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PEARL (Boba or Tapioca): Allergen or Not An Allergen?

Not An Allergen … but may cross react

Pearl (Boba or Tapioca)

Bubble tea (also called milk tea or milk boba tea) is a Taiwanese drink that has taken the world by storm. The signature “pearls” in the drink are made of tapioca which, when uncolored and unflavored, is not a top contact allergen. That said, tapioca is from cassava root, which is one of the foods (along with avocado, mango, tomato, celery, chestnuts, and more) that has shown some cross reactivity with latex. Reports are normally for IgE-mediated reactions and not contact skin reactions (read this for more on the difference between food, naso-bronchial, and skin allergies) but rubber and latex allergies can be complicated. Still, because of the current lack of reports of contact allergy to tapioca, we’re calling it not a top contact allergen.

Latex, rubber (and thiuram) are top skin allergens and they regularly cause contact dermatitis in gloves as well as other things that we tend to handle or come into contact with frequently like phone cases, flip flops, travel mug handles, goggles, and lots of sporting equipment (shin guards, helmets, weights, exercise mats, etc.). Skin contact to boba pearls in food is less likely. They’re usually small and we tend to chew them whole instead of biting into them (which would increase the risk of contact with the lips and around the mouth) as with a larger piece of food. They tend to be sold as dehydrated pearls, flakes, or flour, further reducing the risk of a skin reaction. Making tapioca from scratch (which entails squeezing liquid out of the ground cassava root) might be more of an issue. If you’ve patch tested positive to rubber or tested positive to latex in a prick test or RAST blood test, ask your dermatologist and allergist for guidance.

Tapioca is a staple in Southeast Asian desserts like pudding in Thailand, a thick pancake in Vietnam, halo-halo in the Philippines, and shaved ice desserts in Indonesia. It’s also commonly used in breads and as a thickening agent. While pearls in milk tea tend to have no added flavor (but may have food coloring), tapioca used elsewhere might have additives like honey and artificial flavors — all top contact allergens (many flavorings are related to fragrance).

A contact skin reaction is relatively unlikely but bubble tea is something you want to keep as an occasional treat, like ice cream or a cookie. It’s loaded with processed sugar, normally makes use of non-dairy creamers for texture, and sometimes contains artificial flavors. Tapioca itself is gluten-free but is mostly pure starch with limited nutritional value. All this would make boba tea a more inflammatory food, and inflammation is linked to several health and skin problems, including acne, aging, barrier defect, and more.

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If you have a history of sensitive skin…

…don’t guess! Random trial and error can cause more damage. Ask your dermatologist about a patch test.

To shop our selection of hypoallergenic products, visit vmvhypoallergenics.com. Need help? Ask us in the comments section below, or for more privacy (such as when asking us to customize recommendations for you based on your patch test results) contact us by email, or drop us a private message on Facebook.

For more:

Main References: 

Regularly published reports on the most common allergens by the North American Contact Dermatitis Group and European Surveillance System on Contact Allergies (based on over 28,000 patch test results, combined), plus other studies. Remember, we are all individuals — just because an ingredient is not on the most common allergen lists does not mean you cannot be sensitive to it, or that it will not become an allergen. These references, being based on so many patch test results, are a good basis but it is always best to get a patch test yourself.

  1. Parisi CAS, Kelly KJ, Ansotegui IJ, et al. Update on latex allergy: New insights into an old problem. World Allergy Organ J. 2021;14(8):100569. Published 2021 Jul 28.
  2. DeKoven JG, Silverberg JI, Warshaw EM, Atwater AR, et al. North American Contact Dermatitis Group Patch Test Results: 2017-2018. Dermatitis. 2021 Mar-Apr 01;32(2):111-123.
  3. DeKoven JG, Warshaw EM, Zug KA, et al. North American Contact Dermatitis Group Patch Test Results: 2015-2016. Dermatitis. 2018 Nov/Dec;29(6):297-309.
  4. DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group Patch Test Results 2013-2014. Dermatitis. 2017 Jan/Feb;28(1):33-46.
  5. Warshaw, E.M., Maibach, H.I., Taylor, J.S., et al. North American contact dermatitis group patch test results: 2011-2012. Dermatitis. 2015; 26: 49-59.
  6. W Uter et al. The European Baseline Series in 10 European Countries, 2005/2006–Results of the European Surveillance System on Contact Allergies (ESSCA). Contact Dermatitis 61 (1), 31-38.7 2009.
  7. Wetter, DA et al. Results of patch testing to personal care product allergens in a standard series and a supplemental cosmetic series: An analysis of 945 patients from the Mayo Clinic Contact Dermatitis Group, 2000-2007. J Am Acad Dermatol. 2010 Nov;63(5):789-98.
  8. Warshaw EM, Buonomo M, DeKoven JG, et al. Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis: The North American Contact Dermatitis Group Experience. JAMA Dermatol. 2021 Dec 1;157(12):1456-1465.
  9. Verallo-Rowell VM. The validated hypoallergenic cosmetics rating system: its 30-year evolution and effect on the prevalence of cosmetic reactions. Dermatitis 2011 Apr; 22(2):80-97.
  10. Ruby Pawankar et al. World Health Organization. White Book on Allergy 2011-2012 Executive Summary.
  11. Misery L et al. Sensitive skin in the American population: prevalence, clinical data, and role of the dermatologist. Int J Dermatol. 2011 Aug;50(8):961-7.
  12. Warshaw EM1, Maibach HI, Taylor JS, Sasseville D, DeKoven JG, Zirwas MJ, Fransway AF, Mathias CG, Zug KA, DeLeo VA, Fowler JF Jr, Marks JG, Pratt MD, Storrs FJ, Belsito DV. North American contact dermatitis group patch test results: 2011-2012.Dermatitis. 2015 Jan-Feb;26(1):49-59.
  13. Warshaw, E et al. Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. J AmAcadDermatol 2009;60:23-38.
  14. Foliaki S et al. Antibiotic use in infancy and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old: International Study of Asthma and Allergies in Childhood Phase III. J Allergy Clin Immunol. 2009 Nov;124(5):982-9.
  15. Kei EF et al. Role of the gut microbiota in defining human health. Expert Rev Anti Infect Ther. 2010 Apr; 8(4): 435–454.
  16. Thavagnanam S et al. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy. 2008;38(4):629–633.
  17. Marks JG, Belsito DV, DeLeo VA, et al. North American Contact Dermatitis Group patch-test results, 1998 to 2000. Am J Contact Dermat. 2003;14(2):59-62.
  18. Warshaw EM, Belsito DV, Taylor JS, et al. North American Contact Dermatitis Group patch test results: 2009 to 2010. Dermatitis. 2013;24(2):50-99.
  19. Verallo-Rowell V. M, Katalbas S.S. & Pangasinan J. P. Natural (Mineral, Vegetable, Coconut, Essential) Oils and Contact Dermatitis. Curr Allergy Asthma Rep 16,51 (2016) . https://doi.org/10.1007/s11882-016-0630-9.
  20. Park G, Oh DS, Lee MG, Lee CE, Kim YU. 6-Shogaol, an active compound of ginger, alleviates allergic dermatitis-like skin lesions via cytokine inhibition by activating the Nrf2 pathway. Toxicol Appl Pharmacol. 2016 Nov 1;310:51-59. doi: 10.1016/j.taap.2016.08.019. Epub 2016 Aug 22. PMID: 27562088.
  21. de Groot AC. Monographs in Contact Allergy, Volume II – Fragrances and Essential Oils. Boca Raton, FL: CRC Press Taylor & Francis Group; 2019.
  22. De Groot AC. Monographs in Contact Allergy Volume I. Non-Fragrance Allergens in Cosmetics (Part I and Part 2). Boca Raton, Fl, USA: CRC Press Taylor and Francis Group, 2018.
  23. Zhu TH, Suresh R, Warshaw E, et al. The Medical Necessity of Comprehensive Patch Testing. Dermatitis. 2018 May/Jun;29(3):107-111.

Want more great information on contact dermatitis? Check out the American Contact Dermatitis SocietyDermnet New Zealand, the Contact Dermatitis Institute, and your country’s contact dermatitis association.


Laura is our â€œdew”-good CEO at VMV Hypoallergenics and eldest daughter of VMV’s founding dermatologist-dermatopathologist. She has two children, Madison and Gavin, and works at VMV with her sister CC and husband Juan Pablo (Madison and Gavin frequently volunteer their â€œusage testing” services). In addition to saving the world’s skin, Laura is passionate about health, inclusion, cultural theory, human rights, happiness, and spreading (like a VMV cream!) goodness!

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