A chocolate allergy can develop to one or more ingredients of chocolate, including cocoa, milk, soy lecithin and nuts. In a food allergy, the immune system overreacts to a protein from a certain food and mistakenly attacks it. This reaction is caused by antibodies called immunoglobulins E.
Cocoa
Cocoa is the first ingredient of chocolate and is made of the processed cacao nut, which is a tree nut, and thus potentially allergenic. Due to extensive processing, the cacao proteins are modified into relatively non-allergenic complexes. Therefore, cocoa allergy is “vanishingly rare,” according to the American Academy of Allergy, Asthma and Immunology, or AAAAI.
Soy Lecithin
Soy lecithin extracted from soy oil is added to chocolate as an emulsifier—an additive that keeps two unmixable substances from separating—in this case cocoa and cocoa butter. Soy is a common allergen, but according to the AAAAI, most children will later outgrow this allergy. Heating as a part of soy oil processing should denature the soybean protein, so most but not all soy-allergic people can safely consume soy lecithin.
Milk
Cow’s milk is an ingredient of milk chocolate but not of dark chocolate. Still, contamination is possible if the dark-chocolate manufacturers also make milk chocolate. Milk protein allergy is common in infancy and early childhood, but according to the AAAAI, 85 percent of children will outgrow it.
Nuts
Chocolate bars often include tree nuts, peanuts or peanut butter. Even in chocolates without nuts, contamination is possible if the manufacturers use the same equipment to produce chocolate with and without nuts. Both tree-nut and peanut allergies can be very severe and potentially fatal.
Symptoms
Ingestion of certain chocolate ingredients may trigger the sudden release of molecules that lead to symptoms of an allergic reaction. Symptoms usually appear on the skin, in the form of hives, itchiness and swelling. Gastrointestinal symptoms may also occur, including vomiting and diarrhea, sometimes followed by respiratory symptoms. A severe and quick allergic reaction is called anaphylaxis, with symptoms such as difficulty breathing, dizziness or loss of consciousness. Peanuts and tree nuts can trigger such a reaction in some people, and it is important to seek medical care immediately, recommends AAAAI.
Diagnosis
Doctors—allergists—can perform allergy skin tests to determine which chocolate ingredients trigger the allergic symptoms in a person. Allergists place a small amount of the food extract on the back or arm, and if a bump or small hive develops within 20 minutes, it indicates a possible allergy.
Treatment
According to the AAAAI, the best treatment for food allergy is to avoid the food that triggers it. Carefully read product labels. People allergic to milk should eat dairy-free chocolates, and some chocolate manufacturers even offer soy-free chocolate. There is a substitute for cocoa, called carob, which grows on an evergreen tree.
Patients should always wear an ID bracelet that describes the allergy and carry injectable epinephrine and antihistamines to treat emergency reactions, and also teach close people how to use those. In the event of a severe reaction, AAAAI recommends that a person should be taken to the emergency room, even if symptoms subside.
References
- American Academy of Allergy, Asthma and Immunology: Food Allergy
- The Food Allergy and Anaphylaxis Network: About Food Allergy
- American Academy of Allergy, Asthma and Immunology; Annals of Allergy, Asthma and Immunology; “Food Allergy: A Practice Parameter”; March 2006
- Purdue University: Center for New Crops and Plant Products: Carob
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