Orofacial granulomatosis worsened by chocolate: results of patch testing to ingredients of Cadbury's chocolate

Abstract

We report a 26‐year‐old man with orofacial granulomatosis, characterized by granulomatous swelling of his lips and oral ulceration, confirmed on biopsy. After only partial response to oral steroids, he was referred for patch testing. He volunteered that his symptoms worsened after eating chocolate. Initial patch testing to Cadbury's drinking chocolate (usually consumed by our staff) showed a positive result at 48 h. We subsequently patch tested him to the ingredients of Cadbury's chocolate supplied by the company, including: cocoa liquor, cocoa butter, soya‐based lecithin (emulsifier), rape‐based lecithin (emulsifier) and dark chocolate. He was clearly positive to cocoa liquor, the complex natural product extracted from cocoa beans, establishing that cocoa itself was responsible for his chocolate intolerance (Fig. 1). Flare‐up of our patient's condition during patch testing confirmed the clinical relevance of our findings (Fig. 2).