A single case report confirms rare IgE-mediated cocoa allergy causing anaphylaxis in a child.

This publication combines a systematic review with a detailed case report involving a 2-year-old female patient. The patient had a documented history of allergic rhinitis and anaphylaxis associated with tree nuts. The primary exposure was the ingestion of a dark chocolate bar within a hospital setting. The study aimed to characterize the clinical manifestations and diagnostic confirmation of this specific allergic event.

The intervention involved the oral ingestion of dark chocolate, serving as the trigger for the primary outcome of clinical manifestations. Secondary outcomes included results from skin prick testing, prick-by-prick testing, serum specific IgE levels, and an oral food challenge. Upon ingestion, the patient exhibited immediate multisystemic reactions including cough, wheezing, pruritus, perioral erythema, and urticaria. These findings were consistent with a diagnosis of anaphylaxis.

Management of the acute reaction involved the administration of oral antihistamines, corticosteroids, and inhaled salbutamol, which led to the rapid resolution of symptoms. Notably, intramuscular epinephrine was not administered during this specific event. Diagnostic confirmation was achieved through positive skin prick testing, prick-by-prick testing, and elevated serum specific IgE levels. The oral food challenge further validated the diagnosis of sensitization to cocoa.

Safety considerations highlight that the adverse events were the aforementioned respiratory and cutaneous symptoms, classified as serious adverse events in the context of anaphylaxis. The patient required strict dietary avoidance of cocoa following the event. Limitations of the evidence include the fact that only a few confirmed cases of this specific allergy have been published to date, and true IgE-mediated cocoa allergy is inherently rare. Most suspected reactions are likely caused by sensitization to other allergens present in cocoa products. Consequently, comprehensive diagnostic workup, including oral challenge, is essential to guide correct management and patient counseling.