Food Allergy and Chinese Herbs

 

FOOD ALLERGY AND CHINESE HERBS

by John K. Chen, Ph.D., Pharm.D., O.M.D., L.Ac.

Published May 15, 2026

An allergy is the over-reaction of the body's natural defenses to exposure to a particular substance. Mild to moderate allergies may cause symptoms such as hives, eczema, redness of the skin, an itchy mouth, nasal congestion or a runny nose, sneezing, and others. Severe allergies may cause obstructive swelling of the lips, tongue, and/or throat, trouble swallowing, and shortness of breath or wheezing.

According to the U.S. FDA (Food and Drug Administration), there are nine categories of food that together account for over 90% of food allergies: milk, egg, fish, crustacean shellfish, peanuts, tree nuts, soybeans, wheat and sesame. It is estimated by the CDC (Centers for Disease Control and Prevention) that food allergies affect 4 to 6% of children and 4% of adults. While these individuals may know their food allergies, they are unlikely to know if they have Chinese herb allergies. Therefore, TCM practitioners must inquire about known allergies among their patients, and identify which Chinese herbs and formulas pose a risk of inducing a direct allergy or cross-allergy. Such prudent actions will minimize and prevent allergic reactions to Chinese herbs.

This article will discuss these nine major categories of food allergies, and three additional allergens (gluten, sulfite and latex) and their relationship with Chinese herbs and formulas.

Additionally, if you'd like to earn continuing education credits, Click here [2] to purchase the article course and earn CEUs!

1. MILK

Approximately 2 to 3% of children under 3 years of age are allergic to milk and dairy products. Fortunately, approximately 20% of children outgrow this allergy by age 4, and 80% by age 16. Cow's milk and dairy products are not used in traditional Chinese herbal medicine.

2. EGG

Approximately 2% of children are allergic to eggs and the proteins in egg whites or yolks. Fortunately, approximately 70% of children with an egg allergy will outgrow this condition by age 16.

Table 1. Egg in Herbs and Formulas:

Single Herbs	Ji Zi Huang (Galli Vitellus) – egg yolk
Formulas	E Jiao Ji Zi Huang Tang (Ass-Hide Gelatin and Egg Yolk Decoction)

3. FISH

Fish allergies affect adults much more 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 necessarily mean there will be cross-allergy to other type of fish (i.e., tuna) or shellfish (i.e., shrimp, crab and lobster). Fish is not used in traditional Chinese herbal medicine.

4. SHELLFISH

Shellfish is a category that includes both crustaceans and mollusks. Crustaceans are shellfish with a hard shell and no backbone, such as crab, crayfish, lobster, prawns and shrimp. Mollusks are shellfish with a hinged two-part shell, such as clams, mussels, oysters and scallops, as well as various types of octopus, snails and squid.

Crustaceans

Crustacean shellfish carry a high risk of food allergy. Approximately 0.5 to 2.5% of the general population is allergic to crustacean shellfish. Crustaceans are not used in traditional Chinese herbal medicine.

Note: Cicadas and crustacean shellfish are arthropods and contain a common muscle protein called tropomyosin, which may trigger allergic reactions. Tropomyosin is a muscle protein mainly present in the body of the cicada, but not in the exoskeleton. This cross allergy is often observed and reported in individuals who eat the body of the cicada (e.g., cicada in tacos), but not the exoskeleton (e.g., Chan Tui (Periostracum Cicadae) - cicada molting). Therefore, it is generally considered safe for individuals with shellfish allergies to use cicada shells/exoskeleton/molting in herbal preparations.

Mollusks

For individuals with crustacean allergies, there is a 14% cross-reactivity with mollusk allergies.

Note: For reference only, mollusks used in Chinese herbal medicine include: Ge Qiao (Concha Meretricis seu Cyclinae), Hai Piao Xiao (Endoconcha Sepiae), Mu Li (Concha Ostreae), Shi Jue Ming (Concha Haliotidis), Wa Leng Zi (Concha Arcae), Zhen Zhu (Margarita) and Zhen Zhu Mu (Concha Margaritiferae). These mollusks are unlikely to cause allergies and do not require an allergy warning, according to the FDA.

5. PEANUTS

Peanut allergy is linked with anaphylaxis – a serious and potentially life-threatening condition that requires immediate treatment. Fortunately, approximately 20% of children who have a peanut allergy eventually outgrow it, according to the NIH (National Institute of Health). Note: A peanut is not a tree nut, but a legume (in the same family as soybeans, peas and lentils). Peanuts are not used in traditional Chinese herbal medicine.

6. TREE NUTS

Tree nuts come in many shapes and sizes. Though delicious, they may be linked to anaphylaxis. Tree nut allergies often last a lifetime, and the chance of outgrowing them is less than 10%. Tree nuts with a high risk of food allergy (requiring FDA allergen labeling) include: almond, black walnut, Brazil nut, California walnut, cashew, filbert/hazelnut, heartnut/Japanese walnut, macadamia nut/bush nut, pecan, pine nut/pinon nut, pistachio and walnut (English, Persian).

Table 2. Tree Nuts in Herbs and Formulas with Allergy Warning:

Single Herbs	He Tao Ren [Hu Tao Ren] (Semen Juglandis) – walnut Song Zi Ren (Semen Pini) – pine nut/pinon nut
Formulas	Ren Shen Hu Tao Tang (Ginseng and Walnut Decoction) Wu Ren Wan (Five-Seed Pill)

Note: For individuals with tree nut allergies, the probability of cross-reactivity with other tree nuts is described as very low / rare / negligible. Therefore, a warning label is required for tree nuts with a high risk of allergy (listed above), but not for other tree nuts due to low risk of cross-allergy concerns (listed below).

For reference only, other tree nuts used in Chinese herbs include: Bai Guo (Semen Ginkgo), Bai Zi Ren (Semen Platycladi), Ku Xing Ren (Semen Armeniacae Amarum), Li Zhi He (Semen Litchi), Tao Ren (Semen Persicae) and Yu Li Ren (Semen Pruni). These tree nuts are unlikely to cause tree nut allergies or cross-allergies, and do not require an allergy warning, according to the FDA.

7. SOYBEANS

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 allergies by age 10. In Chinese herbal medicine, soybeans may be used as an herb, and dried/black soybean or soya-bean oil may be used to process other herbs.

Table 3. Soybean in Herbs and Formulas:

Single Herbs

Da Dou Huang Juan (Semen Sojae Germinatum) – sprouted soybean Dan Dou Chi (Semen Sojae Praeparatum) – cooked and fermented soybean Hei Dou (Semen Sojae Nigrum) – dried/black soybean E Jiao (Colla Corii Asini) – processed with soya-bean oil to thicken glue Gui Ban Jiao (Colla Plastrum Testudinis) – processed with soya-bean oil to thicken glue Lu Jiao Jiao (Colla Cornus Cervi) – processed with soya-bean oil to thicken glue

Formulas

Bai Tou Weng Jia Gan Cao E Jiao Tang (Pulsatilla Decoction plus Licorice and Ass-Hide Gelatin)2 Bie Jia Jian Wan (Soft-Shelled Turtle Shell Pill)2 Bu Fei E Jiao Tang (Tonify the Lung Decoction with Ass-Hide Gelatin)2 Cong Bai Qi Wei Yin (Scallion Decoction with Seven Ingredients)1 Cong Chi Jie Geng Tang (Scallion, Prepared Soybean, and Platycodon Decoction)1 Cong Chi Tang (Scallion and Prepared Soybean Decoction)1 Da Ding Feng Zhu (Major Arrest Wind Pearl)2 E Jiao Ji Zi Huang Tang (Ass-Hide Gelatin and Egg Yolk Decoction)2 Huang Tu Tang (Yellow Earth Decoction)2 Huo Po Xia Ling Tang (Agastache, Magnolia Bark, Pinellia, and Poria Decoction)1 Huo Ren Cong Chi Tang (Scallion and Prepared Soybean Decoction from the Book to Safeguard Life)1 Jia Jian Fu Mai Tang (Modified Restore the Pulse Decoction)2 Jia Jian Wei Rui Tang (Modified Polygonatum Odoratum Decoction)1 Jiao Ai Tang (Ass-Hide Gelatin and Mugwort Decoction)2 Jiu Xian San (Nine-Immortal Powder)2 Lian Po Yin (Coptis and Magnolia Bark Decoction)1 Qing Zao Jiu Fei Tang (Eliminate Dryness and Rescue the Lung Decoction)2 San Huang Shi Gao Tang (Three-Yellow and Gypsum Decoction)1 San Jia Fu Mai Tang (Three-Shell Decoction to Restore the Pulse)2 Sang Xing Tang (Mulberry Leaf and Apricot Kernel Decoction)1 Shi Gao Tang (Gypsum Decoction)1 Wen Jing Tang (Warm the Channels Decoction)2 Xiang Su Cong Chi Tang (Cyperus, Perilla Leaf, Scallion, and Prepared Soybean Decoction)1 Xiao Ding Feng Zhu (Minor Arrest Wind Pearl)2 Yang He Tang (Yang-Heartening Decoction)3 Yin Qiao San (Honeysuckle and Forsythia Powder)1 You Gui Wan (Restore the Right [Kidney] Pill)3 Yue Hua Wan (Moonlight Pill)2 Zhi Gan Cao Tang (Honey-Fried Licorice Decoction)2 Zhi Zi Chi Tang (Gardenia and Soja Decoction)1 Zhu Ling Tang (Polyporus Decoction)2 Zi Wan Tang (Aster Decoction)2 Zuo Gui Wan (Restore the Left [Kidney] Pill)3, 4

1. Dan Dou Chi (Semen Sojae Praeparatum) – cooked and fermented soybean

2. E Jiao (Colla Corii Asini) – processed with soya-bean oil to thicken glue

3. Lu Jiao Jiao (Colla Cornus Cervi) – processed with soya-bean oil to thicken glue

4. Gui Ban Jiao (Colla Plastrum Testudinis) – processed with soya-bean oil to thicken glue

Note 1: Soy protein, which causes the soy allergy, may be reduced during the preparation process.

Dan Dou Chi (Semen Sojae Praeparatum) is the cooked and fermented soybean. In comparison with unprocessed soybean, the cooked and fermented soybean contains a greatly reduced soy protein content (up to 96 to 99% in certain fermentation methods), leading to significantly lower immunoreactivity.

Da Dou Huang Juan (Semen Sojae Germinatum) is the sprouted soybean. The sprouting process slightly reduces the soy protein, and individuals with soy allergy should still avoid it.

Hei Dou (Semen Sojae Nigrum) is the dried/black whole soybeans. The black soybeans contains the same major allergenic proteins as the yellow soybeans, and individuals with soy allergy should avoid it.

Note 2: Soya-bean oil may or may not contain soy protein that causes the soy allergy. If the soya-bean oil is highly refined so no soy protein is present, then it will not cause soy allergy. But if the soya-bean oil is not highly refined (i.e., cold pressed or gourmet), then it will leave behind the original soybean components, including soy proteins that can act as allergens. Therefore, it is the presence (or absence) of soy protein in soya-bean oil (based on processing) that will determine whether soy allergy will (or will not) occur in items such as E Jiao (Colla Corii Asini), Gui Ban Jiao (Colla Plastrum Testudinis), Lu Jiao Jiao (Colla Cornus Cervi) and formulas that contain these ingredients.

Note 3: Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) is processed at high temperature (i.e., steaming or stewing) with or without Hei Dou (Semen Sojae Nigrum) – dried/black soybeans. Therefore, it is important to check with the product supplier or on the product label to determine whether dried/black soybean was used or not. Herbal formulas that contain Zhi He Shou Wu include Qi Bao Mei Ran Wan (Seven-Treasure Special Pill for Beautiful Whiskers), Da Huo Luo Dan (Major Invigorate the Collaterals Special Pill) and Dang Gui Yin Zi (Tangkuei Decoction).

8. WHEAT

Wheat allergy develops 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 or runny nose), and lungs (i.e., asthma).

Table 4. Wheat in Herbs and Formulas:

Single Herbs

Fu Xiao Mai (Fructus Tritici Levis) – wheat Xiao Mai (Fructus Tritici) – floating wheat Ban Xia Qu (Rhizoma Pinelliae Massa Fermentata) – contains wheat Jian Shen Qu (Massa Fermentata Praeparata) – contains wheat Mai Ya Qu (Fructus Hordei Germinatus Massa Fermentata) – contains wheat Shen Qu (Massa Fermentata) – contains wheat Yi Tang (Maltosum) – a disaccharide sugar made from wheat, barley, rice, millet or corn

Formulas

Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) Bao He Wan (Preserve Harmony Pill)8 Da Jian Zhong Tang (Major Construct the Middle Decoction)9 Gan Lu Xiao Du Dan (Sweet Dew Special Pill to Eliminate Toxins)8 Gan Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction)5 Ge Hua Jie Cheng San (Pueraria Flower Powder for Detoxification and Awakening)8 Gui Qi Jian Zhong Tang (Tangkuei and Astragalus Decoction to Construct the Middle)9 Huang Qi Jian Zhong Tang (Astragalus Decoction to Construct the Middle)9 Huo Xiang Zheng Qi San (Agastache Powder to Rectify the Qi)6 Mu Li San (Oyster Shell Powder)5 Qing Shu Yi Qi Tang (Clear Summerheat and Augment the Qi Decoction)8 Qu Mai Zhi Zhu Wan (Medicated Leaven, Barley Sprout, Immature Bitter Orange, and Atractylodes Macrocephala Pill)8 Shang Zhong Xia Tong Yong Tong Feng Wan (Upper, Middle, and Lower General-Use Pill for Wind-Pain)8 Xiang Sha Ping Wei San (Cyperus and Amomum Powder to Calm the Stomach)8 Xiao Jian Zhong Tang (Minor Construct the Middle Decoction)9 Yang Xin Tang (Nourish the Heart Decoction)6 Yue Ju Wan (Escape Restraint Pill)8 Zhi Shi Dao Zhi Wan (Immature Bitter Orange Pill to Guide Out Stagnation)8 Zhi Shi Xiao Pi Wan (Immature Bitter Orange Pill to Reduce Focal Distention)6, 7

5. Xiao Mai (Fructus Tritici) – derives from wheat

6. Ban Xia Qu (Rhizoma Pinelliae Massa Fermentata) – contains wheat

7. Mai Ya Qu (Fructus Hordei Germinatus Massa Fermentata) – contains wheat

8. Shen Qu (Massa Fermentata) – contains wheat

9. Yi Tang (Maltosum) – potentially made from wheat, barley, rice, millet or corn

Note: Traditionally, some herbs may be dry-fried by themselves or with wheat bran to enhance digestion and moderate their fierce effect. Therefore, it is important to check with the product supplier or on the product label to determine whether wheat bran was used or not.

Herbs that may be dry-fried with wheat bran include Bai Zhu (Rhizoma Atractylodis Macrocephalae), Cang Zhu (Rhizoma Atractylodis), Zhi Qiao (Fructus Aurantii), Zhi Shi (Fructus Aurantii Immaturus) and others.

Herbal formulas that contain herbs dry-fried with wheat bran include Xing Su Yin (Apricot Kernel and Perilla Leaf Decoction), Ren Shen Bai Du San (Ginseng Powder to Overcome Pathogenic Influences), Shen Su Yin (Ginseng and Perilla Leaf Decoction), Chai Hu Shu Gan Tang (Bupleurum Decoction to Spread the Liver), Bao Chan Wu You Fang (Preserve Pregnancy and Care-Free Decoction), Shi Hu Ye Guang Wan (Dendrobium Pill for Night Vision), Ju He Wan (Tangerine Seed Pill), Huai Hua San (Sophora Japonica Flower Powder), Wu Yao Shun Qi San (Lindera Powder to Smooth the Flow of Qi), Bu Fei E Jiao Tang (Tonify the Lung Decoction with Ass-Hide Gelatin), Xiang Sha Ping Wei San (Cyperus and Amomum Powder to Calm the Stomach), Fen Xiao Tang (Separate and Reduce Decoction), Wen Dan Tang (Warm the Gallbladder Decoction), Zhu Ru Wen Dan Tang (Bamboo Decoction to Warm the Gallbladder), Fu Ling Wan (Poria Pill), Qing Qi Hua Tan Wan (Clear the Qi and Transform Phlegm Pill), Gua Lou Zhi Shi Tang (Trichosanthes Fruit and Immature Bitter Orange Decoction), Zhi Shi Dao Zhi Wan (Immature Bitter Orange Pill to Guide Out Stagnation), and others.

9. SESAME

Sesame allergy affects a notable portion of the people (estimated at 0.23% of U.S. children and adults), and reactions can range from mild to severe (including anaphylaxis). It is a common ingredient in breads, tahini, and sushi, or a hidden ingredient in spices and flavors.

Table 5. Sesame in Herbs and Formulas:

Single Herbs	Hei Zhi Ma / Hu Ma Ren (Semen Sesami Nigrum) – black sesame
Formulas	Qi Bao Mei Ran Wan (Seven-Treasure Special Pill for Beautiful Whiskers) Qing Zao Jiu Fei Tang (Eliminate Dryness and Rescue the Lung Decoction) Sang Ma Wan (Mulberry Leaf and Sesame Seed Pill) Shou Wu Pian (Polygonum Pill) Xiao Feng San (Eliminate Wind Powder) Yi Yi Ren Tang (Coicis Decoction)

10. OTHER ALLERGENS

In addition to the nine major groups of food allergy identified by the FDA, there are three other common allergens: gluten, sulfite and latex.

10.1 Gluten

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 illnesses, such as celiac disease in which the small intestine lining is damaged. Therefore, individuals with gluten sensitivity may wish to avoid herbs that contain, are made from, or are processed with, wheat, barley and rye.

For herbs and formulas that may contain gluten from wheat, please see the section above on 8. Wheat.

For herbs and formulas that may contain gluten from barley, please see Table 6 below.

Rye is not used in traditional Chinese herbal medicine.

Table 6. Barley in Herbs and Formulas:

Single Herbs

Mai Ya (Fructus Hordei Germinatus) – barley sprout

Formulas

Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) Xiang Sha Ping Wei San (Cyperus and Amomum Powder to Calm the Stomach) Zhen Gan Xi Feng Tang (Sedate the Liver and Extinguish Wind Decoction) Jia Wei Ping Wei San (Modified Calm the Stomach Powder) Jian Pi Wan (Strengthen the Spleen Pill) Zhi Shi Xiao Pi Wan (Immature Bitter Orange Pill to Reduce Focal Distention)

Note: Mai Ya (Fructus Hordei Germinatus) is sprouted/germinated barley. The gluten in barley is primarily in the form of hordeins (prolamin storage proteins in the endosperm). Sprouting/germination reduces the gluten content, but does not eliminate gluten completely. Therefore, people with mild gluten sensitivity (without celiac disease) tolerate sprouted grains better (easier digestion, fewer symptoms), but people with severe gluten intolerance or celiac disease should still avoid it entirely.

10.2 Sulfite

Sulfites are preservatives and antioxidants commonly used in food products to prevent discoloration and bacterial spoilage. Sulfite is commonly found in dried fruits (excluding dark raisins and prunes), bottled lemon or lime juice (non-frozen), sauerkraut (and its juice), grape juices (white, white sparkling, pink sparkling, red sparkling), pickled cocktail onions, and wine. Sulfite allergy occurs in approximately 1% of the population.

Note: Herbs that may be treated with sulfite include: Bai Guo (Semen Ginkgo), Bai He (Bulbus Lilii), Ge Gen (Radix Puerariae Lobatae), Gou Qi Zi (Fructus Lycii), Ren Shen (Radix et Rhizoma Ginseng), Shan Yao (Rhizoma Dioscoreae), and Yu Zhu (Rhizoma Polygonati Odorati). For patients with sulfite allergies, inquiry should be made to ensure these herbs are free from sulfite, or within the safety limit (less than 10 ppm according to the FDA).

10.3 Latex

Natural rubber latex is derived from the sap of Hevea brasiliensis, a rubber tree found in Africa and Southeast Asia. Allergic reactions develop in persons who become sensitized to proteins in natural rubber latex. Products that contain natural rubber latex include: disposable gloves, dental dams, airway and intravenous tubing, syringes, stethoscopes, catheters, dressings and bandages. Latex also is found in many consumer products. These include condoms, handbags, balloons, athletic shoes, tires, tools, rubber toys, baby bottles, nipples and pacifiers.

Du Zhong (Cortex Eucommiae) and Du Zhong Ye (Folium Eucommiae), commonly known as eucommia bark and leaf, are derived from Eucommia ulmoides, a hardy rubber tree in central China. They contain only a small amount of latex (approximately 4% by weight). While natural rubber latex is a well-known contact allergen, it is unclear how patients with topical latex allergies would respond to oral ingestion of Du Zhong or Du Zhong Ye. Therefore, practitioners should use these two herbs with caution for patients with known latex allergies.

Note: According to the Therapeutic Goods Administration (TGA), individuals with latex allergies exhibit cross-reactivity with certain plant-based foods (like banana, avocado, and kiwi), as they have similar allergenic proteins. Some practitioners consider Du Zhong (Cortex Eucommiae) and Du Zhong Ye (Folium Eucommiae) to be parts of this potential allergen group.

If you enjoyed this article and would like to earn continuing education credits, Click here to purchase the article course and earn CEUs! [2]

About the Author

Drawing upon a rich family tradition, Dr. John K. Chen has established himself as a distinguished authority in both Western pharmacology and Chinese Herbal Medicine. His academic career includes faculty positions at esteemed institutions such as the University of Southern California (USC) School of Pharmacy, the University of California, San Francisco (UCSF), Yo San University, and the Pacific College of Health and Science. A prolific scholar, Dr. Chen has authored numerous peer-reviewed articles and several seminal textbooks, most notably serving as the lead author for Chinese Medical Herbology and Pharmacology (2003) and Chinese Herbal Formulas and Applications (2008). He may be reached at john.chen@evherbs.com [3] or (626) 810-5530.

To learn more about Dr. John Chen and herbs, click here [4] to view a complete list of courses by Dr. John Chen.

REFERENCES

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3. Food Allergy by National Institute of Health. https://www.niaid.nih.gov/diseases-conditions/food-allergy [7]

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8. Allergens by Food Allergy Research and Education. https://www.foodallergy.org/home [11]

9. Chen J.K., and Chen T.T. Chinese Medical Herbology and Pharmacology, 2004. City of Industry, CA USA. Art of Medicine Press.

10. Chen J.K., and Chen T.T. Chinese Herbal Formulas and Applications, 2009. City of Industry, CA USA. Art of Medicine Press.

11. Pharmacopoeia of People's Republic of China, 2010 Volume I. Chinese Pharmacopoeia Commission. People's Medical Publishing House.

12. Woo, CK and Bahna SL, Not all shellfish "allergy" is allergy! Clin Transl Allergy. 2011; 1:3.

13. Dharmananda S., Eucommia – a Unique Rubber Tree. Institute for Traditional Medicine, Portland, Oregon. http://www.itmonline.org/arts/eucommia.htm [12]

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17. The Therapeutic Goods Administration (TGA). Medicines containing Eucommia ulmoides (known as Du-Zhong or Tu-chung). https://www.tga.gov.au/safety/safety-monitoring-and-information/safety-alerts/medicines-containing-eucommia-ulmoides-known-du-zhong-or-tu-chung [15]