolate allergies include:
- Milk intolerance. Also called lactose intolerance, this is a condition in which a person lacks sufficient amounts of the enzyme lactase needed to breakdown the lactose in milk. Some people with milk intolerance will experience related symptoms, such as stomach cramping or discomfort, after eating chocolate.
- Gluten intolerance. People with gluten intolerance (also called celiac disease) are sensitive to the protein gluten, which is commonly found in wheat, barley, oats and rye. The condition involves an inappropriate immune system reaction to gluten that results in inflammation in the small intestine. This inflammation damages the interior wall of the small intestine, reducing the ability of the body to absorb food nutrients into the bloodstream. This often leads to malnourishment. Gluten is commonly found in chocolate products and people with this condition may need to avoid such foods.
- Contact dermatitis. A broad range of reactions caused by the direct contact of an allergen or irritant to the skin’s surface. Signs and symptoms include itching, redness, rash, swelling and blisters. Nickel allergy often produces contact dermatitis, and highly sensitive people may be warned to avoid nickel–containing foods. Nickel is commonly found in chocolate and people with this condition may need to avoid chocolate.
- Hives. Red swollen patches of skin that occur in groups and may sting, burn or itch. Cocoa or other ingredients/additives in chocolate can cause hives in allergic people. People with this condition may need to avoid chocolate products.
Signs and symptoms of chocolate allergy
There are a number of symptoms experienced by people that have an allergy to chocolate or chocolate ingredients. These symptoms may be caused by the chemicals in chocolate or by the other ingredients. Reactions to chocolate may include:
- Rectal itching
- Breathing problems
In severely allergic people, chocolate allergies may trigger anaphylaxis – an allergic reaction involving two or more body systems that can lead to the potentially life–threatening anaphylactic shock. Symptoms of anaphylaxis may include:
- Shortness of breath
- Dizziness or lightheadedness
- Chest pain or tightness
- Severe drop in blood pressure
- Heart palpitations
- Nausea and vomiting
- Diarrhea or stomach cramps
- Loss of consciousness
Diagnosis methods for chocolate allergy
The first step a physician is likely to take in the diagnosis of a food allergy is to complete a physical examination and create a detailed medical history, including the dietary history of the patient. The history may include the following information:
- Timing of the reaction (e.g., whether the reaction occurred within an hour after eating)
- Whether the reaction is always associated with a certain food
- How much of the food was consumed, because the severity of a reaction may relate to the amount of food consumed
- Whether treatment for a reaction was successful (e.g., if taking antihistamines relieved the symptoms)
While these first steps are often inconclusive, they can create a better idea of where to proceed with further testing. There are several additional evaluation options available to physicians.
- Skin test. This test involves pricking, scratching or injecting food extracts into the patient’s skin. The skin will react with redness and swelling for those extracts capable of eliciting an allergic reaction when consumed. This type of test does not provide results that are 100 percent accurate, however, and results will vary depending on the food being tested.
- RAST (radioallergosorbent test). This type of blood test allows a laboratory to directly examine a blood sample for antibodies that correspond to specific foods or food additives. While less sensitive than a skin test, it can be used on individuals who have reactions too severe for a skin test.
- Elimination diet. This involves removing suspect foods from a patient’s diet to see if the allergic reactions persist. This trial–and–error approach often takes weeks for results, but it can be effective at pinpointing and removing a problem food.
- Oral food challenge. Also called the double–blind food challenge, this is considered the most effective way of determining the cause of a food allergy because it supplies the most convincing results. Different foods are placed within capsules to hide their identity. Neither the patient nor the physician knows which capsule contains the suspected allergen. The patient consumes the capsules and the physician looks for signs of an allergic reaction. This type of test is time–consuming and difficult. It is often reserved to confirm suspicions that a patients symptoms are not caused by a food allergy.
Treatment and prevention
Treatment and prevention for chocolate allergies focus on the ingredient to which the person is sensitive. For allergies to cocoa, this will mean the complete avoidance of chocolate products. However, people allergic to other chocolate ingredients may be able to safely enjoy some chocolate products. For instance, a person with a milk allergy may avoid milk chocolate and yet still eat premium dark chocolate.
Carob, a cocoa substitute derived from the seeds of the carob tree, is thought to be nonallergenic and may be tolerated by those allergic to chocolate. This alternative should be discussed with a physician before being added to the diet.
Avoiding only certain ingredients in chocolate will involve careful inspection of food labels and possibly the purchasing of only pure, premium chocolates. People with allergies to soy, nuts and other common chocolate ingredients should avoid all mass produced chocolates, which commonly use these ingredients.
People with chocolate or other food allergies need to pay close attention to the ingredients of the foods they consume and even how the food is prepared. Food allergies can be triggered by even the tiniest quantities of a problem food.
For instance, people with nut allergies may experience a reaction from eating chocolate that was produced in a factory that also processes nuts – even if the chocolate product itself does not list nuts as an ingredient. This is because trace amounts of the nuts can be transferred to the chocolate during processing. Manufacturers must list on their packaging whether a chocolate product is processed in a factory that also processes nuts, as required by the U.S. Food and Drug Administration (FDA). People with questions about a specific product are encouraged to contact the manufacturer.
Complete avoidance of foods or ingredients is not always possible. Therefore a number of medications may be used to relieve the symptoms associated with chocolate allergies. These may include:
- Antihistamines. Medications that provide relief for more basic allergy reactions such as hives, sneezing, runny nose and gastrointestinal symptoms. Antihistamines directly counteract the effects of the histamines, which are responsible for many food allergy symptoms. With mild symptoms, these drugs are usually administered orally. For more severe allergic reactions, a physician may recommend an injected form of antihistamine.
- Topical creams. Some creams may be prescribed for people that develop hives or contact dermatitis from allergies to chocolate or chocolate ingredients.
- Bronchodilators. Medications that open the airways of the lung, relieving symptoms such as shortness of breath or wheezing. They may be recommended for people whose food allergies trigger asthma attacks or asthma–like symptoms. They are usually breathed directly into the lungs using an inhaler.
- Epinephrine injection. A synthetic form of adrenaline that, when injected, is a powerful bronchodilator, opening breathing tubes and restoring normal respiration quickly. It is usually reserved for the most severe allergic reactions that involve anaphylaxis. Most physicians recommend that patients susceptible to severe food reactions carry an injection of epinephrine with them at all times and understand how to self–administer the drug. A medical alert bracelet or necklace is also a good idea for these individuals.
- Corticosteroids. Medications that reduce inflammation. These drugs are often taken regularly to prevent an allergic attack or reduce the severity of symptoms.
A number of non–allergy related symptoms may occur in some people related to eating chocolate. For these people, other medications may be useful in relieving symptoms. These may include:
Questions for your doctor on chocolate allergies
- Antacids. Medications that lower the amount of acid in the refluxed material. Some people with gastroesophageal reflux disease (GERD) should avoid chocolate. Chocolate or chocolate ingredients may weaken the lower esophageal sphincter. Other foods that should be avoided with this condition include caffeine, fats, peppermint and citrus juice. GERD is not an allergic condition.
- Antidiarrheals. Some of the additives in chocolate may cause gastrointestinal symptoms in sensitive people. Antidiarrheal medications may help relieve these symptoms.
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following chocolate allergy–related questions:
- What tests will you use to determine if I am allergic to chocolate?
- What treatment options are available to me?
- Can I safely consume a small amount of chocolate?
- Can I safely consume high quality chocolate?
- Can I pass my chocolate allergy on to my children?
- I have chocolate intolerance. Does this mean I am more likely to develop a chocolate allergy?
- Will my child outgrow his or her chocolate allergy?
- Is it safe for me to consume carob?
- What should I do if I accidentally consume chocolate?
- What terms should I look for when reading an ingredient label?
©2007 Healthology, Inc.