While most of us relish all kinds of delicacies, without giving much thought to their ingredients, some folks have to be extremely vigilant with regards to the same. About 2% of our world's population suffers from food allergies, wherein their bodies reject specific ingredients. All kinds of food allergies exist, for example; soy allergy, nuts allergy, milk allergy, etc. However, have you heard of chocolate allergy? Chocolate allergy in its true form, that is allergy to cocoa is something that is possible but is very rare and is virtually non-existent in today's medical literature. When people say they are allergic to chocolate, it is because they are actually allergic to one or more ingredients in the chocolate. Most of the commercially available chocolates comprise cocoa mixed with a number of additives, such as milk, nuts, gluten, corn, soy or caffeine. People who have specific food allergies, such as allergy to gluten, milk, corn, soy or any of the above-mentioned items present in chocolates, may develop chocolate allergy. When a person suffers from a food allergy, his or her immune system responds inaccurately to a food protein. The immune system presumes the food proteins to be foreign bodies and as a result produces antibodies called immunoglobulin E (IgE) to attack these food proteins. These antibodies attach themselves to a type of white blood cell called mast cells and when they come in contact with the concerned food protein, they release chemicals. The allergic reactions that are seen in the body, are caused by the release of these chemicals and they range from headaches to vomiting, diarrhea and hives. A severe allergic reaction known as anaphylactic shock (type of anaphylaxis) can even be life-threatening and result in death. Potential Causes of Chocolate Allergy There are different causes of chocolate allergy. Let's have a look at them. Additives In mass-produced chocolates, cocoa beans are fermented, roasted, ground and then mixed with a large percentage of additives, such as corn syrup, milk, soy, nuts, food coloring, etc. An allergy to chocolate is most commonly an allergy developed to these additives, present in the chocolate and not to cocoa. The different ingredients or additives in chocolates that cause chocolate allergy are as follows: Milk: People who are lactose intolerant or who have milk allergy show reactions on consumption of chocolate. This is because the milk added to the chocolate causes the allergy. If you are one of those people, then you could try eating bittersweet, dark or semi-sweet chocolate, wherein the quantity of cocoa is more and that of milk and sugar is less. You could also opt for dairy free chocolates. Soy: Soy lecithin is an additive which is added to chocolate as an emulsifier, in order to keep the chocolate solid at room temperature, but soy is capable of triggering allergic reactions in some people. Nuts: Chocolate bars often include peanuts and tree nuts and some chocolates are even filled with peanut butter. People with tree nut allergies and peanut allergies develop allergic reactions as severe as anaphylaxis. However, sometimes even chocolate bars that lack nuts and peanut butter can cause allergic reactions. This is because most chocolate manufacturers use the same manufacturing line to make assorted chocolates. It's advisable to purchase chocolates from nut-free chocolate manufacturing companies. In the US, the Food and Drug Administration regulations state that chocolate wrappers must indicate if they were processed in a factory that processes nuts as well. Corn: High fructose corn syrup is commonly used by chocolate manufacturers. Besides corn syrup, even corn is used in some production lines. People who are allergic to corn will develop allergy on consumption of chocolate. The FDA regulation makes it mandatory for chocolate manufacturers to mention on the label, if corn has been added. Usually white chocolate contains corn, so be on your guard! Caffeine: Chocolate contains small amounts of caffeine. For example, only six milligrams of caffeine will be found in one ounce of chocolate. Dark chocolate contains a little more. Thus, people who are highly sensitive to caffeine may develop allergic symptoms, like headaches after munching on some chocolates. Wheat and Gluten: Wheat and gluten are added as binders in chocolates by manufacturers. Wheat is a common food allergen while gluten is a major source of food intolerance. They are usually added to chocolate based products that are produced on a large-scale. These products are mostly sold in the form of candies and not as premium chocolates. As per FDA regulations, food labels have to mention the presence of wheat and gluten. Heredity People with family history of hives, eczema, rashes or hay fever are more likely to have children with possible food allergies. To be on the safer side, those of you with a family history of allergies, should refrain from giving your baby chocolate until he or she is a year old. Then again, chocolate allergy can occur at any time in one's life, right from childhood to adulthood. Symptoms of Chocolate Allergy A number of signs and symptoms can be experienced by people suffering from chocolate allergy. The common chocolate allergy symptoms are:

• Heartburn
• Confusion and irritability
• Hives
• Breathing problems
• Rectal itching
• Headache
• Itching

Chocolate allergy is seen to even trigger asthma attacks in asthmatic patients. Further, in cases of severe chocolate allergy, the person may suffer from anaphylaxis which can lead to the life-threatening anaphylactic shock. The symptoms of anaphylaxis are:

• Heart palpitations
• Vomiting and nausea
• Fainting or loss of consciousness
• Dizziness
• Drop in blood pressure
• Diarrhea and stomach cramps
• Wheezing and shortness of breath
• Difficulty in breathing due to inflammation of the airway

Diagnosing Chocolate Allergy To identify the exact allergen, the doctor will have to conduct a 'Food Challenge Test'. In this test, the patient is asked to refrain from chocolate for a certain period of time. Then, the doctor gives a piece of pure chocolate to the patient to eat. This chocolate lacks additives and is chocolate in its purest form. If the patient encounters allergic reactions after this step, it is confirmed the patient is allergic to cocoa in chocolate. However, in case of absence of allergic symptoms, step by step elimination of different additives has to be done. Skin and blood tests are also carried out to test if one is allergic to chocolate. The skin test involves injecting food extracts into the skin and waiting for allergic reactions to appear. The blood test, RAST (radioallergosorbent test), involves testing the blood for possible antibodies corresponding to common food additives. Treatment and Prevention of Chocolate Allergy Since most people are allergic to the above-mentioned additives, the first task is to narrow down the additive one is allergic to. One must scrutinize the list of ingredients on the label and only purchase chocolates without that allergen. For example, those with milk allergies must stick to consuming dark chocolates, while those with nut, soy, caffeine or corn allergies, should avoid chocolates containing these ingredients. Proper inspection of the chocolate label is required. You also get gluten-free, soy-free, dairy-free chocolates these days, so try purchasing them instead. Moreover, try opting for chocolates with higher percentage of cocoa, as this will minimize the risk of consuming the allergen considerably. One can also opt for a cocoa substitute called carob (seed of the carob tree), believed to be non-allergic, which can be consumed instead of cocoa. However, it's not possible to always avoid the allergy-causing chocolates and thus certain medicines are prescribed to reduce the symptoms. Antihistamines (for hives and gastrointestinal reactions), topical creams (hives / dermatitis), bronchodilators (for shortness of breath and wheezing), Epinephrine injection (in case of anaphylaxis) and corticosteroids (in case of inflammation) are used, to reduce the severity of the allergic reactions. Chocolate allergy can occur to anyone at any age, that is it can occur in adults as well as in children. What's important is that you don't ignore the allergic reactions, but immediately consult a doctor for advice. Avoid food products containing the allergens and before trying out a substitute, always consult the doctor.