Food Allergy & Chinese Herbs
An allergy is the over-reaction of natural bodily defenses in response to a particular substance. Potential exposure to allergy-provoking substances takes place through our interaction with the world around us: by breathing, ingesting foods, or by the contact of allergens with skin and mucus membranes. Mild to moderate allergic conditions may cause symptoms such as hives, eczema, redness of the skin, itchy mouth and throat, nasal congestion or a runny nose, sneezing, eye irritation and other related symptoms. Severe allergic responses may involve obstructive swelling of the lips, tongue, and/or throat, trouble swallowing, and shortness of breath or wheezing. Allergies may progress with these and more symptoms, while some allergic responses are immediate and emergency-level anaphylaxis, a serious and potentially life-threatening state that requires immediate treatment.
Major categories of food allergies include milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, soybeans, and wheat, which together account for over 90% of food allergies, according to the Food and Drug Administration (FDA). In addition, it is estimated by the Centers for Disease Control (CDC) that food allergies affect 4 to 6% of children and 4% of adults.
While these individuals may know of their food allergies, they are not likely to know that they may have allergies to Chinese herbs that are the same substance as or related to their food allergy triggers. Therefore, practitioners of TCM must inquire as to the known allergies for each patient, and identify which Chinese herbs and formulas pose actual or potential risk to induce direct allergic response or cross allergy (from a substance similar in content to their primary allergen). Prudent action by the practitioner in this way will minimize and prevent allergic reactions to Chinese herbs, and facilitate smoother progress in care.
Listed below are the major categories of allergens, including their relationship with Chinese herbs and formulas in general, and suggested substitutes for the potential allergen where possible.
Approximately 2 to 3% of children under 3 years of age are allergic to cow’s milk and dairy products. Fortunately, 20% of children outgrow this allergy by age 4, and 80% of children outgrow it by age 16.
Cow’s milk is NOT used in Evergreen herbs and formulas, nor are dairy products.
Approximately 2% of children are allergic to eggs and the proteins in egg whites or yolks. Fortunately, 70% of children with an egg allergy outgrow this condition by age 16.
Eggs are NOT used in Evergreen herbs and formulas.
Note: Though Ji Zi Huang (Galli Vitellus), literally 'egg yolk', has been listed in the Chinese materia medica in the past, it is rarely used today as herbal medicine. It is more likely to be discussed as nutritional options.
Allergy to fish affects adults much more often than children. The risk of cross allergy is relatively low with fish, as having an allergy to one type of fish (i.e., bass, flounder, or cod) does not mean there will be cross allergy to other types of fish (i.e., tuna) or shellfish (shrimp, crab and lobster).
Fish is NOT used in Evergreen herbs and formulas.
The general category ‘shellfish’ includes both crustacea and mollusks. Approximately 0.5 to 2.5% of the general population is allergic to shellfish.
Crustacea
Crustacea is a type of shellfish that has a hard shell and no backbone, such as crabs, crayfish, lobster, prawns and shrimp. For those who are sensitive to this, crustaceans carry high risk of provoking food allergy.
Crustaceans are NOT used in Evergreen herbs and formulas.
Mollusks
Mollusks are shellfish that have hinged two-part shells, such as clams, mussels, oysters and scallops, as well as various types of octopus, snails and squid. (Octopus and squid have internalized their shells, so do not completely resemble their company in the mollusk family.)
Mollusks usually are associated with low risk of allergic responses, and there is only a minor risk of cross allergy to mollusks for those who are allergic to crustacean shellfish.
Chinese herbs or formulas that contain substances from mollusk shellfish are listed in the following table.
Peanut allergy is linked with anaphylaxis – which is, as mentioned above, a serious and potentially life-threatening condition that requires immediate treatment. About 20% of children who have peanut allergies eventually outgrow it, according to the National Institutes of Health.
Note: A peanut is a legume (in the same family as soybeans, peas and lentils), not a tree nut.
Peanuts are NOT used in Evergreen herbs and formulas, but may be mentioned in therapeutic recipes in Chinese nutrition.
Tree nuts come in many shapes and sizes. Though delicious, tree nuts may also be linked to anaphylaxis. Tree nut allergies often last a lifetime, and the chances of outgrowing tree nut allergies is less than 10 percent. Tree nuts associated with high risk of food allergy include: almonds, beech nuts, brazil nuts, butternuts, cashews, chestnuts, chinquapins, coconut, hazelnuts, gingko nuts, hickory nuts, lichee nuts, macadamia nuts, pecans, pine nuts, pili nuts, pistachios, shea nuts, and walnuts.
HIGH Risk Tree Nuts
Chinese herbs that have high risk of triggering related tree nut allergy include ginkgo nuts and lichee nuts.
| Herb/Formula | Suggested Replacement | |
|---|---|---|
| Single Herbs | Bai Guo (Semen Ginkgo) | Wu Wei Zi (Fructus Schisandrae Chinensis) |
| Li Zhi He (Semen Litchi) | Ju He (Semen Citri Reticulatae) | |
| Herbal Formula | Dissolve (GS) 5 | Yin Chen Hao Tang (Artemisia Combination) |
5 contains Li Zhi He (Semen Litchi) |
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LOW Risk Tree Nuts
Chinese herbs that have low association with risk of tree nut allergies include peach seeds, Chinese dwarf cherry seeds, Chinese arborvitae seed and bitter apricot seeds.
Soy is a common ingredient in infant formulas and many other processed foods. Allergy to soy is most common in infants and children under 3 years of age. Fortunately, most children outgrow soy allergy by age 10.
Some Chinese herbs are derived from soy or are processed with soy beans or soya-bean oil.
Wheat allergies develop when the body’s immune system becomes sensitized and overreacts to wheat protein. Allergic reactions affect many parts of the body, including skin (i.e., rash or eczema), nose (i.e., stuffy nose, runny nose), lung (i.e., asthma), and others.
Some Chinese herbs are derived from wheat or contain wheat.
Gluten is a protein found in wheat, barley and rye. Hypersensitivity to gluten may cause general signs and symptoms (i.e., diarrhea, constipation, abdominal pain or fatigue) and specific illness (i.e., celiac disease in which the lining of the small intestine is damaged).
Some Chinese herbs are derived from wheat, barley and rye, and may contain gluten.
In April 2021, under the Food Allergy Safety, Treatment, Education, and Research (FASTER) Act sesame was added as the 9th major food allergen recognized by the United States. Approximately 0.23% of the US population is allergic to sesame.
Chinese herbs or formulas that contain sesame are listed in the following table.
| Herb/Formula | Suggested Replacement | |
|---|---|---|
| Single Herbs | Hei Zhi Ma (Hu Ma Ren) (Semen Sesami Nigrum) | He Shou Wu [Zhi] (Radix Polygoni Multiflori Praeparata) |
| Herbal Formulas | Qing Zao Jiu Fei Tang (Eriobotrya & Ophiopogon Combination) 27 | Mai Men Dong Tang (Ophiopogon Combination) |
| Xiao Feng San (Tangkuei & Arctium Formula) 27 | Silerex | |
| Dermatrol (Dry) 27 | Wen Qing Yin (Tangkuei & Gardenia Combination) | |
| Polygonum 14 27 | Qi Bao Mei Ran Dan (Seven Treasures Formula) | |
27 contains Hei Zhi Ma (Hu Ma Ren) (Semen Sesami Nigrum) |
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- Food Allergies: What You Need to Know by US Food and Drug Administration.
- Food Allergy by National Institute of Health. https://www.niaid.nih.gov/diseases-conditions/food-allergy
- Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations by Centers for Disease Control & Prevention
- Allergens by Food Allergy Research and Education.
- Chen J.K., and Chen T.T. Chinese Medical Herbology and Pharmacology, 2004. City of Industry, CA USA. Art of Medicine Press.
- Chen J.K., and Chen T.T. Chinese Herbal Formulas and Applications, 2009. City of Industry, CA USA. Art of Medicine Press.
- Chen J.K., and Chen T.T. Chinese Herbal Formulas and Applications, 2009. City of Industry, CA USA. Art of Medicine Press.
- Woo, CK and Bahna SL, Not all shellfish “allergy” is allergy! Clin Transl Allergy. 2011; 1:3.
- Dharmananda S., Eucommia - a Unique Rubber Tree. Institute for Traditional Medicine, Portland, Oregon.
- Quist C., Herbal Treatment in Special Populations.
- Prevalence and Severity of Sesame Allergy in the United States