Cocoa allergy T78.1

Cocoa is obtained from "semen cacao", the seeds of Theobroma cacao, the cacao tree. The cacao tree grows in tropical West Africa, Brazil and the Philippines. It is a tree from the cacao family that grows up to 5 m high. The seeds are embedded in the cucumber-like cocoa fruit, which is about 20 cm long. The 40-60 white, bitter cocoa seeds are subjected to a special fermentation process lasting several days, whereby they lose their bitterness and take on their familiar brown-red colour. The cocoa seed is roasted in the presence of potash (K2CO3) or magnesium oxide or potassium hydroxide. Powdered mixtures containing cocoa are obtained by adding sucrose, glucose, whole milk powder or skimmed milk powder and, if necessary, flour or malt flour of barley or oats.

Chocolate powder is made by adding finely ground sugar to cocoa powder. It also contains flavoring and aroma substances, free organic acids (acetic and citric acid) and phenolic substances. Cocoa contains relevant proportions of biogenic amines such as: spermidine, putrescine, histamine, tyramine, beta-phenylethylamine, cadaverine and serotonin (Restuccia D et al. (2015).

Hypersensitivity to cocoa can be divided into true allergic symptoms and pseudoallergic symptoms triggered by biogenic amines without the involvement of IgE antibodies(Jäger L et al. 2001).

True allergic reactions to cocoa-containing foods are very rare. Symptoms may manifest as oral allergy syndrome (itching in mouth and throat) or as classical food allergy (gastrointestinal complaints such as diarrhoea, abdominal cramps). Furthermore, respiratory distress and urticaria and shortness of breath may occur. A cross-reacting allergen between tobacco, cocoa, coffee and ragweed has been reported (Jäger L et al. 2001).

Cocoa dust can cause IgE-mediated "occupational" bronchial asthma in workers exposed to it. Serial allergological studies have shown a high degree of sensitisation to cocoa powder in this group, ranging from 5 to 30% (Zuskin E et al. 1998).

On the other hand, there are animal studies indicating that cocoa extracts are able to suppress IgE-mediated allergic symptoms, thus granting them a potential effect in the treatment of atopic eczema (Kang H et al. 2017). In animal experiments, a cocoa-enriched diet was able to suppress anaphylactic reactions to food allergens (Abril-Gil M et al. 2016). Furthermore, it has been shown in animal experiments that allergen-induced changes in the lymphoid tissue of the Peyer's plaques of the small intestine are suppressed by a cocoa-containing diet (Camps-Bossacoma M et al. 2017).

Prick, RAST, if necessary oral provocation

1. Abril-Gil M et al (2016) Effect of a cocoa-enriched diet on immune response and anaphylaxis in a food allergy model in Brown Norway rats.J Nutr Biochem 27:317-326.https://www.ncbi.nlm.nih.gov/pubmed/26601599
2. Camps-Bossacoma M et al (2017) Effect of a cocoa diet on the small intestine and gut-associated lymphoid tissue composition in an oral sensitization model in rats.J Nutr Biochem 42:182-193. https://www.ncbi.nlm.nih.gov/pubmed/28189917
3. Jäger L et al (2001) Food allergens. In Jäger L et al (ed.) Food allergies and intolerances. Urban&Fischer publishing house p.171-172
4. Kang H et al (2017) Theobroma cacao extract attenuates the development of Dermatophagoides farinae-induced atopic dermatitis-like symptoms in NC/Nga mice. Food Chem 216:19-26. https://www.ncbi.nlm.nih.gov/pubmed/27596387
5. Restuccia D et al (2015) Determination of biogenic amine profiles in conventional and organic cocoa-based products. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 32:1156-1163.https://www.ncbi.nlm.nih.gov/pubmed/25833003
6. Zuskin E et al (1998) Respiratory function and immunological status in cocoa and flour processing workers.Am J Ind Med 33:24-32.https://www.ncbi.nlm.nih.gov/pubmed/9408526