Chocolate Allergy Signs and Treatments

A true chocolate allergy is rare, and the symptoms you experience may be due to chocolate or other ingredients used in the manufacturing of chocolate. It is also possible to have a non-allergic sensitivity to chocolate, cocoa, or cacao (the bean from which cocoa, cocoa butter, and chocolate are derived).

Understanding the difference between a true allergy and a food sensitivity is important as the treatment and risks are very different. With a true allergy, you may be at risk of a potentially life-threatening allergic reaction called anaphylaxis requiring immediate emergency treatment.

This article explains the symptoms of a chocolate allergy, the difference between food allergies and food sensitivities, and ways to manage and avoid allergic reactions.

Chocolate Allergy vs. Chocolate Sensitivity

A chocolate allergy and chocolate sensitivity can often cause similar symptoms, but the underlying mechanisms are very different.

Food Allergies

A food allergy involves a specific immune response to an allergy-causing substance (allergen). When exposed to an allergen—in this case, chocolate—the immune system will release an antibody called immunoglobulin E (IgE) that sets off a chain reaction, causing immune cells to break open and release an inflammatory chemical called histamine into the bloodstream.

Histamine is the chemical responsible for the characteristic symptoms of a true allergy, both in the skin, digestive tract, and respiratory tract.

Food Sensitivity

In contrast, food sensitivities do not involve IgE or histamine. Instead, when certain foods are eaten, the body is unable to break them down as they should. This may be due to a lack of digestive enzymes (such as the lack of lactase in people with lactose intolerance) or a general intolerance of food additives and chemicals.

With food sensitivity, the response is limited to the digestive tract.

Symptoms

Chocolate allergies are rare, affecting between 0.5% to 0.7% of the general population. Symptoms range from mild and transient to life-threatening.

With a true chocolate allergy, a person may experience symptoms like:

• Dizziness or lightheadedness
• Itchiness or hives
• Coughing
• Shortness of breath
• Sneezing
• Runny or blocked nose
• Stomach pain
• Nausea or vomiting
• Diarrhea
• Swelling of the lips, face, and eyes

Symptoms may develop soon after eating chocolate or several days later.

By contrast, there is little data on how common chocolate sensitivities are. This is because it is hard to determine if the sensitivity is due to chocolate or some other ingredient in the chocolate confection.

With chocolate sensitivity, a person may experience symptoms like:

• Stomach pain
• Bloating and gas
• Indigestion
• Belching
• Stomach cramps
• Nausea or vomiting
• Diarrhea

As opposed to food allergies in which symptoms may be delayed, food intolerances almost invariably cause symptoms soon after a food is eaten.

Causes of a Reaction to Chocolate

When you buy a chocolate bar, chocolate is not the only thing you are consuming. In addition to cocoa and cocoa butter derived from cacao, there may also be added ingredients like milk, milk powder, soy, vegetable fats, and flavorings like vanilla.

As such, you may be allergic to the cacao derivatives or some other ingredient in the confection, such as:

Milk

Dairy allergies are very common, especially in children, and almost all chocolate contains at least some milk.

If you have a known allergy to dairy, you may be able to eat bittersweet or dark chocolate. Those chocolates are required by law to contain a higher percentage of chocolate and less (or no) milk and sugar.

Dairy-free chocolates are on the market from brands like Tropical Source, Amanda's Own, Premium Chocolatiers, and Chocolate Decadence.

Peanuts and Tree Nuts

Some chocolates are filled with peanut butter or whole nuts. Even when they aren't, they may be manufactured in plants where peanuts and tree nuts are used. In such instances, cross-contamination can occur, placing people with peanut or tree nut allergies at risk of exposure.

Labeling rules do not require manufacturers to mention this on food labels, so only buy products marked "manufactured in a dedicated nut-free facility." You can also buy chocolate from nut-free manufacturers like Vermont Nut-Free.

Wheat

People with wheat allergies may need to avoid filled chocolates that often use flour or wheat starch as a binder. Wheat allergies are relatively uncommon, affecting around 1% of the general population, mostly children.

A wheat allergy is not the same thing as gluten intolerance in which you react to gluten found in wheat and other cereal grains. With a true wheat allergy, you may be allergic to any of the four main proteins in wheat, including albumin, globulin, gliadin, and gluten.

Soy

Technically, chocolate is an emulsion (a mixture of two liquids that would otherwise separate). Most utilize some form of emulsifier to keep the chocolate solid at room temperature.

Among the most common is soy lecithin, which may be problematic for people with soy allergies. This should be listed clearly on food labels, so double-check if you have a known allergy or buy products marked "soy-free."

Corn

Corn is incredibly difficult to avoid in the industrial food supply, and chocolate is no exception. In addition to high-fructose corn syrup used to sweeten many chocolate candies, some manufacturers use corn on their production lines. Be especially alert for the presence of corn in white chocolate.

Corn allergies are more common than most people think, affecting anywhere from 1% to 6% of the general population.

Caffeine

Contrary to popular belief, chocolate is extremely low in caffeine; one ounce of milk chocolate contains only around six milligrams. In comparison, one 12-ounce can of cola has 34 milligrams, while a two-ounce double espresso can range from 45 to 100 milligrams.

However, if you are highly sensitive to caffeine or have a caffeine allergy, chocolate can cause a reaction. Dark chocolate has far more caffeine than milk chocolate.

Other Reasons for Allergy-Like Symptoms

In the absence of a true chocolate allergy, there are other possible explanations for why you react to chocolate, cocoa, or cacao.

Celiac Disease or Gluten Intolerance

If you have digestive symptoms after eating chocolate, it may be the result of celiac disease or non-celiac gluten sensitivity (NCGS),

Celiac disease is an autoimmune disease in which the immune system attacks the lining of the intestine whenever gluten is consumed. It differs from a wheat allergy in that IgE is not involved; rather, the immune system releases "auto-antibodies" that directly target and attack tissues.

NGCS is a food sensitivity that occurs in response to eating gluten. NCGS is not well understood but has no auto-antibodies associated with celiac disease or IgE antibodies associated with wheat allergies.

If you have celiac disease or NGCS, most plain chocolates are safe as they don't contain gluten. Problems may arise when you eat filled chocolates made with wheat binders. The same can occur with crisped rice which often includes barley malt (another rich source of gluten).

Gluten-free chocolatiers include Endangered Species Chocolate and Equal Exchange.

Drug Interactions

Chocolate can cause allergy-like symptoms in people who take Prozac (fluoxetine) or Zoloft (sertraline), both of which belong to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), Eating lots of chocolate while taking an SSRI can cause itchiness and burning sensations of the scalp, torso, and back.

The reaction is caused by an amino acid in chocolate called tryptophan that is converted into the hormone serotonin in the body. High serotonin levels are known to cause itchiness. When chocolate is combined with an SSRI (which also raises serotonin levels), the risk of itchiness is increased.

The reaction is seen primarily in people who eat a lot of chocolate regularly.

Managing Chocolate Allergies

The main approach to dealing with any food allergy is to avoid the allergen—in this case, chocolate. Even so, chocolate may not be the actual culprit, and additional testing may be needed to ascertain which ingredient you are allergic to.

An allergy specialist known as an allergist can perform tests to pinpoint the likely cause or causes, including:

• Skin prick tests, in which tiny amounts of different allergens are inserted beneath the skin to see if you have a reaction
• Blood tests, like AllerScan, that can detect IgE antibodies specific to different foods

Allergy shots used to desensitize people to respiratory allergens do not work for food allergies. The avoidance of food allergens is the frontline approach.

When to Seek Emergency Care

On rare occasions, exposure to chocolate can lead to anaphylaxis, a dangerous, whole-body allergy that can lead to coma, shock, respiratory distress, and death if left untreated.

Call 911 or rush to your nearest emergency room if you develop signs and symptoms of anaphylaxis, including:

• Sudden, severe rash or hives
• Shortness of breath
• Wheezing
• Rapid, shallow breathing
• Dizziness or fainting
• Flushing
• Rapid heartbeats
• Nausea or vomiting
• Sudden diarrhea
• Swelling of the lips, tongue, or throat
• A feeling of impending doom

Anaphylaxis is a medical emergency requiring an immediate injection of epinephrine to avoid a dangerous drop in blood pressure that can lead to shock.

Summary

A true chocolate allergy is rare, affecting less than 1% of the population, but one that can cause anaphylaxis in certain people. By contrast, chocolate intolerance can cause food allergy-like symptoms but without the risk of anaphylaxis. Allergy testing can reveal if you are truly allergic to chocolate or simply have a non-allergic food sensitivity.