Balsam of Peru Diet

Balsam of Peru is a naturally occurring sticky substance that is harvested by wounding the Myroxylon pereirae tree, found in Central America. It has an odor similar to cinnamon and vanilla.  Notably, it cross-reacts with a number of synthetic fragrances found in perfumes, lotions, cleaning products, etc. It is a natural substance containing hundreds of components that also cross react with both natural and synthetic food flavorings.

In a significant number of people (but not all), who are confirmed on patch testing to be allergic to BOP, avoidance of skin contact with fragrances will lead to resolution of their allergic contact dermatitis (rash).  For a smaller subset of people (those more sensitized), avoiding fragrances is not enough. In these people, ingesting (eating/drinking) of foods high in BOP can trigger a widespread rash.

The standard patch test screening kit screens for the whole balsam of Peru extract.  In those with widespread rashes who have significant improvement on the low balsam diet, identification of the subgroup may be beneficial.  A diary of associated food flares can help identify the sub-unit food groups.  When available, a more extended patch test may be able to detect the individual component allergies, specifically benzoates, vanillin, ferrulic acid, cinnamates, and coniferins.

Because the complete low balsam of Peru diet can be a challenge to follow, identifying trigger foods within the sub-unit groups can simplify the avoidance diet, making it easier to follow.

High Risk Processed Foods

Foods that frequently contain ingredients high in BOP

Meats

Poultry, Meat, Fish, SeafoodPossible BOP Ingredients
barbequed meats (pork, chicken, beef)paprika, cinnamon
canned meats and fishbenzoates
fish and seafood, seasoneddill, paprika, cinnamon, allspice
frankfurternutmeg, mace
ham, glazedcloves, cinnamon, vanilla

Fruits and Vegetables

Fruits and VegetablesPossible BOP Ingredients
applesauceallspice, cinnamon
canned fruits and vegetablesbenzoates
fresh thin-skinned fruits and vegetables (apples, cucumbers)beeswax glaze (used to increase shelf life)
pickled vegetablesdill, cloves
spiced fruitscloves, cinnamon, vanilla, allspice, nutmeg

Desserts

Pastries and Other DessertsPossible BOP Ingredients
cakes, muffins, and cookiesvanilla, cinnamon, nutmeg, cloves, allspice
candyvanilla, cinnamon, nutmeg, cloves, allspice
caramelvanilla
chocolatevanilla
custard and puddingvanilla
Danish pastriesvanilla, cinnamon, nutmeg, cloves, allspice
ice-creamvanilla
spiced fruit piesvanilla, cinnamon, nutmeg, cloves, allspice
yogurtvanilla

Cuisines

CuisinesPossible BOP Ingredients
Africancloves
Indiancloves, bay leaves, cinnamon, cloves
Italiantomato, basil, bay leaves
Mediterraneantomato, basil, dill
Mexicantomato, allspice
Middle Easterncloves, allspice
Southeast Asian (Thai, Vietnamese)basil
Caribbeanallspice, cinnamon, paprika, cloves

Condiments and Sauces

Condiments and SaucesPossible BOP Ingredients
barbeque saucetomato, paprika, cinnamon, cloves
chutneycitrus peel
ketchuptomato
maple syrupvanilla
marinadescloves, dill
marmalade and fruit jamcitrus peel
pestobasil
picklesdill, cloves
salad dressingswine vinegars, dill
steak saucetomato, cinnamon, cloves

Spice Blends

Spice BlendsPossible BOP Ingredients
Blackening seasoningpaprika
Chili powderpaprika
Chinese Five spiceanise, cloves, cinnamon
Currycloves, cinnamon
Dry rubpaprika, cinnamon
Garam Masalacinnamon
Herbs de provencecitrus zest, bay leaves
Jerk seasoningallspice, cinnamon
Pickling Spicedill, bay leaves
Pumpkin Pie Spicecinnamon, nutmeg, cloves
Quatre Epices/French Four Spicecloves, nutmeg

Beverages

BeveragesPossible BOP Ingredients
aperitifs (vermouth, lillet, pernod)citrus peel, anise, cloves, cinnamon, basil, vanilla
brandiescitrus peel
citrus juicescitrus peel
colacinnamon, nutmeg, vanilla
spiced liquors (rum, bourbon, whiskey)anise, cloves, cinnamon, vanilla
spiced teascinnamon, cloves, citrus peel, lemon balm

High Risk Primary Ingredients

Specific BOP avoidance diets

Primary Ingredients Potentially High in BOP

Spices
allspice
anise
basil
bay leaves
cardamom
cassia (Chinese cinnamon, coumarin)
cinnamon
citrus peel
cloves
dill
Jamaican pepper
lemon balm
nutmeg and mace
paprika
synthetic vanilla
vanilla
Fruits and Vegetables
asparagus
beets
blueberry
cranberry
huckleberry
tomato
Beverages
beer
citrus juices
wine
Grains
wheat and rye
Other Sources
beeswax
benzoate preservatives
brewer’s yeast

Low Vanillin Diet

Spices
cloves
synthetic vanilla
vanilla
 
Beverages
beer
wine
 
Grains
wheat
rye

Low Ferulic Acid Diet

Spices
citrus peel
dill
 
Fruits and Vegetables
tomato
 
Beverages
wine
 
Grains
wheat
rye

Low Benzoates Diet

Spices
anise
cassia (Chinese cinnamon, coumarin)
chocolate
cinnamon
vanilla
 
Fruits and Vegetables
blueberry
cranberry
huckleberry
 
Other Common Sources
brewer’s yeast
benzoate preservatives

Low Eugenol Diet

Spices
allspice
anise
basil
bay leaves
chocolate
cinnamon
cloves
dill
lemon balm
nutmeg and mace
synthetic vanilla
 
Fruits and Vegetables
tomato
 
Beverages
beer

Low Coniferins Diet

Fruits and Vegetables
asparagus
beets
tomato
 
Beverages
beer
wine
 
Other Common Sources
brewer’s yeast

Low Cinnamates Diet

Spices
anise
basil
bay leaves
cassia (Chinese cinnamon, coumarin)
cinnamon
citrus peel
 
Fruits and Vegetables
tomato
 
Beverages
beer
citrus juice
wine

References

  1. Scheman A, Rakowski EM, Chou V, Chhatriwala A, Ross J, Jacob SE. Balsam of Peru: past and future. Dermatitis. 2013 Jul-Aug;24(4):153-60. doi: 10.1097/DER.0b013e31828afab2. Review. PubMed PMID: 23857009.
  2. Salam TN, Fowler JF Jr. Balsam-related systemic contact dermatitis. J Am Acad Dermatol. 2001 Sep;45(3):377-81. PubMed PMID: 11511833.
  3. Veien NK, Hattel T, Laurberg G. Can oral challenge with balsam of Peru predict possible benefit from a low-balsam diet? Am J Contact Dermat. 1996 Jun;7(2):84-7. PubMed PMID: 8796747.
  4. Balsam of Peru. [Internet PDF]. TRUE TEST Allergen Info Sheets. c2014 [cited April 14, 2016]. Available from https://www.smartpractice.com/dermatologyallergy/pdfs/allergens/Balsam-of-Peru-Patient-Info.pdf
  5. Balsam of Peru allergy [Internet]. New Zealand. Jan 10, 2016 [cited Apr 14, 2016]. Available from http://www.dermnetnz.org/dermatitis/balsam-of-peru-allergy.html
  6. Han E. 25 Spice Mixes from Around the World [Internet]. May 14, 2013 [cited April 14, 2016]. Available from http://www.thekitchn.com/spice-mixes-189368
  7. Cajun and Blackening Seasoning [Internet]. Epicurious. In the kitchen with the Pike Place Fish Guys. c2013 [cited April 14, 2016] Available from http://www.epicurious.com/recipes/food/views/cajun-and-blackening-seasoning-51168200
  8. Nelson, J. Spirits: The Art of the Aperitif [Internet]. Food & Wine. May 2002. [Cited April 14, 2016] Available from http://www.foodandwine.com/articles/spirits-the-art-of-the-aperitif
  9. How to Make Vermouth [Internet]. The Art of Drink. February 19, 2011 [cited April 14, 2016]. Available from https://www.artofdrink.com/ingredient/how-to-make-vermouth
  10. Ehrlich, SD, NMD. Lemon Balm. [Internet]. Complementary and Alternative Medicine Guide. University of Maryland Medical Center. Jan 2, 2015 [cited April 17, 2016]. Available from http://umm.edu/health/medical/altmed/herb/lemon-balm