Is Black Pepper the Cause of My Allergy Symptoms?

Black pepper is a favored spice for many people. It’s included in numerous recipes and manufactured foods, making it difficult to avoid.

This spice is harvested from peppercorns, the dried berries that grow on the vines of the black pepper plant, according to Britannica. Black pepper is native to India.

Symptoms of an allergic reaction to black pepper can occur when you have a “true” food allergy, Cleveland Clinic says. They can also occur when you have mast cell activation syndrome (MCAS), a form of immune dysfunction, according to research.

In both cases — whether you have a “true” allergy to black pepper or MCAS — you may experience symptoms that range from mild discomfort to serious and potentially life-threatening.

Black pepper can also act as an everyday irritant when your immune system isn’t involved. Sneezing and congestion on their own are common symptoms of ingesting pepper.

When you have a food allergy, consuming the offending food triggers your immune system into defending itself against a (mistaken) enemy via an antibody, Cleveland Clinic says. An allergic reaction typically occurs within two hours after consuming the allergen.

Mast cells are the same immune cells responsible for true allergic reactions and produce similar symptoms, according to an article by Lisa Klimas, a microbiologist and molecular biologist in Boston who researches mast cell disorders.

With MCAS, mast cells don’t function correctly, leading them to release histamine and many other chemicals in response to harmless triggers, including foods like black pepper.

A mast cell reaction may occur immediately or can be delayed by hours or days, according to an article by Kara Wada, MD, an allergist and immunologist in Columbus, Ohio.

Symptoms of an antibody-triggered allergy or an MCAS reaction to black pepper can range from annoying to life-threatening.

According to Cleveland Clinic and research, common symptoms include hives, flushing of the skin, itchiness, abdominal pain, diarrhea, nausea, and vomiting. You may also experience wheezing, congestion, dizziness, or lightheadedness.

Swelling of the lips, tongue, mouth, and throat may also occur as well as airway constriction. Symptoms like anxiety, cognitive dysfunction, and depression may be present.

Anaphylaxis, which is potentially fatal, is a serious reaction in which symptoms occur in multiple organ systems at once, StatPearls says. It has a rapid onset and typically occurs within minutes to hours of consuming a trigger food. It requires immediate medical treatment.

Doctors diagnose an antibody-triggered food allergy by taking your history and performing tests. The tests may include skin and blood tests as well as a food challenge. During a food challenge, you consume small amounts of the suspected allergen under the supervision of a doctor, Cleveland Clinic says.

Diagnosing MCAS is much harder, Dr. Wada writes, for a variety of reasons. One reason is that triggers are highly variable; you may react to pepper one day and not the next.

Your doctor will take a detailed history and may ask you to track your symptoms to look for patterns. They’ll test your blood and urine for a variety of chemicals that indicate mast cells have been activating inappropriately, though these tests are limited and can be inaccurate.

Your doctor will also assess your response to treatment: Do antihistamines and other medications used for MCAS help you?

It’s important to find a specialist who has experience diagnosing and treating complex immune disorders like MCAS.

Treatment for exposure to black pepper depends on the nature of your reaction, whether it’s an antibody-triggered allergy or an MCAS reaction. The goal of treatment is to lessen your symptoms and discomfort while minimizing chances of reactions later on.

For antibody-triggered allergies, antihistamines may be effective for minor reactions. Severe reactions may require using an epinephrine auto-injector (EpiPen, Auvi-Q) and an emergency room visit, Cleveland Clinic says.

If you have MCAS, treatment is more complex. It will likely involve daily medication, including antihistamines, Klimas writes. Antihistamines like diphenhydramine (Benadryl) are often used during reactions, as are epinephrine auto-injectors.

Several MCAS treatments, such as cromolyn (Gastrocrom), aim to prevent mast cells from ever releasing the chemicals that cause reactions.

Because MCAS presents differently in everyone, there’s no standard treatment regimen. It may take some time to figure out a combination that helps stabilize your immune system.

Prevention is your best bet. Discuss your trigger with your server in restaurants and the hosts of events, and check ingredient lists diligently in the grocery store.