Chocolate is found in many popular desserts and even in some savory dishes. Though many people view chocolate as a sweet treat, there are some who have a sensitivity or allergy to chocolate or an ingredient in a chocolate-based food.

Do you think you might have a problem with chocolate? Here’s how to tell whether cocoa or chocolate-based foods should be on your “no eat” list.

Chocolate allergies and chocolate sensitivities aren’t the same thing.

If you are allergic to chocolate and eat it, your immune system will release chemicals like histamine into the bloodstream. These chemicals can affect your:

If you have an allergy to chocolate, you may have some of these symptoms after eating it, or even just coming into direct contact with it:

These symptoms are part of a severe allergic reaction called anaphylaxis. This condition can be life-threatening if you don’t treat it right away. Allergies that may lead to anaphylaxis are diagnosed by high levels of immunoglobulin E (IgE) antibodies.

A chocolate sensitivity or intolerance is different from an allergy in that it doesn’t involve IgE antibodies. However, other parts of the immune system may still be involved. And most of the time it isn’t life-threatening.

If you have a sensitivity to the cocoa itself or to other ingredients like the amino acid tyramine, you may be able to eat small amounts of chocolate without any problem. But in larger amounts, chocolate can trigger a reaction in your GI tract or elsewhere in your body.

People who are sensitive to chocolate can have symptoms like:

The caffeine in chocolate can trigger its own set of symptoms, which include:

You’re more likely to have a reaction to chocolate if you’re allergic to it or its source, which is cocoa. But ingredients in chocolate-based foods, such as milk, wheat, and nuts, can also set off a reaction.

People with a gluten intolerance or celiac disease sometimes react to chocolate, especially milk chocolate. One theory is that this reaction is caused by cross-reactivity.

In people with celiac disease, the body reacts to gluten. Gluten is a protein found in wheat, rye, and barley. And chocolate contains a protein that’s similar in structure, so the immune system sometimes mistakes it for gluten.

The immune system produces antibodies in response to gluten. These antibodies trigger symptoms like:

Some people react to the chocolate itself. For example, chocolate contains caffeine, which is a stimulant that’s considered a drug. It can cause shakiness, headaches, and other symptoms in people who are sensitive to it.

Other people are allergic or sensitive to ingredients in chocolate-based foods, such as:

  • nuts, like hazelnuts, peanuts, or almonds
  • wheat
  • milk
  • sugar

It may not seem obvious, but chocolate can also be a problem for people who have a nickel allergy. About 15 percent of the population is allergic to nickel. Dark and milk chocolate, cocoa powder, and many of the nuts found in chocolate bars are high in this metal. Chocolate is also often contaminated with the heavy metals lead and cadmium.

If you’re sensitive or allergic to chocolate or ingredients in chocolate products like nuts or milk, know what’s in your food. At restaurants, ask to have your meals and desserts prepared without chocolate. And when you go to the supermarket, read package labels to make sure the products you buy don’t contain chocolate or cocoa.

Along with candy bars and other desserts, chocolate can hide in places where you might not expect. Cocoa is used to make certain soft drinks, flavored coffees, and alcoholic beverages, like brandy. You can also find it in some jams and marmalades. And, it’s an ingredient in the savory Mexican sauce, mole. Even some medications, including laxatives, may contain cocoa.

People who are sensitive to chocolate may want to try carob. This legume is like chocolate in color and taste. And it can replace chocolate in just about any recipe, from chocolate bars to cookies. Carob is also high in fiber, low in fat, and sugar- and caffeine-free, so it can be a healthier dessert alternative.

If you’re sensitive to the milk in chocolate, consider switching to dark chocolate. Dark chocolate usually doesn’t list milk as an ingredient. However, many people with milk allergies have reported reactions after eating it. And when the FDA did a review of dark chocolate bars, they found that 51 out of 100 bars they tested contained milk that wasn’t listed on the label.

If you have a severe allergy to nuts or milk, you might want to avoid any chocolate products that don’t say nut- or dairy-free.

If you suspect you might have an allergy or sensitivity to chocolate, see an allergist. Skin prick tests, blood tests, or elimination diets can pinpoint whether chocolate is causing your reaction. Depending on the severity of your response to chocolate, your doctor might tell you to avoid it. Or you may only need to limit chocolate in your diet.

If you have a severe allergy, carry an epinephrine auto-injector wherever you go. This device delivers a dose of the hormone epinephrine to stop the reaction. The shot should relieve symptoms like shortness of breath and swelling of the face.

Chocolate allergies are rare. If you’re having a reaction when you eat chocolate, you may be reacting to something else. You also may have a sensitivity instead of an allergy.

Talk to your doctor about your symptoms. If you continue to experience discomfort when eating chocolate, explore alternatives.

Many children outgrow allergies to foods like milk and eggs as they get older. But this is unlikely the case if you were diagnosed with a sensitivity as an adult.