Lettuce allergy what to avoid

One reason so numerous people experience allergy and food intolerance symptoms after eating chocolate is that chocolates often contain foods that are problematic for people.

Here are some common allergens you can discover in chocolate:

  1. Peanuts and Tree Nuts: Obviously, some chocolates are filled with peanut butter or with whole nuts. But even chocolates that don't include peanuts or tree nuts as ingredients can be problematic for people with peanut allergies or tree nut allergies because manufacturers that make chocolate assortments containing nuts often make every of their chocolates on the same manufacturing line.

    Labeling rules do not require manufacturers to mention this on food labels, so always call manufacturers before eating high-risk foods love chocolates. You can also purchase chocolate from nut-free manufacturers love Vermont Nut-Free, or glance for label indications love "manufactured in a dedicated nut-free facility."

  2. Corn: Corn is incredibly hard to avoid in the industrial food supply, and chocolate is no exception.

    In addition to high-fructose corn syrup in some chocolate brands, some manufacturers may use corn on production lines. Be especially alert for the presence of corn in white chocolate.

  3. Wheat and Gluten: The same issues that apply to peanuts and tree nuts also affect people with wheat allergies and celiac disease. Filled chocolates often use flour or wheat starch as a binder, and crisped rice can be problematic for celiacs because it often includes barley malt. Gluten-free chocolatiers include Endangered Species Chocolate and Equal Exchange.
  4. Soy: Technically, chocolate is an emulsion (a mixture of two liquids that would otherwise separate), and just love mayonnaise and shelf-stable salad dressings, it generally includes an emulsifier to hold it solid at room temperature.

    Among the most common is soy lecithin, which is problematic for numerous people with soy allergies. This should be listed clearly on food labels.

  5. Milk:Dairy allergies are extremely common, especially in children, and almost every chocolate contains at least some milk. If you're lactose intolerant and can tolerate little amounts of dairy products, attempt bittersweet, semisweet, or dark chocolate: Those chocolates are required by law to contain a higher percentage of chocolate liquor and, therefore, will own less milk and sugar.

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

  6. Berries: Berries are among the more common allergenic fruits. Be careful of assortments; no matter how carefully you read the legend indicating which type of chocolate is located where in the box, it's too simple for pieces to get mixed up.

Always double-check labels on anything you purchase, since manufacturing practices can change without warning.


Other Potential Problems

There are two other potential issues with chocolate:

  1. Drug Interactions: Rarely, chocolate may cause symptoms that resemble allergy symptoms (like skin itchiness) in people taking the common medication Prozac (fluoxetine).

    It's possible that the sensitivity to the biological chemical serotonin that seems to cause this unusual reaction can happen due to Prozac, or other similar drugs. Be certain your allergist is aware of any medications you're taking before you undergo allergy testing. This could be especially useful information if your tests are negative.

  2. Visioli F, Bernardini E, Poli A, Paoletti R. Chocolate and Health: A Brief Review of the Evidence. Chocolate and Health. 2012:63-75. doi:10.1007/978-88-470-2038-2_5

  3. Lopes JP, Kattan J, Doppelt A, Nowak-Węgrzyn A, Bunyavanich S.

    Not so sweet: True chocolate and cocoa allergy. The Journal of Allergy and Clinical Immunology: In Practice. 2019;7(8):2868-2871. doi:10.1016/j.jaip.2019.04.023

  4. Bedford B, Yu Y, Wang X, Garber EAE, Jackson LS. A Limited Survey of Dark Chocolate Bars Obtained in the United States for Undeclared Milk and Peanut Allergens.

    Lettuce allergy what to avoid

    Journal of Food Protection. 2017;80(4):692-702. doi:10.4315/0362-028x.jfp-16-443

  5. Caffeine: Contrary to favorite belief, chocolate is extremely low in caffeine: one ounce of milk chocolate contains only six milligrams of caffeine. In comparison, one 12-ounce can of Coca-Cola has 34 milligrams, and a 2-ounce double espresso can range from 45 to 100 milligrams. However, if you are highly sensitive to caffeine, chocolate may exacerbate your symptoms, and you may discover that you're better off avoiding it. Dark chocolate has far more caffeine than milk chocolate.
  6. Cederberg J, Knight S, Svenson S, Melhus H.

    Lettuce allergy what to avoid

    Itch and skin rash from chocolate during fluoxetine and sertraline treatment: case report. BMC Psychiatry. 2004;4:36.

    Lettuce allergy what to avoid

    Published 2004 Nov 2. doi:10.1186/1471-244X-4-36

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to study more about how we fact-check and hold our content precise, dependable, and trustworthy.

  • Visioli F, Bernardini E, Poli A, Paoletti R. Chocolate and Health: A Brief Review of the Evidence. Chocolate and Health. 2012:63-75. doi:10.1007/978-88-470-2038-2_5

  • Class II recalls include situations where exposure to the violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is rare.
  • Cederberg J, Knight S, Svenson S, Melhus H.

    Itch and skin rash from chocolate during fluoxetine and sertraline treatment: case report. BMC Psychiatry. 2004;4:36. Published 2004 Nov 2. doi:10.1186/1471-244X-4-36

  • Cederberg, Jonas, et al. "Itch and Skin Rash from Chocolate During Fluoxetine and Sertraline Treatment: Case Report." BMC Psychiatry. 2004. 4:36.
  • Class I recalls are the most serious and involve situations where there is a reasonable probability that exposure to the violative product will cause serious adverse health consequences or deaths.

    FDA is aware of deaths occurring among sulfite-sensitive asthmatics.

  • Bedford B, Yu Y, Wang X, Garber EAE, Jackson LS.

    Lettuce allergy what to avoid

    A Limited Survey of Dark Chocolate Bars Obtained in the United States for Undeclared Milk and Peanut Allergens. Journal of Food Protection. 2017;80(4):692-702. doi:10.4315/0362-028x.jfp-16-443

  • Lopes JP, Kattan J, Doppelt A, Nowak-Węgrzyn A, Bunyavanich S. Not so sweet: True chocolate and cocoa allergy. The Journal of Allergy and Clinical Immunology: In Practice. 2019;7(8):2868-2871. doi:10.1016/j.jaip.2019.04.023

  • Class III recalls includes situations where exposure to the violative product is not likely to cause adverse health consequences.

Additional Reading

  1. Cederberg, Jonas, et al. "Itch and Skin Rash from Chocolate During Fluoxetine and Sertraline Treatment: Case Report." BMC Psychiatry. 2004.

    4:36.

Sulfur dioxide (SO2), sodium bisulfite (NaHSO3), potassium metabisulfite (KHSO3), sodium metabisulfite (Na2S2O5), potassium metabisulfite (K2S2O5), and sodium sulfite (Na2SO3) are allowed as food ingredients in the U.S. These substances are considered as GRAS (Generally Recognized as Safe).

The U.S.

Foodand Drug istration (FDA) requires that the presence of sulfites be declared on food labels when used as an ingredient in the food and also when used as a processing aid or when present in an ingredient used in the food (e.g. dried fruit pieces). Sulfites must be declared in these cases when the concentration in the food is ≥10 ppm entire SO2. [21 CFR 101.100 (a)(4) «For the purposes of paragraph (a)(3) of this section, any sulfiting agent (sulfur dioxide, sodium sulfite, sodium bisulfite, potassium bisulfite, sodium metabisulfite, and potassium metabisulfite) that has been added to any food or to any ingredient in any food and that has no technical effect in that food will be considered to be present in an insignificant quantity only if no detectable quantity of the agent is present in the finished food.

A detectable quantity of sulfiting agent is 10 parts per million or more of the sulfite in the finished food.»] If naturally occurring sulfites also exists in foods, it would contribute to the analytical result. Basically, if the food contains≥ 10 ppm entire SO2, then sulfite must be declared on the label. This will most typically happen when sulfite is deliberately added to the food. The specific name of the additive (e.g. sodium bisulfite) must be declared in the case of use as an intentional ingredient.

Sulfites are also prohibited from certain uses in the U.S. Sulfites may not be used in products such as meats that serve as a excellent source of vitamin B1 because sulfites can scavenge that vitamin from foods.

In 1986, following the identification of numerous cases of sulfite-induced asthma occurring on ingestion of green or fruit salads treated with sulfites, FDA prohibited the use of sulfites on fruits and vegetables intended to be served raw or presented unused to the public (Fed. Regist. 51:25021-25026, 1986). The only exception is sulfite use on minimally processed potatoes sliced or shredded for frying where sulfite use is still permitted (although FDA has a long-standing, though never finalized, proposal to ban that use also). Sulfite use as a fungicide during the shipment of unused table grapes is regulated by the U.S.

Environmental Protection Agency, but the concentration of SO2 residues on the table grapes as consumed must be <10 ppm entire SO2.

The labeling of the presence of sulfites on alcoholic beverages is under the jurisdiction of the Taxand Trade Bureau (TTB) of the U.S. Dept. of Treasury. While most ingredients in alcoholic beverages are not declared on the container, the presence of sulfites must be declared. Sulfites are commonly used in wine fermentation to control undesirable growth of acid-producing bacteria while allowing alcohol-producing yeast to proliferate.

Total SO2 levels in foods and beverages should be sure by the optimized Monier-Williams distillation-titration procedure, a method approved by the Association of Official Analytical Chemists (AOAC).

Alternate methods do exist but FDA and other federal agencies will typically use the AOAC method so any alternative method must provide similar results.

Food products that contain undeclared sulfites at levels above 10 ppm entire SO2 will be subject to potential recall actions. In the U.S., three recall categories are used:

  1. Class I recalls are the most serious and involve situations where there is a reasonable probability that exposure to the violative product will cause serious adverse health consequences or deaths.

    FDA is aware of deaths occurring among sulfite-sensitive asthmatics.

  2. Class II recalls include situations where exposure to the violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is rare.
  3. Class III recalls includes situations where exposure to the violative product is not likely to cause adverse health consequences.

For sulfites, recalls can drop into any of the 3 recall classifications.

Using data from controlled oral clinical challenges of sulfite-sensitive asthmatics, the FDA has established dose levels that are associated with Class I, Class II, or Class III recalls. Analysis is done for entire SO2 based upon the AOAC procedure. The analytical result is given in terms of a concentration (ppm).

Lettuce allergy what to avoid

FDA determines a worst case dose (mg SO2 equivalents) by using the 95th percentile level of consumption of the food in question. Dose estimates are based upon single occasion exposures. The estimated 95th percentile sulfite ingestion dose (in mg) for a single occasion is then obtained by multiplying the sulfite concentration of the food product (in ppm or mg per kg of food) by the 95th percentile level of food consumption (in kg) for the specific food.

Class Est. 95th Percentile Dose
Class I ≥10 mg
Class II 3.7 — 9.9 mg
Class III < 3.7 mg

Timbo B, Koehler KM, Wolyniak C, Klontz KC.

2004. Sulfites — a Foodand Drug istration review of recalls and reported adverse events. J Food Prot 67:1806-1811.

Additional Reading

  1. Cederberg, Jonas, et al. "Itch and Skin Rash from Chocolate During Fluoxetine and Sertraline Treatment: Case Report." BMC Psychiatry. 2004. 4:36.

Sulfur dioxide (SO2), sodium bisulfite (NaHSO3), potassium metabisulfite (KHSO3), sodium metabisulfite (Na2S2O5), potassium metabisulfite (K2S2O5), and sodium sulfite (Na2SO3) are allowed as food ingredients in the U.S.

These substances are considered as GRAS (Generally Recognized as Safe).

The U.S. Foodand Drug istration (FDA) requires that the presence of sulfites be declared on food labels when used as an ingredient in the food and also when used as a processing aid or when present in an ingredient used in the food (e.g. dried fruit pieces). Sulfites must be declared in these cases when the concentration in the food is ≥10 ppm entire SO2. [21 CFR 101.100 (a)(4) «For the purposes of paragraph (a)(3) of this section, any sulfiting agent (sulfur dioxide, sodium sulfite, sodium bisulfite, potassium bisulfite, sodium metabisulfite, and potassium metabisulfite) that has been added to any food or to any ingredient in any food and that has no technical effect in that food will be considered to be present in an insignificant quantity only if no detectable quantity of the agent is present in the finished food.

A detectable quantity of sulfiting agent is 10 parts per million or more of the sulfite in the finished food.»] If naturally occurring sulfites also exists in foods, it would contribute to the analytical result. Basically, if the food contains≥ 10 ppm entire SO2, then sulfite must be declared on the label. This will most typically happen when sulfite is deliberately added to the food. The specific name of the additive (e.g. sodium bisulfite) must be declared in the case of use as an intentional ingredient.

Sulfites are also prohibited from certain uses in the U.S. Sulfites may not be used in products such as meats that serve as a excellent source of vitamin B1 because sulfites can scavenge that vitamin from foods.

In 1986, following the identification of numerous cases of sulfite-induced asthma occurring on ingestion of green or fruit salads treated with sulfites, FDA prohibited the use of sulfites on fruits and vegetables intended to be served raw or presented unused to the public (Fed. Regist.

Lettuce allergy what to avoid

51:25021-25026, 1986). The only exception is sulfite use on minimally processed potatoes sliced or shredded for frying where sulfite use is still permitted (although FDA has a long-standing, though never finalized, proposal to ban that use also). Sulfite use as a fungicide during the shipment of unused table grapes is regulated by the U.S.

Lettuce allergy what to avoid

Environmental Protection Agency, but the concentration of SO2 residues on the table grapes as consumed must be <10 ppm entire SO2.

The labeling of the presence of sulfites on alcoholic beverages is under the jurisdiction of the Taxand Trade Bureau (TTB) of the U.S. Dept. of Treasury. While most ingredients in alcoholic beverages are not declared on the container, the presence of sulfites must be declared. Sulfites are commonly used in wine fermentation to control undesirable growth of acid-producing bacteria while allowing alcohol-producing yeast to proliferate.

Total SO2 levels in foods and beverages should be sure by the optimized Monier-Williams distillation-titration procedure, a method approved by the Association of Official Analytical Chemists (AOAC).

Alternate methods do exist but FDA and other federal agencies will typically use the AOAC method so any alternative method must provide similar results.

Food products that contain undeclared sulfites at levels above 10 ppm entire SO2 will be subject to potential recall actions. In the U.S., three recall categories are used:

  1. Class I recalls are the most serious and involve situations where there is a reasonable probability that exposure to the violative product will cause serious adverse health consequences or deaths. FDA is aware of deaths occurring among sulfite-sensitive asthmatics.
  2. Class II recalls include situations where exposure to the violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is rare.
  3. Class III recalls includes situations where exposure to the violative product is not likely to cause adverse health consequences.

For sulfites, recalls can drop into any of the 3 recall classifications.

Using data from controlled oral clinical challenges of sulfite-sensitive asthmatics, the FDA has established dose levels that are associated with Class I, Class II, or Class III recalls. Analysis is done for entire SO2 based upon the AOAC procedure. The analytical result is given in terms of a concentration (ppm). FDA determines a worst case dose (mg SO2 equivalents) by using the 95th percentile level of consumption of the food in question. Dose estimates are based upon single occasion exposures.

The estimated 95th percentile sulfite ingestion dose (in mg) for a single occasion is then obtained by multiplying the sulfite concentration of the food product (in ppm or mg per kg of food) by the 95th percentile level of food consumption (in kg) for the specific food.

Class Est. 95th Percentile Dose
Class I ≥10 mg
Class II 3.7 — 9.9 mg
Class III < 3.7 mg

Timbo B, Koehler KM, Wolyniak C, Klontz KC. 2004. Sulfites — a Foodand Drug istration review of recalls and reported adverse events.

J Food Prot 67:1806-1811.


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