Cochineal dye-induced immediate allergy: Review of Japanese cases and proposed new diagnostic chart

Naoko Takeo, Masashi Nakamura, Satoshi Nakayama, Osamu Okamoto, Naoki Sugimoto, Shinichi Sugiura, Nayu Sato, Susumu Harada, Masao Yamaguchi, Naoya Mitsui, Yumiko Kubota, Kayoko Suzuki, Makoto Terada, Akiyo Nagai, Junko Sowa-Osako, Yutaka Hatano, Hiroshi Akiyama, Akiko Yagami, Sakuhei Fujiwara, Kayoko Matsunaga

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Background: Cochineal dye is used worldwide as a red coloring in foods, drinks, cosmetics, quasi-drugs, and drugs. The main component of the red color is carminic acid (CA). Carmine is an aluminum- or calcium-chelated product of CA. CA and carmine usually contain contaminating proteins, including a 38-kDa protein thought to be the primary allergen. Severe allergic reactions manifest as anaphylaxis. The aim of this study was to review all Japanese reported cases and propose useful diagnostic chart. Methods: All reported Japanese cases of cochineal dye-induced immediate allergy were reviewed, and newly registered cases were examined by skin prick test (SPT) with cochineal extract (CE) and measurement of CE and carmine-specific serum IgE test. Two-dimensional (2D) western blotting using patient serum was conducted to identify the antigen. Results: Twenty-two Japanese cases have been reported. SPT and the level of specific IgE test indicated that six cases should be newly registered as cochineal dye allergy. All cases were adult females, and all cases except three involved anaphylaxis; 13 cases involved past history of local symptoms associated with cosmetics use. Japanese strawberry juice and fish-meat sausage, and European processed foods (especially macarons made in France) and drinks were recent major sources of allergen. 2D western blotting showed that patient IgE reacted to the 38-kDa protein and other proteins. Serum from healthy controls also weakly reacted with these proteins. Conclusions: SPT with CE and determination of the level of CE and carmine-specific IgE test are useful methods for the diagnosis of cochineal dye allergy.

Original languageEnglish
Pages (from-to)496-505
Number of pages10
JournalAllergology International
Issue number4
Publication statusPublished - 10-2018

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy


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