Here’s an allergy question I get asked on a near daily basis:

QUESTION:

“My child (usually less than 2 years old… often with a history of eczema) develops a rash around his/her mouth with strawberries. Is he/she allergic?” (Note: you can substitute strawberry with several other foods… see list below…)

ANSWER:

“Not likely.”

EXPLANATION:

Most of the time when children develop a rash around their mouth with strawberries and other fresh fruits / berries, this is an irritation reaction, not an allergy. (Note: Kiwi is the exception here… it more frequently is associated with anaphylactic reactions). In other words, these foods are irritating the skin, but are not triggering the immune system to attack the food (ie. an allergic reaction). The importance of making this distinction is that irritation reactions are not life threatening. The reason this rash occurs is likely due to the acidity of these foods. The rash is typically red and flat (ie. you CAN’T feel it when you rub your hand over it) and will last several minutes to hours. Occasionally, the irritation can worsen your child’s eczema (eczema is a red, dry rash) which can last days to weeks without treatment. The rash is not itchy and the most important feature is: IT IS NOT ASSOCIATED WITH OTHER SYMPTOMS OF ANAPHYLAXIS (ie. swelling of the lips, trouble breathing, vomiting, irritability or lethargy). In other words, the rash does not bother the child.

Here is an example of the rash. This is my 1-year-old daughter. She has mild eczema and had just eaten strawberries. There was no rash prior.

This irritation rash occurs because children have thin, sensitive skin. As they get older, the skin gets thicker and less sensitive, and the rash no longer occurs. Occasionally you will see this rash over the chest and hands (ie. the places where the foods has come in contact). Other common foods that cause skin irritation include:

  1. Tomatoes or tomato-based products (ie. ketchup, tomato sauce, spaghetti sauce)
  2. Blueberries
  3. Citrus fruits – oranges, lemons, limes
  4. Watermelon
  5. Pineapple

WHEN TO BE EVALUATED BY AN ALLERGIST?

  1. IF THE RASH IS ELEVATED (ie. hives) OR IS ASSOCIATED WITH ANY OTHER SYMPTOMS OF ANAPHYLAXIS (ie. Trouble breathing, vomiting, irritability, lethargy, lip or facial swelling)
  2. IF THE RASH OCCURS IN AREAS WHERE THE FOOD HAS NOT COME IN CONTACT (ie. the back, legs, etc.)
  3. IF THE FOOD IS NOT A FRUIT OR BERRY – If your child is developing a rash around their mouth with eggs, milk, wheat, soy, peanuts, tree nuts (ie. almonds, cashew, pistachio, hazelnut, walnut, pecan, macadamia nut), sesame seeds, fish or shellfish – they should be seen by an allergist. Similarly, if this occurs with Kiwi (the main exception to the fruit rule), they should be assessed. These foods are common triggers of anaphylactic reactions while most fruit and berries (except KIWI) are not.
  4. IF YOU ARE WORRIED – I am always happy to see your child for any allergy questions – no matter how insignificant you may think they are. If you are stressed about a food, it’s important to get this addressed. With new evidence suggesting avoidance of foods can predispose children to allergies, getting your concerns evaluated can potentially prevent your child from developing an allergy. This blog post is in no way meant to deter you from seeking an allergist’s opinion, merely to provide information on an issue that may be easily addressed at home.

HOW CAN I PREVENT THIS FROM HAPPENING?

  1. Apply a thick barrier ointment (ie. Vaseline) around the mouth prior to the child eating these foods.
  2. Use a bib to prevent dribbling on the chest.
  3. Once you have established that this is an irritant reaction – ie. When you apply vaseline as a barrier, the rash does not return – then you can simply ignore the rash. As stated above, the rash should not bother your child. If the foods are worsening your child’s eczema around the mouth, then I suggest using the vaseline to help prevent this.

Hope this is helpful! Please feel free to post your comments below. Please note that I am unable to give specific advice regarding your child’s allergy issues online. While I can provide general information about allergies, to have your child’s specific concerns addressed, you need to speak with their physician.

— Alex

6 Comments

  1. My son(8 months) hasn’t reacted to strawberries but developed red rashes around mouth while eating a slice of steamed apple. However he’s fine with applesauce.and they had disappeared when he woke up the next morning. He has mild eczema as well. I noticed similar(but lesser) reaction to bananas and some random items..but nothing to orange! Ped wasn’t too concerned and assured it wasn’t food allergy. What are your thoughts on this?

    • Hi Sandy,
      Unfortunately due to legal reasons I can’t give advice on a specific patient over my website but I will say that, in general, food allergies present with hives that last no more than 3-6 hours. Rashes that last longer than this are generally irritation and unlikely to progress to anaphylaxis. Some children react to specific foods while not to others (ie. some have issues with apples but not oranges) and this is partly due to how dry their skin is that particular day. (I often see children who will get irritation from the same food on one day but not another day – presumably because they either got less food on their face or their eczema/skin was better that day). Sorry I can’t be more specific but hopefully this is still helpful. If not, or you still have questions, I’d suggest seeing an allergist. – Alex

  2. Hi Alex,
    Thanks for this great post. My son breaks out in a very similar rash to the one depicted above. I noticed it once after he ate strawberries, but it mainly appears after he eats scrambled eggs (but nothing with eggs baked in it). I also noticed the rash after he tried peanut butter and hummus (on two separate occasions). I am definitely going to find a good allergist to take my son to but I’m just wondering if you have ever heard of such a rash occurring after a child eats eggs, hummus, or peanut butter. I’m having a hard time believing he could just be allergic to so many different foods. Ultimately, though, I just want to get to the bottom of all this !

    Thank you,
    Kelly Patel

    • Hi Kelly,
      As foods such as eggs, peanuts and hummus (chickpea, sesame) are higher risk for true anaphylactic allergies, I would suggest you see an allergist to have these evaluated. While it is possible these are irritation reactions given his issues with strawberries, he should be properly assessed.
      Alex

  3. Thank you for this very informative articles! Takes a bunch of worry off my mind. My 6 year old son gets the around the mouth rash with any tomato based product, strawberries ( his favorite fruit!), blueberries, cherries and pancake syrup ( just noticed this as he has it so infrequently). I had assumed it was a reaction to acid in the foods, until the random, strange pancake syrup one. So no more of that! I will try the Vaseline barrier next time he eats any of these foods. He has no other problems, except very mild eczema on his cheeks near the jawbone. He has lotion recommended by his pediatrician for it. Just wanted to thank you. I just began noticing this atime beginning of summer when he started eating more fresh fruits. It isn’t check up time and didn’t want to go to doctor unless it seemed to be a problem. But I feel my suspicions are correct with the information in the article pretty much confirming them.

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