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The Balsam of Peru Avoidance Diet


Case of Balsam of Peru Allergy


Last year, I treated a patient with a very itchy, stubborn, and widespread dermatitis. Although he was using very strong steroid creams, and closely following his dermatologist's recommendations, his rash did not get better. He had noticed that his rash and itching were worse after eating pizza and spaghetti sauce, but food allergy testing (via skin prick testing and blood testing) did not show any food allergies.


He then underwent patch testing, to see if any of his skin care products, or other substances, might be playing a role in his dermatitis. The patch testing showed that he was allergic to a natural substance called Balsam of Peru. This substance is related to both fragrance and flavoring additives. This meant that he was allergic to fragrance additives, found in many skin care products. It also meant that he could potentially react to certain foods, including tomatoes.


After changing his skin care products, and avoiding tomatoes, citrus, and cinnamon for 6 weeks, his skin finally improved.




Balsam of Peru is one type of fragrance additive. It's either used in, or chemically related to, many of the fragrance additives that are used in different skin care products.


It's also related to certain foods.


In some patients who react to fragrance in their skin care products, eating these foods may also trigger a rash. This is a different type of immune system reaction than the usual food allergy. This type of allergic reaction is called systemic contact dermatitis. Patch testing is used to identify the trigger. 


It's hard to know which fragrance-allergic patients will react to these foods. In one study, researchers gave dietary instructions to a group of fragrance-allergic patients. These patients hadn't gotten better, even after avoiding fragrance in all of their skin care products.


After avoiding these foods, close to half of these patients finally improved.




If you’ve changed your skin care products (and successfully avoided fragrance additives) for at least 6 weeks, but your skin is still flaring, then your physician may recommend a Balsam of Peru avoidance diet.


You will have to avoid these foods for at least 6 weeks to see if this will make a difference in your dermatitis. During this time, you’ll continue to treat your dermatitis with medications, and you'll continue to use the right skin care products.


While there are a lot of foods on this list, it's important to remember that most people eventually find that just a few of the foods on this list act as a trigger for them.


The top triggers that I see are tomatoes, citrus, and cinnamon.

Infographic Balsam of Peru avoidance diet including tomatoes citrus cinnamon chocolate tomato products colas liquers flavored teas

Here are more detailed instructions: 

The Balsam of Peru Avoidance Diet


Some people who are allergic to Balsam of Peru by patch testing find that their skin condition improves when they eliminate or greatly reduce their intake of the foods listed below. We recommend that you eliminate as many of these foods as possible for 6 weeks. By the end of that time, you should be able to tell if following the diet has helped your skin. It can take up to 6 weeks to see a response.


While the list of foods is quite long, most people eventually find that just a few items on the list are the culprits. Not everyone will have a skin reaction when they eat all of these foods, but since individual food testing is not always reliable, we recommend avoidance of all and then reintroduction of individual foods one at a time. After 6 weeks, you can reintroduce these foods, one at a time, spaced 1 week apart. This way you’ll be able to eventually narrow down the list. There does seem to be a wide difference in the amounts of these foods that different individuals can handle. 


The following food items may contain balsams:


▪Products that contain citrus fruits: oranges, lemons, and grapefruits, as well as juices, marmalades, and some baked goods


▪Spices such as cinnamon, cloves, vanilla, allspice, anise, and ginger


▪Foods that may contain cinnamon and vanilla flavorings, such as ice cream, baked goods, candy, and chewing gum


▪ “Flavorings” that may be found in toothpaste, chewing gum, mints, cough drops, and mouthwash


▪Tomatoes and tomato-containing products


▪Red sauces and tomato-based foods, including salsa, pizza, chili, and Italian food


▪Spicy condiments: ketchup, chili sauce, barbecue sauce, and chutney




▪Cola (Coca-Cola, Dr. Pepper)


▪Other (for some people): some wine, beer, gin, vermouth, perfumed or flavored tea and tobacco, pickles and pickled vegetables

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