FOOD INTOLERANCE NETWORK FACTSHEET
Natural red colour cochineal (120)
Keywords: cochineal, carminic acid, allergy, allergic, colour, 120, E120, carmine, CI 75470
Introduction: what is cochineal?
Cochineal is made from the bodies of dried pregnant scale insects which feed on cacti in Central America. An extract from the cochineal insects is combined with aluminium to form carminic acid, also known as carmine.
This colour is regarded as safe from the food intolerance point of view - there have been no reports of behavioural reactions to it. However, there are rare but increasing reports of true allergic reactions - including urticaria, asthma, vomiting, diarrhoea and anaphylaxis - to the proteins in the insects. True allergy also known as IgE-mediated allergy or type 1 allergy is a reaction to the proteins in foods as opposed to food intolerance which is a reaction to the chemicals in foods.
Allergies to cochineal are increasing
Cochineal is used increasingly in foods and cosmetics as artificial colours are phased out. As its use increases, the number of reports of allergic reactions to the insect proteins in cochineal are increasing, see reports in Scientific References below.
Confusing labelling of cochineal
It is important that parents, relatives and carers of children with allergies should be able to identify products that contain this additive. Cochineal colour can appear in labelling as:
- colour (120)
- colour (E120)
- carmine (not to be confused with artificial colours carmoisine 122 or indigo carmine 132)
- cochineal carmine
- carminic acid
- colour index (CI 75470)
- This may be confusing for consumers, see Reader Report below.
It is important that products containing allergens be clearly labelled, see the Food Industry's Food Allergen Guide 2007.
 True allergy to cochineal (120) also known as carmine (November 2008)
My daughter (now 10) is extremely sensitive to cochineal 120. She develops a rash on her face that extends from under her eyes to around the jaw line. It is a raised, red rash that feels like "sand under the skin". There is noticeable facial swelling also. This occurs within a few minutes of ingestion and lasts for a couple of days. We had great difficulty pinpointing the cause until she had some Breaka strawberry milk. The only thing that could it could have been was the cochineal 120. We confirmed this ourselves by placing 1 drop of cochineal into a drink and she responded with a small amount immediately. An allergist has confirmed that she should avoid this colour. She had a few severe episodes as a young child that involved total head to toe rash and many family photos look like she has a fat face and is sunburned. We now recognize this as a reaction.
We are finding a huge increase in the number of foods that contain 120, many have wording stating no artificial colours. We read labels where at all possible and try to make safer choices otherwise. This is getting increasingly difficult. We try to make our daughter responsible for her diet otherwise she tends to resent the policing of it. Grandparents and friends are struggling with the different labeling also. For example in a particular brand of fruit cup cordial, colours are listed as beta carotene and carmine. I had concerns about the carmine, believing it to be a red colour and found it is another label for cochineal 120.
I have concerns about some colours being labelled by names other than their commonly known ones. It makes reading labels difficult. Friends, relatives and my child read everything before eating and had presumed this one ok. We were very lucky we checked before giving her some. – mother of an allergic child, by email
Kotobuki Y and others, Case of urticaria due to cochineal dye in red-colored diet [Article in Japanese] Arerugi. 2007;56(12):1510-4. Department of Dermatology, Osaka University.
We herein describe a 33-year-old female who recurrently exhibited urticaria accompanied by vomiting, diarrhea and dyspnea after taking red-colored food. From her history, we suspected the cochineal dye, the commonly used natural red dye in red-colored food and beverage, to be the cause of her symptoms. Oral provocation test using cochineal dye-stained red-colored boiled-fish-paste induced urticaria and respiratory symptoms. Furthermore the prick tests and the scratch tests with cochineal dye and carminic acid, the major ingredient of cochineal dye, were also positive. These results indicate that type 1 allergy to cochineal dye caused urticaria in this patient. Thereafter, she avoided the foods containing a cochineal dye and showed a complete clinical remission. Recently, the number of literatures described about increased incidence of type 1 allergy to cochineal dye. As the usage of cochineal dye is increasing in the Japanese market, we should keep in mind that cochineal dye can be a cause of urticaria in daily practice.
Acero S and others, Occupational asthma and food allergy due to carmine. Allergy. 1998 ;53(9):897-901.Seccion Alergología, Hospital Virgen del Camino, Pamplona, Spain
Carmine (E120), a natural red dye extracted from the dried females of the insect Dactylopius coccus var. Costa (cochineal), has been reported to cause hypersensitivity reactions. We report a case of occupational asthma and food allergy due to carmine in a worker not engaged in dye manufacturing. A 35-year-old nonatopic man, who had worked for 4 years in a spice warehouse, reported asthma and rhinoconjunctivitis for 5 months, related to carmine handling in his work. Two weeks before the visit, he reported one similar episode after the ingestion of a red-colored sweet containing carmine. Peak flow showed drops higher than 25% related to carmine exposure. Prick tests with the cochineal insect and carmine were positive, but negative to common aeroallergens, several mites, foods, and spices. The methacholine test was positive. Specific bronchial challenge test with a cochineal extract was positive with a dual pattern (20% and 24% fall in FEV1). Double-blind oral challenge with E120 was positive. The patient's sera contained specific IgE for various high-molecular-weight proteins from the cochineal extract, as shown by immunoblotting. Carmine proteins can induce IgE-mediated food allergy and occupational asthma in workers using products where its presence could be easily overlooked, as well as in dye manufacture workers.
Chung K and others, Identification of carmine allergens among three carmine allergy patients. Allergy. 2001 ;56(1):73-7. Department of Internal Medicine, University of Michigan Hospital, Ann Arbor 48109-0380, USA.
BACKGROUND: There have been several reports of carmine allergy; however, identification of the responsible carmine allergens has not been widely documented. METHODS: Three female patients presented with a history of anaphylaxis and/or urticaria/angioedema after ingestion of carmine-containing foods. All three patients had 4+ skin prick tests to carmine. Among them, two patients were confirmed to have carmine allergy by blinded, placebo-controlled food challenges to carmine. SDS-PAGE of cochineal insects and carmine, immunoblotting for IgE antibody with sera from all three patients, and immunoblotting inhibition with carmine were performed. RESULTS: SDS PAGE of minced cochineal insects revealed several protein bands of 23-88 kDa. Several of these bands were variably recognized by our three patients' sera, and this reactivity was inhibited by carmine. Although no protein bands could be visualized on SDS-PAGE of carmine in Coomassie brilliant blue staining, three protein bands were recognized by two of the three patients' serum. CONCLUSIONS: These results suggest that commercial carmine retains protein-aceous material from the source insects. These insect-derived proteins (possibly complexed with carminic acid) are responsible for IgE-mediated carmine allergy. Patient reactivity to these proteins may vary.
Quirce S and others, Occupational asthma and immunologic responses induced by inhaled carmine among employees at a factory making natural dyes. J Allergy Clin Immunol. 1994 ;93(1 Pt 1):44-52. Department of Allergy, Hospital Virgen del Camino, Pamplona, Spain.
Carmine is a natural red dye widely used as a food coloring agent and for cosmetic manufacture. It is extracted from the dried females of the insect Dactylopius coccus var. Costa (cochineal). Although it has been reported that inhalation of carmine may give rise to occupational asthma and extrinsic allergic alveolitis, there is little evidence of its immunogenic capacity. We studied nine current employees at a factory making natural dyes and one former employee who had left this plant after occupational asthma developed. A current employee had work-related symptoms of rhinitis and asthma that were confirmed by bronchial provocation tests, and another worker had rhinitis. Immunologic sensitization to carmine and cochineal was evaluated by means of skin testing and determination of serum-specific IgE and IgG subclass antibodies by RAST and ELISA, respectively. The specificity of the RAST assay was investigated by RAST inhibition with different fractions of carmine. The three workers with respiratory symptoms had positive skin prick test reactions to both carmine and cochineal. An immediate response to the bronchial provocation test with carmine and cochineal was observed in the current employee with asthma. Specific IgE antibodies against carmine and cochineal were found only in this worker. RAST inhibition studies indicated that the main allergen had a molecular weight between 10 and 30 kd. Specific IgG antibodies against carmine and cochineal, mainly the subclasses IgG1, IgG3, and IgG4, were found in the 10 subjects surveyed. These findings suggest that carmine may induce immunologic responses, most likely IgE mediated in workers with symptoms of occupational asthma.
Wüthrich B and others Anaphylactic reactions to ingested carmine (E120). Allergy. 1997 ;52(11):1133-7. Department of Dermatology, University Hospital, Zurich, Switzerland.
We report five cases of anaphylactic reaction to carmine (cochineal, E120) after patients drank an alcoholic beverage. By means of positive skin prick tests (SPT) and positive RAST to carmine. IgE-mediated sensitization could be established. One nonatopic patient showed also a great amount of serum IgE antibodies to the carmine acid-albumin conjugate. Due to its widespread use in the food and cosmetic industry, carmine should be tested in the allergy work-up in case of allergic reactions after a drink or a meal.
Baldwin JL and others, Popsicle-induced anaphylaxis due to carmine dye allergy. Ann Allergy Asthma Immunol. 1997;79(5):415-9. Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
BACKGROUND: IgE-mediated hypersensitivity is a suggested mechanism to explain adverse reactions from carmine-containing products. OBJECTIVE: To describe a patient who experienced anaphylaxis after ingestion of a popsicle colored with carmine and to provide additional evidence that the adverse reaction was IgE-mediated. METHODS: The patient and her husband underwent skin prick tests to the popsicle and carmine. The patient also received skin prick tests and/or open oral challenge to each of the other components of the incriminated food. Topical application of cosmetics with and without carmine to the patient's forearm was also performed. To confirm carmine-specific IgE, a Prausnitz-Kustner (P-K) test was performed using the patient's husband as recipient. Twenty control subjects also were tested to carmine by skin prick test. RESULTS: The patient showed 4+ skin prick test responses to the popsicle and carmine. Skin prick tests and/or open oral challenge to each of the other components of the popsicle were negative. The patient's husband's and 20 control subjects' skin prick tests to carmine were negative as was the patient's husband's skin prick test to the popsicle. Skin prick test reactivity to the popsicle and carmine were successfully transferred to the patient's husband in P-K format. Cosmetics applied to the patient's forearm elicited no immediate response. CONCLUSION: The positive skin prick tests to the popsicle and carmine and the successful (P-K) transfer of skin prick test reactivity support a carmine-specific, IgE-mediated mechanism in explaining our patient's popsicle-induced anaphylaxis
Ferrer A, Occupational asthma to carmine in a butcher. Int Arch Allergy Immunol. 2005 Nov;138(3):243-50. Allergy Department, Hospital de la Vega Baja, Orihuela, Spain.
Hypersensitivity to carmine (E120) has been identified as a cause of food intolerance and occupational asthma. We present a case of occupational asthma following exposure to carmine in a manufacturer of sausages and review the literature. CASE REPORT: A 42-year-old non-atopic male presented with a 5-year history of rhinoconjunctivitis and asthma on occupational exposure to food additive dusts. Symptoms increased after work. The patient had been exposed for more than 20 years. METHODS: Skin prick tests were performed with a battery of common inhalant allergens and spices. Cochineal, carmine lake and additive mixes used by the patient were extracted and subsequently used for skin prick test, bronchial provocation and in vitro measurements (specific IgE, Western blot and chromatographic fractionation). RESULTS: Prick tests were positive to carmine and carmine-containing additives; carmine-specific IgE and bronchial challenge tests were also positive (PC20 = 0.0004 mg/ml and 1.6 kU/l). Western blot showed IgE binding to bands of about 30 kDa on cochineal extract and a diffuse pattern at 40-97 kDa on carmine. This result was confirmed by gel filtration chromatography and dot blot. Carmine completely inhibited IgE binding to cochineal extract. DISCUSSION: Carmine is a potential sensitizer in an occupational setting: 18 cases of occupational asthma have been described to date. Carmine allergens are poorly defined; in general, proteins from cochineal not removed by the extraction process are considered as the main allergens in carmine. Our results are consistent with this, but show that these proteins may be subject to chemical modification.
DiCello MC and others, Anaphylaxis after ingestion of carmine colored foods: two case reports and a review of the literature.Allergy Asthma Proc. 1999 Nov-Dec;20(6):377-82. Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0383, USA.
Two patients with adverse food reactions to foods colored with carmine dye are presented, along with a review of the medical literature addressing adverse reactions to carmine colorant. This review summarizes the mounting evidence suggesting that adverse reactions to carmine colorant are the result of an IgE mediated mechanism.
Zenaidi M and others, Allergy to food colouring. A prospective study in ten children [Article in French]Tunis Med. 2005;83(7):414-8. Service de Gastro-entérologie et Nutrition Pédiatriques, Hôpital d'enfants Armand Trousseau, Paris, France.
In order to know more about allergy to food colouring, we conducted a prospective open study over 8 months in a group of 10 atopic children with repeated urticaria. The mean age was 6.5 years (4.2 - 13.5 years). The diagnosis was based on oral challenge tests along with hisory taking there were 3 cases of allergy to food colourings. Clinical features were mainly skin symptoms, sometimes associated with GI manifestations which were not only rare (1 case in our series) but also non specific. Colourings-free diet was recommended in consequence. It resulted in the disappearance of the symptoms in a child (Red cochineal) and their regression in the two others (Red cochineal, Red beet) with a follow up of 8 months and 3 months respectively.
Tabar AI and others, Asthma and allergy due to carmine dye [Article in Spanish] An Sist Sanit Navar. 2003;26 Suppl 2:65-73. Servicio de Alergología, Hospital Virgen del Camino, Pamplona.
Cochineal carmine, or simply carmine (E120), is a red colouring that is obtained from the dried bodies of the female insect Dactylopius coccus Costa (the cochineal insect). We have evaluated the prevalence of sensitization and asthma caused by carmine in a factory using natural colouring, following the diagnosis of two workers with occupational asthma. The accumulated incidence of sensitization and occupational asthma due to carmine in this factory are 48.1% and 18.5% respectively, figures that make the introduction of preventive measures obligatory. Occupational asthma caused by inhaling carmine should be considered as a further example of the capacity of certain protein particles of arthropods (in this case cochineal insects) to act as aeroallergens. Carmine should be added to the list of agents capable of producing occupational asthma, whose mechanism, according to our studies, would be immunological mediated by IgE antibodies in the face of diverse allergens of high molecular weight, which can vary from patient to patient. Nonetheless, given the existence of different components in carmine, it cannot be ruled out that substances of low molecular weight, such as carminic acid, might act as haptenes. Besides, since we are dealing with a colouring that is widely used as a food additive, as a pharmaceutical excipient and in the composition of numerous cosmetics, it is not surprising that allergic reactions can appear both through ingestion and through direct cutaneous contact. We find ourselves facing a new example of an allergen that can act through both inhalation and digestion, giving rise to an allergolical syndrome that can show itself clinically with expressions of both respiratory allergy and alimentary allergy.
Beaudouin E and others, Food anaphylaxis following ingestion of carmine. Ann Allergy Asthma Immunol. 1995 May;74(5):427-30., Service d'Immunologie Clinique et d'Allergologie, CHRU de Nancy, Hôpitaux de Brabois, Rue du Morvan, Vandoeuvre-les-Nancy, France.
BACKGROUND: The risk of sensitization to reactive dyes is well established. The clinical situation is caused most often by synthetic azo dyes and triphenylmethane derivatives but natural dyes such as carmine extracted from dried female insects, Coccus cacti (cochineal), have been incriminated. OBJECTIVE: Study of a case of anaphylaxis after ingestion of yogurt to establish the responsibility of carmine. METHOD: Case report of a patient who received skin prick test and leukocyte histamine release test with carmine and yogurt. CONCLUSIONS: This case provided evidence of an IgE-dependent mechanism and draws attention to the triggering dose of carmine (1 mg) although the acceptable daily intake is up to 5.0 mg per kg of body weight.
Fed Up by Sue Dengate (Random House, 2008)
© Sue Dengate update June 2011