Not An Allergen … but can cause allergic reactions

Cacao, Cocoa

It’s unlikely to see cacao (the raw, unprocessed version of cocoa), cocoa, or chocolate in a patch test tray and while there are case reports of allergic or systemic contact dermatitis to these substances, they are still relatively rare. The risk can be higher if your job requires you to handle these items frequently, such as if you work in the food industry.

It is important to emphasize that it is possible to have a food allergy to cacao, cocoa, or chocolate (although this, too, seems quite rare). This can be confirmed by a RAST, prick, or scratch test with an allergist. As a rule, B-cell reactions and T-cell reactions (skin) do not cross over (there is quite a bit of difference between skin and other types of allergies). But there are exceptions. If you think you might be sensitive to cacao, cocoa, or chocolate and have a history of naso-brochial, food, or other allergies as well as sensitive skin, get both a prick, scratch, or RAST test from an allergist AND a skin patch test from a dermatologist.

For skin in particular:

• Be cautious if you patch tested positive to nickel or benzyl alcohol, both of which occur naturally in cacao.
  • Note that many natural substances are proven contact allergens, enough so that a recent study in the Journal of Drugs in Dermatology states, “We emphasize the misconception of clean, natural, organic, and vegan to equal safe … Many naturally derived ingredients are the cause of dermatitis.” Opt for validated hypoallergenic and use your patch test results to guide you.
• Chocolate might have other additives that are also top skin allergens such as cinnamon, vanilla, citruses, fruits, Balsam of Peru, and other flavors (many of which are related to fragrance), as well as dyes and certain preservatives.
• Look out for chocolate as a scent added to skincare or cosmetics products, too.

If your job entails handling these substances …

• If you notice a skin reaction after handling cacao, cocoa, or chocolate, see an allergist for a prick or scratch test, and a dermatologist for a patch test (especially if you also have atopic dermatitis, aka eczema) to help rule out other possible substances that could be causing the reaction. Your doctor can provide you with antihistamines or other medications should you need them.
• When on the job, use protective gloves (make sure they’re of unbleached pure cotton cloth or another material and color that you are not sensitive to; your patch test can guide you).
  • Applying a purely mineral, non-comedogenic barrier-protective product like Stay-On-Point! (or Armada Baby or Post-Procedure) or Boo-Boo Balm on your hands before putting on cotton gloves (not if you’re using non-cotton gloves; moisture under latex gloves can cause the skin to get macerated and more irritated). This may provide further protection from your contact allergens and the gloves themselves.
• Change out of work clothes as quickly as possible. Use an allergen-free laundry soap such as Fawn & Lauder or even Superwash!
• Wash hands with Essence Skin-Saving Soap, Superwash, or any of our facial cleansers.
• Use our allergen-free moisturizers liberally on hands every day and even multiple times during the day such as after hand washing.
• For very irritated hands, try this overnight layering intensive moisturization technique: apply moisturizer liberally all over hands. Follow with Know-It-Oil virgin coconut oil then Boo-Boo Balm. Wrap in cling wrap or pure, organic cotton cloth or socks (Cottonique makes some) and leave on overnight.

Subscribe to VMVinSKIN.com and our YouTube channel for more hypoallergenic tips and helpful “skinformation”!

If you have a history of sensitive skin…

…don’t guess! Random trial and error can cause more damage. Ask your dermatologist about a patch test.

To shop our selection of hypoallergenic products, visit vmvhypoallergenics.com. Need help? Ask us in the comments section below, or for more privacy (such as when asking us to customize recommendations for you based on your patch test results) contact us by email, or drop us a private message on Facebook.

For more:

• On the prevalence of skin allergies, see Skin Allergies Are More Common Than Ever. 
• For the difference between irritant and allergic reactions, see It’s Complicated: Allergic Versus Irritant Reaction.
• For the difference between food, skin, and other types of reactions: see Skin & Food Allergies Are Not The Same Thing. 
• On the differences between hypoallergenic, natural, and organic, check out Is Natural Hypoallergenic? and this video in our YouTube channel. 
• To learn about the VH-Rating System and hypoallergenicity: What Is The Validated Hypoallergenic Rating System?

Main References: 

Regularly published reports on the most common allergens by the North American Contact Dermatitis Group and European Surveillance System on Contact Allergies (based on over 28,000 patch test results, combined), plus other studies. Remember, we are all individuals — just because an ingredient is not on the most common allergen lists does not mean you cannot be sensitive to it, or that it will not become an allergen. These references, being based on so many patch test results, are a good basis but it is always best to get a patch test yourself.

1. Sadhasivamohan A, Karthikeyan K. Chocolate and Skin: The Impact of an Insatiable Indulgence. Indian Dermatol Online J. 2022 Oct 21;13(6):806-809. doi: 10.4103/idoj.idoj_238_22. PMID: 36386751; PMCID: PMC9650740.
2. Jacob, S.E, Hamann, D, et al. (2015), Easter Egg Hunt Dermatitis: Systemic Allergic Contact Dermatitis Associated with Chocolate Ingestion. Pediatr Dermatol, 32: 231-233. https://doi.org/10.1111/pde.12490.
3. Krecisz B, Chomiczewska D, et al. Systemic contact dermatitis to nickel present in cocoa in 14-year-old boy. Pediatr Dermatol. 2011 May-Jun;28(3):335-6. doi: 10.1111/j.1525-1470.2011.01235.x. Epub 2011 Mar 3. PMID: 21371113.
4. Lopes JP, Kattan J, et al. Not so sweet: true chocolate and cocoa allergy. J Allergy Clin Immunol Pract. 2019; 7: 2868-2871.
5. Nin Valencia A, Retes LS, et al. Allergy to Theobroma Cacao. Clin Case Rep. 2024;0:e8803. doi:10.1002/ccr3.8803
6. Urban K, Giesey R, et al. A Guide to Informed Skincare: The Meaning of Clean, Natural, Organic, Vegan, and Cruelty-Free. J Drugs Dermatol. 2022 Sep 1;21(9):1012-1013.
7. Houle M-C, DeKoven JG, et al. North American Contact Dermatitis Group Patch Test Results: 2021–2022. Dermatitis®. 2025;36(5):464-476. doi:10.1089/derm.2024.0474.
8. DeKoven JG, Warshaw EM, Reeder MJ, Atwater AR, Silverberg JI, Belsito DV, Sasseville D, Zug KA, Taylor JS, Pratt MD, Maibach HI, Fowler JF Jr, Adler BL, Houle MC, Mowad CM, Botto N, Yu J, Dunnick CA. North American Contact Dermatitis Group Patch Test Results: 2019-2020. Dermatitis. 2023 Mar-Apr;34(2):90-104. doi: 10.1089/derm.2022.29017.jdk. Epub 2023 Jan 19. PMID: 36917520.
9. Uter W, Wilkinson SM, Aerts O, Bauer A, Borrego L, Brans R, Buhl T, Dickel H, Dugonik A, Filon FL, Garcìa PM, Giménez-Arnau A, Patruno C, Pesonen M, Pónyai G, Rustemeyer T, Schubert S, Schuttelaar MA, Simon D, Stingeni L, Valiukevičienė S, Weisshaar E, Werfel T, Gonçalo M; ESSCA and EBS ESCD working groups, and the GEIDAC. Patch test results with the European baseline series, 2019/20-Joint European results of the ESSCA and the EBS working groups of the ESCD, and the GEIDAC. Contact Dermatitis. 2022 Oct;87(4):343-355. doi: 10.1111/cod.14170. Epub 2022 Jun 24. PMID: 35678309. https://pubmed.ncbi.nlm.nih.gov/35678309/
10. DeKoven JG, Silverberg JI, Warshaw EM, Atwater AR, et al. North American Contact Dermatitis Group Patch Test Results: 2017-2018. Dermatitis. 2021 Mar-Apr 01;32(2):111-123.
11. DeKoven JG, Warshaw EM, Zug KA, et al. North American Contact Dermatitis Group Patch Test Results: 2015-2016. Dermatitis. 2018 Nov/Dec;29(6):297-309.
12. DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group Patch Test Results 2013-2014. Dermatitis. 2017 Jan/Feb;28(1):33-46.
13. Warshaw, E.M., Maibach, H.I., Taylor, J.S., et al. North American contact dermatitis group patch test results: 2011-2012. Dermatitis. 2015; 26: 49-59.
14. W Uter et al. The European Baseline Series in 10 European Countries, 2005/2006–Results of the European Surveillance System on Contact Allergies (ESSCA). Contact Dermatitis 61 (1), 31-38.7 2009.
15. Wetter, DA et al. Results of patch testing to personal care product allergens in a standard series and a supplemental cosmetic series: An analysis of 945 patients from the Mayo Clinic Contact Dermatitis Group, 2000-2007. J Am Acad Dermatol. 2010 Nov;63(5):789-98.
16. Warshaw EM, Buonomo M, DeKoven JG, et al. Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis: The North American Contact Dermatitis Group Experience. JAMA Dermatol. 2021 Dec 1;157(12):1456-1465.
17. Verallo-Rowell VM. The validated hypoallergenic cosmetics rating system: its 30-year evolution and effect on the prevalence of cosmetic reactions. Dermatitis 2011 Apr; 22(2):80-97.
18. Ruby Pawankar et al. World Health Organization. White Book on Allergy 2011-2012 Executive Summary.
19. Misery L et al. Sensitive skin in the American population: prevalence, clinical data, and role of the dermatologist. Int J Dermatol. 2011 Aug;50(8):961-7.
20. Warshaw EM1, Maibach HI, Taylor JS, Sasseville D, DeKoven JG, Zirwas MJ, Fransway AF, Mathias CG, Zug KA, DeLeo VA, Fowler JF Jr, Marks JG, Pratt MD, Storrs FJ, Belsito DV. North American contact dermatitis group patch test results: 2011-2012.Dermatitis. 2015 Jan-Feb;26(1):49-59.
21. Warshaw, E et al. Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. J AmAcadDermatol 2009;60:23-38.
22. Marks JG, Belsito DV, DeLeo VA, et al. North American Contact Dermatitis Group patch-test results, 1998 to 2000. Am J Contact Dermat. 2003;14(2):59-62.
23. Warshaw EM, Belsito DV, Taylor JS, et al. North American Contact Dermatitis Group patch test results: 2009 to 2010. Dermatitis. 2013;24(2):50-99.
24. Verallo-Rowell V. M, Katalbas S.S. & Pangasinan J. P. Natural (Mineral, Vegetable, Coconut, Essential) Oils and Contact Dermatitis. Curr Allergy Asthma Rep 16,51 (2016) . https://doi.org/10.1007/s11882-016-0630-9.
25. de Groot AC. Monographs in Contact Allergy, Volume II – Fragrances and Essential Oils. Boca Raton, FL: CRC Press Taylor & Francis Group; 2019.
26. De Groot AC. Monographs in Contact Allergy Volume I. Non-Fragrance Allergens in Cosmetics (Part I and Part 2). Boca Raton, Fl, USA: CRC Press Taylor and Francis Group, 2018.
27. Zhu TH, Suresh R, Warshaw E, et al. The Medical Necessity of Comprehensive Patch Testing. Dermatitis. 2018 May/Jun;29(3):107-111.

Want more great information on contact dermatitis? Check out the American Contact Dermatitis Society, Dermnet New Zealand, the Contact Dermatitis Institute, and your country’s contact dermatitis association.

Laura is our “dew”-good CEO at VMV Hypoallergenics and eldest daughter of VMV’s founding dermatologist-dermatopathologist. She has two children, Madison and Gavin, and works at VMV with her family and VMV’s signature “skinfatuated, skintellectual, skingenious” team. In addition to saving the world’s skin, Laura is passionate about health, cultural theory, human rights, happiness, and spreading goodness (like a VMV cream)!