Weird feeling eating chocolate?
September 27, 2016 11:36 AM   Subscribe

I've started getting this weird hot/puckery/irritated feeling eating chocolate. Allergy testing results suggest it's not an allergy, though. What else could it be?

For the last couple of years, I've noticed that my mouth seems to get this weird hot, puckery, irritated feeling when I eat chocolate. It's sort of difficult to describe and I don't get it with other foods. It happens instantly on the first bite; occasionally the top of my throat also feels irritated a little later. After about 30 minutes it's mostly faded away and after an hour it's totally gone.

My first thought was obviously a food allergy, but: 1. apparently allergy to chocolate itself is super rare, like case-report rare -- and 2. I've had skin testing done since this started happening, and while I am apparently allergic to a ton of environmental stuff (3-4+ ratings for pet dander, dust mites, and some trees/grasses/weeds), the skin test came up flatly negative for chocolate. My impression is that false negatives are pretty rare in skin tests, esp. compared to false positives.

I did get a mild skin reaction to one tree nut (pecans), but I have this same reaction to chocolate that is supposed to be nut-free (e.g., Trader Joe's Semi-Sweet Chocolate Chips, which doesn't list any nut cross-contamination and which nut allergy sites list as safe). I also thought maybe it could be oral allergy syndrome, but I've never found any evidence that chocolate could be a potential pollen-food cross-reaction. And chocolate is heated during preparation, I think, while most OAS-causing epitopes aren't heat-stable except nuts and seeds. (I'm also not allergic to birch, ragweed, or mugwort -- just grasses and other weeds/trees.)

So all that together kind of makes me doubt it's a bona fide allergy, but at the same time, I don't know what else it could be.

A couple other things I considered: I do remember that I used to get aphthous ulcers all the time, and chocolate was unique among foods in that it was extremely painful on contact. But this happens even in the absence of ulcers. I've also read some stuff about burning mouth syndrome but that seems different since most foods don't cause this reaction, just chocolate. And tannins in tea and wine do make me pucker up, but not this intensely and not with that same kind of burning feeling.

While the discomfort is very noticeable, it's also not so intense that it alone would prevent me from eating chocolate now and again (as long as I don't have a mouth ulcer), and I also don't want to restrict my diet unnecessarily. I just want to make sure I'm not tempting anaphylaxis or something. I'm also just curious about what it could be, especially since I don't remember having this sensation growing up, at least not this intensely. Are there any other plausible reasons besides a food allergy that I could be experiencing something like this?

Obviously YANMD, but I don't even know what I should be asking my doctor about, if anything. I also know I'm prone to health anxiety, so I don't want to go off and request an endless series of tests if it's probably something normal/benign.

Thanks in advance for any thoughts!
posted by en forme de poire to Health & Fitness (18 answers total) 5 users marked this as a favorite
Could it be one of the ingredients in the chocolate that's affecting you? I assume your skin test also tested for soy,but if not that's another common allergen (though, it's in so many foods that you'd think there would be other things that bother you) -- ditto dairy.

Is the sensation something that you could qualitatively quanitfy, like on a 1-5 scale? Because I'd be interested to know if it gets better or worse as you go darker or milkier on the scale.

I might also wonder if it could be the packaging, especially if you don't eat many other processed/packaged foods.

I have a friend who is who is allergic to all alliums, it's a toss-up between that and chocolate as far which food allergy I dread developing most. Good luck!
posted by sparklemotion at 11:46 AM on September 27, 2016 [1 favorite]

Is it all chocolate? Or a specific brand? I'm wondering if it's a specific additive particular to a brand or manufacturer.
posted by clone boulevard at 11:46 AM on September 27, 2016 [1 favorite]

Wine, tea, chocolate -- sulfite sensitivity?
posted by Iris Gambol at 12:00 PM on September 27, 2016 [1 favorite]

Maybe it's the tannins? Foods high in tannins give me a puckery feeling - oaky red wines, walnuts, dark chocolate, persimmons... [oops! ETA you already mentioned tannins]
posted by beyond_pink at 12:20 PM on September 27, 2016 [2 favorites]

Those symptoms are consistent with some sort of allergic response. Have you specifically seen an allergist, not just a primary care doctor? Did you get IgE blood testing done in addition to skin prick testing? Did you do an in-office food challenge so the doctor could observe your symptoms? I am especially concerned that after finding evidence of a tree nut allergy, the doctor you saw did not do more to confirm that diagnosis. There is not really any such thing as a "mild" tree nut allergy. If you have a tree nut allergy you need to have a prescription for an EpiPen.

I'm also concerned that you were told that chocolate allergy was "case study" rare, because, as the parent of a child with a peanut allergy, I belong to multiple allergy support groups, and I can assure you that I have met (in person, even) more than one person who is genuinely allergic to chocolate. Chocolate allergy is not as common as say, nut or shellfish allergies are, but it's more common than you've been led to believe.

I see three main routes of investigation for you here:

1.) Find out if your skin test to chocolate was a false negative. False positives are more common than false negatives in food allergy testing, but false negative tests do happen. I would recommend that you do a second skin test for chocolate, an IgE blood test for chocolate, and an in-office food challenge for chocolate. If you are currently seeing an allergist who won't do a blood test and an in-office food challenge, find another one who will. Doing all three tests is standard diagnosis protocol, especially when test results conflict with reaction history. For the in-office challenge, try to find a chocolate that is unlikely to be contaminated with other common allergens. Enjoy Life brand and Pascha brand chocolate are both supposed to be free from the top 8 most common allergens (peanuts, tree nuts, dairy, soy, wheat, egg, fish and shellfish), so those would be good brands to try.

2.) Find out if you are definitely allergic to another food. As you surmised, people who are allergic to peanuts or tree nuts will often react to chocolate as most commercial chocolate candies and chips sold in the U.S. are cross contaminated with peanut and tree nut residue due to the use of shared manufacturing equipment with nut-flavored chocolate candies. People with dairy allergies will also react to chocolate (even dark chocolate) for the same reason. And soy is a common additive to chocolate, so people with soy allergies may react to it too. Now, I assume that if you were allergic to dairy or soy you would already know it, because those are such common ingredients that you would be reacting to all manner of foods besides chocolate, so my money is on the pecan allergy being the culprit here if you are not actually allergic to chocolate. You are right that Trader Joe's chocolate chips are listed on a lot of nut-safe lists, but Trader Joe's changes its manufacturing partners all the time, so I wouldn't rely on a random internet safe list to check whether any of TJ's packaged foods are safe-- most people I know who manage food allergies actually call TJ's customer service line regularly to check and re-check allergen info. Those "may contain" or "made on shared equipment with" allergen advisory warnings on food labels are VOLUNTARY and NOT REGULATED by U.S. law, so just because a package does not have a warning for nut cross contamination, that does not necessarily mean that the food in the package is nut-free.

3.) Find out if you are allergic to a non-food ingredient or contaminant that is likely to be found in chocolate. I've read that people with severe cockroach allergies will sometimes react with allergy symptoms to chocolate because cheap chocolate tends to contain . . . well, bug bits. (Sorry.) There also may be preservatives or additives causing you trouble.

You are not acting like a paranoid person by wanting to follow up on this, by the way. Right now your symptoms sound more annoying than anything else but, with allergies, the severity of past reactions is not a reliable predictor of the severity of future reactions; it's possible for an allergy to get better or worse at any time. It's a very good idea to have your situation thoroughly checked out by a competent allergist who will do thorough testing and will not be dismissive of your questions and concerns. If you have a true food allergy you will need good medical advice on how to adjust your diet and you will need a prescription for epinephrine in case you ever have a severe reaction. Good luck. I hope you can figure this out!
posted by BlueJae at 12:23 PM on September 27, 2016 [16 favorites]

The same thing started happening to me this summer. I have oral allergy syndrome, diagnosed by an allergist; I don't think you should discount it.

Unfortunately I hadn't made the connection before I talked to the allergist -- I'd thought it was nuts causing the reaction, but have since realized it happens when I eat dark chocolate that doesn't have nuts, too -- so I can't pass on any chocolate-specific advice.
posted by The corpse in the library at 1:13 PM on September 27, 2016

A couple other things I considered: I do remember that I used to get aphthous ulcers all the time, and chocolate was unique among foods in that it was extremely painful on contact.

I think this is strong evidence it's related to your (T cell mediated) apthous stomatitis, but that's such a complex condition I'm not sure how much guidance that would offer if it were the case.
posted by jamjam at 1:18 PM on September 27, 2016

Chocolate allergy isn't all that rare. My sister developed an allergy to chocolate in her teens (it seems to be cocoa solids) and it's the only thing she's allergic to. She gets ulcers all over her mouth and throughout her digestive tract. Before they found out, she had so many ulcers that she developed anemia from all the blood loss and they did all the tests for inflammatory bowel conditions because of all the ulceration. I don't know what allergy testing they did, but the thing that settled it was an elimination diet and then reintroduction.

Now she can manage small amount with just a few ulcers but if she does it more than once every few months she starts to have problems again. There's never been any suggestion of anaphylaxis for her.
posted by kadia_a at 1:26 PM on September 27, 2016

I am not actually allergic to any foods, but I am allergic to trees/weeds/mold/dust mites/dogs/cats. I have oral allergy syndrome particularly from my birch tree allergy which results in my mouth and throat getting all itchy/tight when I eat raw stone fruit (peaches, plums, cherries, etc) and raw pears and a concentrated amount of raw carrot because my body thinks they are all birch trees. I can eat these foods when they are heated or pickled because it denatures the protein I am reacting to.

Chocolate does have high histamine levels, which may be what's causing your reaction, or you may be actually allergic, but it also could be that whatever you're allergic to that causes OAS isn't denaturing because chocolate doesn't get heated thoroughly enough? Have you had this full discussion with your allergist or are some of your thoughts in your post just things you've researched alone without expert input?
posted by vegartanipla at 1:41 PM on September 27, 2016 [1 favorite]

I have a mild allergy to nuts, so that's a thing. I get a reaction ranging from red cheeks to full body hives, depending on the nut and amount.
Reading the above responses, I guess I also have OAS, though I never knew it had a name. Just that chamomile tea acts like ragweed, and raw celery and pumpkin seeds make my mouth and ears super itchy.
Honestly, allergies are weirder than we think and a lot is still unknown. My allergist would tell you "if it hurts to eat chocolate, don't eat chocolate." I have been known to eat the occasional slice of pecan pie with the nuts picked out, so it's probably fine. Carry Benadryl with you though!
posted by Valancy Rachel at 2:03 PM on September 27, 2016

My partner has a bunch of weird allergies, including a caffeine allergy which at one point got nasty enough that chocolate had to go off the table. (Several years of strict avoidance of all caffeine brought the mouth hives symptoms down enough that thankfully smallish amounts of chocolate are now okay.) So I went and asked them what they thought.

Apparently chocolate allergies often go along with copper allergies, of all the weird-ass things, and so does reactions to tea. Have you maybe had copper looked at? The amount of copper in a chocolate allergy sample might not have been enough to cause a reaction compared to the amount of it (or the amount of whatever it is you are actually reacting to) in a mouthful of chocolate.
posted by sciatrix at 2:08 PM on September 27, 2016 [1 favorite]

I definitely wouldn't discount that tingly feeling -- I've only had it twice, but it was real stuff: the first time (tuna), it was followed by hives and a general food poisoning experience, and the second time, I stopped eating the melon immediately! Your body is telling you something, even if it's still just a mild something...
posted by acm at 3:20 PM on September 27, 2016

Response by poster: Just to follow up really quick:

It's all chocolate, not just one brand. The comments about the relative rarity of chocolate allergy are interesting - based on what I've read (e.g.) chocolate is one of the most common self-reported hypersensitivities but is very rarely confirmed as a bona fide IgE allergy by testing. Still, may be worth looking into further.

Re: tree nuts, to be totally clear, the only food reaction I got (pecans) actually seemed kind of borderline -- the nurse reading the test scored it at the lowest level for a positive reaction, and at first the allergist was actually kind of skeptical that there was any reaction there at all (she did sign off on it eventually but still seemed kind of skeptical tbh). My allergist told me that based on these test results, she wouldn't advise me to avoid tree nuts or peanuts, and she also didn't think I needed an EpiPen prescription. (I actually went to the allergist because I thought I was developing an almond allergy, but that was negative, as was cashew, walnut, etc.) That's part of why I thought this might be something other than an allergy.

I think they didn't do the blood test because there's a yet higher rate of false positives compared to the skin test, and they didn't want me to limit my diet unnecessarily. A supervised food challenge might be a good idea though. I am 99% sure it's not dairy or soy since I consume those every day without problems and the skin tests were negative.

Copper is an interesting idea but coffee, avocado, and leafy greens don't bother me (tea makes my mouth pucker, but without this burning sensation).
posted by en forme de poire at 3:54 PM on September 27, 2016

Apparently chocolate allergies often go along with copper allergies, of all the weird-ass things, and so does reactions to tea. Have you maybe had copper looked at? The amount of copper in a chocolate allergy sample might not have been enough to cause a reaction compared to the amount of it (or the amount of whatever it is you are actually reacting to) in a mouthful of chocolate.

That's fascinating, sciatrix.

As you well may know, candy of all sorts is traditionally made in unlined copper kettles, and decades ago, I happened to do a temp stint in a candy factory which made all their candies, including chocolates, in rotating, ~50 gal. unlined, cement mixer shaped and tilted copper vessels.

When I went looking for a connection between copper and aphthous stomatitis, here's what I found:
Copper/zinc and copper/selenium ratios, and oxidative stress as biochemical markers in recurrent aphthous stomatitis.

Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae, and oxidative stress presumably contributes to its pathogenesis. The aim of this study is to scrutinize the relationship between oxidative stress and serum trace elements (copper, Cu; zinc, Zn; selenium, Se), and to evaluate the ratios of Cu/Zn and Cu/Se in this disorder.

Patients with RAS (n = 33) and age- and sex-matched healthy control subjects (n = 30) were enrolled in this study.

Oxidative stress was confirmed by the significant elevation in plasma MDA, and by the significant decrease in CAT, SOD1, and GPx (p < 0.05). When compared to controls, Zn and Se levels were significantly lower in patients, whereas Cu levels was higher in RAS patients than those in controls (p < 0.05). In addition, the correlation results of this study were firstly shown that there were significant and positive correlations between Se-CAT, Se-GPx, and Cu-MDA parameters, but negative correlations between Se-Cu, Se-MDA, Cu-CAT, Cu-SOD1 and Cu-GPx parameters in RAS patients. Furthermore, the ratios of Cu/Zn and Cu/Se were significantly higher in the patients than the control subjects (p < 0.05). Our results indicated that lipid peroxidation associated with the imbalance of the trace elements seems to play a crucial role in the pathogenesis of RAS. Furthermore, the serum Cu/Zn and Cu/Se ratios may be used as biochemical markers in these patients.
And even if the chocolate en forme de poire is consuming now does not contain significant copper, it's conceivable a reaction to chocolate was developed by association with copper in the past.
posted by jamjam at 4:21 PM on September 27, 2016 [1 favorite]

Dark chocolate and black tea are high in oxalates, and foods high in oxalates often irritate my mouth. I'm a little less certain of this possibility since you mention leafy greens don't bother you. Most cooked greens don't bother me, but I've had bad experiences with Swiss chard, and raw spinach is the worst.

In any case, it's possible to have an unpleasant reaction from a sensitivity or intolerance that is not a "true" allergy.
posted by hsieu at 4:35 PM on September 27, 2016 [3 favorites]

You just described an allergic reaction. You have a chocolate allergy. I have a chocolate allergy. The real food allergy test is by eating the substance and seeing if you have a reaction. You have a reaction -- you have a chocolate allergy. It is that simple. Skin test reactions are different than food allergies. They do not track, in my experience.
posted by djinn dandy at 6:27 PM on September 27, 2016 [1 favorite]

Toxicologist here.

Does the problem resolve if you take an antihistamine before/during an episode? That's one of the first questions a physician will ask. Also, are you sensitive to caffeine? Are you taking any medications on a routine basis?

"Allergy" is a complicated word. You can have a response on the allergy spectrum without testing positive in a skin test, but it's still debated what that means (i.e. you might have signs of an allergic response without much or any threat of anaphylaxis from an exposure assmall as a piece of chocolate after dinner). You may well be having an irritant response and/or non-allergic hypersensitivity, even pseudoallergy (all distinct from classical allergy in the layperson's sense). I wouldn't think twice about asking my doctor for a follow-up visit or specialist reference if it's out of usual doctor's range.
posted by late afternoon dreaming hotel at 8:37 AM on September 28, 2016 [3 favorites]

Are there any other plausible reasons besides a food allergy that I could be experiencing something like this?

It's uncommon, but it could be a mild/early sign of oral lichen planus, [warning: extreme example photos] which is an autoimmune disease. I was diagnosed with this about 18 months ago but it started slowly long betore that. I actually turned out to have a super rare other thing (like, 100 people have itj!) but it's basically the same, it just responds to different treatment.

Out of all my forbidden foods (including tomato, strawberry, nuts, cinnamon, spicy foods, rough textures) chocolate is the worst of all. Like you the reaction is immediate. You mentioned you had ulcers. I had them and didn't realize that food (and stress!!) was bringing them on because they might not be painful until something else like chocolate irritated it.

If you're not having luck following the allergy trail you might want to see a dentist or doctor specializing in oral and maxillofacial pathology (OMP)if your doctor isn't familiar with the disease. (Many doctors have never seen a case in the wild.)
posted by Room 641-A at 10:23 PM on September 28, 2016 [1 favorite]

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