Cochineal
A vivid red dye extracted from dried cochineal insects, used to colour yoghurts, sweets, drinks and other foods.
Can cause IgE-mediated allergic reactions including urticaria, asthma and anaphylaxis. Reactions can be triggered by very small amounts. People with known allergies to house dust mites or crustaceans may also react. Not suitable for vegetarians or vegans.
What is it?
Carminic acid extracted from dried, crushed female cochineal insects (Dactylopius coccus), scale insects farmed on prickly pear cacti in South America and the Canary Islands. The extract is purified into carminic acid or converted into aluminium or calcium lake salts called carmines. It has been used as a red dye for centuries.
What does it do?
The carminic acid molecule binds strongly to protein and aluminium ions, producing a stable, heat- and light-resistant deep red to purplish-red colour. In food, it gives a vivid natural-looking red or pink without fading over the product shelf life.
Where you will see it
Strawberry, raspberry and cherry yoghurts; red and pink sweets and gummies; flavoured milk drinks; some aromatised wines and fruit-flavoured alcoholic drinks; lumpfish roe and imitation caviar; cocktail cherries; some ice creams and sorbets. On a UK ingredient label it appears as E120, carminic acid or carmines. The term 'cochineal' is no longer permitted on UK food labels since October 2019 and must not be used.
What the science says
IgE-mediated allergy and anaphylaxis from food
Carmine contains proteins from the cochineal insect that can sensitise the immune system and trigger IgE-mediated reactions. Case reports from the 1990s onwards document anaphylaxis from ingesting foods coloured with carmine, including yoghurts, popsicles and alcoholic drinks. One documented case involved a reaction to as little as 1mg of carmine. The allergen is the insect protein fraction, not the carminic acid pigment molecule itself.
Anaphylaxis following consumption of carmine-coloured yoghurt was shown to be IgE-dependent by positive skin prick tests and leukocyte histamine release assays; one case reacted to 1mg carmine.
Popsicle-induced anaphylaxis confirmed as IgE-mediated carmine-specific reaction via positive skin prick testing to carmine; insect proteins, not carminic acid, were identified as the allergenic fraction.
In 110 patients with urticaria or suspected food additive hypersensitivity, verified carmine allergy by oral challenge was found in 8% (9 patients); all affected patients had chronic inducible urticaria.
Occupational asthma and respiratory sensitisation in workers
Workers who inhale carmine dust in manufacturing, food processing or cosmetics production face a high rate of sensitisation and occupational asthma. Studies in processing facilities found that over 40% of current workers became sensitised, and around 8-18% developed occupational asthma. When workers who had already left because of illness were included the asthma rate was higher, suggesting underestimation among current employees. The same insect protein fraction drives respiratory sensitisation as food allergy.
In a natural dye processing facility, 41.7% of current workers showed positive skin tests to carmine and 8.3% developed occupational asthma; when three former workers who had left were included, the cumulative sensitisation rate rose to 48.1% and the occupational asthma rate to 18.5%.
Carmine is a confirmed dermal and respiratory sensitiser; dusting potential measured at an average of 6,545mg per cubic metre of air (range 5,515-7,285mg/m3) in occupational settings, and the FEEDAP Panel concluded inhalation exposure is very likely.
Relationship to house dust mite and crustacean allergy
Because cochineal insects are arthropods, some researchers assumed that carmine allergy depended on pre-existing sensitisation to dust mites or shellfish, which share insect-class proteins. Studies found that while mite sensitisation is common in carmine-allergic patients, carmine reactions can and do occur independently and are not driven by cross-reactivity alone. Newer diagnostic work using purified carminic acid rather than whole cochineal extract resolves this interference.
Of 3,164 patients tested with carmine skin prick tests, 94 (3%) were positive; of those 94, 74% also reacted to dust mites, but ingestion-associated symptoms were not dependent on concurrent mite reactivity in 42% of cases, and carmine sensitisation without any mite sensitisation occurred in approximately one-quarter of positive patients.
Routine testing using cochineal lice-specific IgE is hampered by cross-reactivity with crustaceans and house dust mite; IgE inhibition and basophil activation testing with carminic acid provides highly specific primary carmine allergy diagnosis.
Regulatory toxicology and the acceptable daily intake
Long-term rat feeding studies found no adverse effects at the highest dose tested. JECFA and EFSA have both set an acceptable daily intake of 5mg carmine per kilogram of body weight per day. This figure is derived from toxicology endpoints, not allergy endpoints, and a sensitised person may react at amounts far below it.
A combined chronic toxicity and carcinogenicity study in rats identified a NOAEL of 500mg carmine per kilogram body weight per day; applying an uncertainty factor of 100 gives the ADI of 5mg per kilogram body weight.
JECFA confirmed an ADI of 5mg per kilogram body weight for carmines; no numerical ADI was set for cochineal extract due to insufficient data at the time of evaluation.
Where it stands with the regulators
Who should be careful
Anyone with a known allergy to carmine, cochineal or related insect proteins should avoid it. People with chronic inducible urticaria, such as pressure or cold-induced types, are at increased risk of reacting. Those with dust mite or shellfish allergies may also be sensitised, though the relationship is not straightforward. Vegetarians and vegans avoid it as it is derived from insects; it is also rejected by most halal and kosher certifying bodies. On a UK label look for E120, carminic acid or carmines.
The honest read
The allergenicity evidence for carmine is well established and consistent across decades of case reports, challenge studies and workplace surveys. The reactions documented range from urticaria to full anaphylaxis. What remains uncertain is the overall prevalence of sensitisation in the general population, because most studied groups are people already attending allergy clinics. The insect protein fraction drives the allergy; the carminic acid pigment molecule itself appears to be non-allergenic, which matters for diagnosis but not for avoiding the additive on a label. The 5mg/kg ADI applies to toxicological endpoints and does not set a threshold for allergic individuals.
Related additives
Common questions
Is E120 banned in the UK?
No. E120 is approved for use in the UK under the assimilated version of EU Regulation 1333/2008, with specific maximum levels for each permitted food category. Only the label term 'cochineal' was withdrawn in October 2019; the additive itself remains permitted.
Can carmine cause a severe allergic reaction?
Yes. Multiple published case reports and challenge studies document IgE-mediated anaphylaxis from carmine in foods and drinks. One case occurred with as little as 1mg of carmine. The allergenic component is insect protein from the cochineal insect, not the pigment molecule itself. People with known reactions should treat carmine as a significant allergen.
What foods contain E120?
Strawberry, raspberry and cherry yoghurts are the most common source. Also found in red and pink sweets, gummy confectionery, some flavoured milk drinks, aromatised wines and fruit-flavoured alcoholic drinks, lumpfish roe, imitation caviar and cocktail cherries. Look for E120, carminic acid or carmines in the ingredients list.
Is E120 vegan?
No. Carmine is extracted from dried and crushed female cochineal insects. It is not suitable for vegans or vegetarians. Most halal certifying bodies also reject it as insect-derived, though there is some scholarly disagreement within Islamic dietary law; it is generally not considered kosher. Beetroot extract (E162) is a common plant-based alternative used in reformulated products.
Sources
- UK FSA: Approved additives and E numbers
- EFSA ANS Panel: Scientific Opinion on the re-evaluation of cochineal, carminic acid, carmines (E 120) as a food additive. EFSA Journal 2015;13(11):4288
- EFSA FEEDAP Panel: Safety and efficacy of a feed additive consisting of carmine for cats and dogs. EFSA Journal 2022;20(10):7609
- JECFA: Cochineal Extract, Carmine and Carminic Acid monograph. WHO Food Additives Series 46
- Beaudouin E et al. Food anaphylaxis following ingestion of carmine. Ann Allergy Asthma Immunol. 1995;74(5):427-430
- Baldwin JL et al. Popsicle-induced anaphylaxis due to carmine dye allergy. Ann Allergy Asthma Immunol. 1997;79:415-419
- Tabar-Purroy AI et al. Carmine (E-120)-induced occupational asthma revisited. J Allergy Clin Immunol. 2003;111(2):415-419
- Liippo J and Lammintausta K. Allergy to Carmine Red (E120) Is Not Dependent on Concurrent Mite Allergy. Int Arch Allergy Immunol. 2009;150(2):179-183
- Ganseman S et al. Diagnosis of carmine allergy using carminic acid solves interference of house dust mite and crustacean cross-reactivity. Clin Exp Allergy. 2022;52(10):1225-1229
- Sadowska B et al. Carmine allergy in urticaria patients. Postepy Dermatol Alergol. 2022;39(1):94-100
- Commission Regulation (EU) 2019/800 - extension of carmine use and labelling amendment
- Campden BRI: Cochineal regulations - carminic acid and carmines to be used on food labels from October 2019
- UK assimilated Regulation (EU) 1333/2008 Annex II (food additives)
Aaron Keen is the founder of NutraSafe. He researches and writes every additive entry himself, from the primary sources. About the research →
This is a guide, not medical advice. If an additive affects you, speak to your GP or a dietitian.
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