Food allergy: nut oils in topical products
Question:
11/19/2020
My question is about almond oil in cosmetic products and food allergy. My own toddler has moderate-severe eczema. I sent Cetaphil Moisturizing Cream for him to his daycare (which is "nut-free"). I was called by the daycare due to the listed ingredient Prunus Amygdalus Dulcis (Sweet Almond) Oil and told this cannot be in the building. They know I am an allergist and were happy to accept a document from me about the safety of nut oils.
I generally tell patients that highly refined nut oils are unlikely to contain adequate allergenic protein to elicit a reaction when ingested. I have never specifically recommended avoidance of topical products which contained nut oils. However, when I searched for documentation to support the safety of almond oil in cosmetics, I found numerous websites recommending avoidance of these products by food allergic patients. Is this an actual risk? I previously doubted that if a nut-allergic child in my son's class accidentally ingested his Cetaphil, this could lead to anaphylaxis. If that scenario occurred in a patient of mine, I would feel compelled to search very hard for another etiology before concluding it was the Cetaphil. However, I could not find literature on allergen content in almond oil, either. The most official documentation I can find is the FDA statement that refined oils are exempt from food allergen labeling. Is there any data on this? Should I be telling my almond-allergic patients to avoid using these cosmetics?
Answer:
This is an interesting question. A PubMed search revealed that this has not been well studied, as noted in a 2006 article for which I could only access the abstract. In that article, eleven cases of contact urticaria and contact dermatitis were noted. No nuts were mentioned; wheat, egg, oat, milk and peanut were implicated. A 2010 report described 2 patients with allergy to lipid transfer proteins (one of whom was allergic to various nuts and fruits) who developed acute allergic reactions to moisturizing cream. This report didn't investigate the specific allergenic ingredients in the cream for the nut-allergic individual.
Whether a nut oil contains allergenic protein depends upon the extraction process used to obtain the oil. As you noted, refined oils are extracted using chemical agents or high heat and generally do not contain proteins or other natural nutrients while unrefined (cold-pressed) nut oils do. More and more, “natural” or boutique cleansers (soaps, moisturizers, haircare products) and cosmetic products appear to be using non-refined nut oils, so there is potential for topical exposure to allergenic food proteins.
I encourage patients to ask the manufacturer whether a nut oil ingredient is refined or not before using the product or after an adverse reaction has occurred.
I hope this information is helpful to you in the care of your patient.
Jacqueline A. Pongracic, MD, FAAAAI