Gelatin

A Guide for People with Alpha-gal Syndrome

Gelatin

Gelatin (or gelatine) is a translucent, tasteless, soluble mixture of peptides and proteins derived from collagen. Collagen is found in the cartilage, bones, tendons, ligaments, and skin of animals.

• Most gelatin is produced from the skin and bones of pigs and cattle.
  • Pigs and cattle are mammals, and gelatin derived from them contains alpha-gal.
  • Gelatin made from cows is called bovine gelatin.
  • Gelatin made from pigs is called porcine gelatin.
• Less than 1% of gelatin is derived from fish or chicken.
  • Gelatin from fish or chicken doesn’t normally contain alpha-gal.
  • Some products marketed to people who avoid porcine or bovine gelatin due to religious prohibitions contain fish gelatin.

Other Names for Gelatin

Gelatin can also be listed on labels as hydrolyzed collagen (99), hydrolyzed animal protein, collagen hydrolysate, denatured collagen, and gelatina. Other names for gelatin, including trade names, are listed here and here.

Uses of Gelatin

Gelatin is used in foods, personal care products, medications and other medical products. It also has some industrial uses.

People with alpha-gal syndrome (AGS) can react to gelatin derived from mammals, like bovine or porcine gelatin. The risks related to gelatin exposure are profoundly different depending on the route of exposure.

Exposure through the mouth

• Examples:
  • Eating foods that contain gelatin
  • Swallowing medications that contain gelatin, such as medications in gelatin capsules
• Fewer than 10% of people with AGS react to gelatin in foods (57).
• Some have severe reactions (27,28).
• Gummi candies and marshmallows seem to be particularly problematic foods for people who react to gelatin (27,28,57).

Parenteral exposure

• Examples:
  • Vaccination with vaccines that contain gelatin, such as  Zostavax, MMR, yellow fever, rabies, oral typhoid, FluMist and others (6,28,39,42,43,57,92)
  • Administration of medical products that contain gelatin intravenously (through an IV), such as gelatin-based plasma volume expanders (6,28,52,57)

Other routes of exposure

• Topical/transdermal, such as:
  • Lotions and ointments applied to the skin
  • Patches, like lidocaine patches (6)
• Suppositories (inserted into the vagina or rectum)
  • There has been at least one case of gelatin in a vaginal capsule triggering anaphylaxis (37).
• The use of products during surgery, such as:
  • Hemostatic agents applied to help stop bleeding (6,53)
  • Absorbable gelatin sponges (6)
  • Collagen-containing agents, including implants (28,87)

Other factors influencing the severity of reactions

In addition to the route of exposure, other factors also influence the severity of reactions to gelatin. Alpha-gal allergic reactions are highly unpredictable, vary from individual to individual and exposure to exposure,  and can be profoundly influenced by co-factors.

Drugs and other medical products that may contain gelatin

Products that contain or may contain gelatin include, but are not limited to:

• Gelatin-based plasma expanders, such as Gelafundin, Gelofusine, Haemaccel (not commonly used in the U.S. if at all) (6,28,52,57)
• Many vaccines. In the U.S., these include Zostavax, MMR, yellow fever, rabies, oral typhoid, FluMist and others (6,28,39,42,43,57,92)
• Hemostatic agents, such as Surgiflo (53), Floseal hemostatic matrix, and Surgifoam powder (6)
• Absorbable gelatin sponges (6), like Gelfoam
• Gabapentin oral solution (6)
• Lidocaine patch (6)
• Gummy supplements (57)
• Vaginal capsules (37)
• Suppositories (28,87)
• Medications with gelatin capsules (6,57)
• Colostomy bags (103)
• Many other perioperative, prescription, and over-the-counter OTC drugs  (32,33,34,35,57).

Medical uses of collagen

Collagen has an array of medical applications, including:

• Implants (28,87)
• Orthopedic applications (102)
• Surgical applications, including cosmetic surgery (102)
• As a healing aid for burn patients (102)
• Bone reconstruction (102)
• As an artificial skin substitute (102)

Most medical collagen is derived from cattle or pigs. Human collagen is also sometimes used, but is more expensive (102).

Finding substitutes for medications that contain gelatin

For most medications, there are alternatives that do not contain mammalian-derived ingredients like gelatin. When substitutes aren’t available, a compounding pharmacy can usually make one. When alternatives are not an option, you and your physician may need to weigh the risks of exposure to gelatin–which vary from individual to individual and product to product–against the benefits of taking the a medication. If your supplements and/or medications contain gelatin, seek a physician’s advice about what to do. 

Figure 1. The risk and also severity of reactions in the α-Gal syndrome relate to the amount of the oligosaccharide that is present in food, drugs, or other therapeutics. The route of administration is relevant to the speed at which reactions occur; that is, intravenous administration is associated with rapid reactions, whereas oral ingestion has delayed onset. Cofactors such as NSAIDs, exercise, and alcohol can be additional risk modifiers. This schematic reflects clinical experience, as well as challenge studies and laboratory investigations. CroFab, Crotalidae polyvalent immune Fab; MMR, measles, mumps, and rubella; NSAID, Nonsteroidal anti-inflammatory drug.

Reproduced from: Platts-Mills TA, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and management of patients with the α-Gal syndrome. The Journal of Allergy and Clinical Immunology: In Practice. 2020 Jan 1;8(1):15-23, with permission from Elsevier.

Reproduced from: Platts-Mills TA, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and management of patients with the α-Gal syndrome. The Journal of Allergy and Clinical Immunology: In Practice. 2020 Jan 1;8(1):15-23, with permission from Elsevier.

Fewer than 10% of people with AGS react to mammalian gelatin in foods (57), but some have severe reactions (27,28).

• In general, fewer of us react to gelatin in foods than to dairy.
• A minority of us react to gelatin in foods despite tolerating dairy. 

Functional properties of gelatin in foods

Learning about the various reasons why gelatin is added to foods can help you develop a sense of the categories of foods you need to be most cautious about.

• Gelatin is used as an ingredient in many foods as a stabilizer, thickener, texturizer and to improve the mouth-feel of reduced-fat foods.
• Gelatin is also used as a processing aid, for example to clarify beverages, like wine, beer and juice.
  • When gelatin is used processing aid in the manufacture of a product, there may be residues of gelatin left in it.
  • Processing aids do not need to be listed as ingredients (103)

Source: Organic Materials Review Institute for the USDA National Organic Program. (2002). “Gelatin: Processing.” National Organic Standards Board Technical Advisory Panel Review.

Foods that can contain gelatin include, but are not limited to:

• Candy including Starburst, Altoids, gummy worms and other gummy candies, peeps, some candy corn, and jelly beans
• Gummy vitamins and supplements, including fish oil in gelatin capsules
• Jello gelatin
• Marshmallows
• Dairy products, including yogurt, ice cream, whipped cream, sour cream, cream cheese, cottage cheese, cheese spreads, and semi-fat cheese spreads
• Margarine
• Desserts, including popsicles, instant dessert powders, cakes or cake fillings, instant puddings, cheesecake
• Jellies and jams
• Icing and frosting
• Syrups
• Snacks, including Rice Krispy Treats,  Poptarts, snack bars, and fruit-flavored snacks
• Pastries and other baked goods
• Some cereals, like Lucky Charms, Kellogg’s Frosted Mini-Wheats and other frosted cereals, cereals with marshmallows in them, and many others.
• Peanuts, such as Planters Dry Roasted Peanuts, which are coated with gelatin to help the salt stick
• Fruit salads
• Food foams (espuma)
• Aspic
• Dips
• Soups and stock, including jellied tomato consommé
• Sauces
• Glazes
• Meats and meat products, including:
  • Bouillon
  • Sausage coatings
  • Ground meat
  • Sausages
  • Frozen turkey products
  • Lunch meats
  • Chicken rolls
  • Canned meat
  •  Turkey
  • Instant gravy, instant sauces and soups
• Beverages, including:
  • Soft Drinks
  • Gelled beverages
  • Powdered drink mixes
• Animal glue, for example, as an adhesive on stickers used on fruit
• As a coating on fresh vegetables and fruit

• Gelatin is used as a processing aid for:
  • Clarification of beverages such as wine, beer, vegetable and fruit juice (especially apple juice), and possibly vinegar
  • Microencapsulation of colors, flavors, oils, vitamins

If you react to gelatin, always check labels to see if foods, medications, and personal care products contain it before you buy them. Fish gelatin is not from mammals and many people with AGS use it as a substitute for mammalian gelatin.

✅ Paskesz Marshmallows (made with fish gelatin)

✅ Annie’s Organic Bunny Fruit Snacks

✅ Newman’s Own Organics Peppermints

✅ Some Unfrosted Poptarts

✅ Kirkland Signature Roasted and Salted Super Extra-Large Peanuts

✅ Kashi Autumn Wheat Organic Whole Wheat Biscuits

✅ Fish Gelatin

Personal Care Products That May Contain Gelatin

Most people with AGS tolerate gelatin in personal care products, but some do not. Gelatin in oral care products tends to be the most problematic. Personal care products that may contain gelatin include, but are not limited to:

• Skin care products, such as:
  • Moisturizers and lotions (99,100)
  • Face creams (99)
  • Serums & essences (100)
  • Facial cleansers (100)
• Hair products, such as:
  • Shampoo (99,100)
  • Hair sprays (99)
  • Styling gel/lotion (100)
• Cosmetics
  • Nail treatments (101)
  • Creamy cosmetics (101)
• Sunscreens (99)
• Bath salts and bubbles (99)
• Body wash/cleansers and shower gels (99,100)
• Nail polish remover (100)
• Oral care products:
  • Tooth whiteners (100)

See the Environmental Working Group’s Skin Deep database for more information about personal care products that contain gelatin. 

Household and Other Products That May Contain Gelatin

Household products that may contain gelatin include, but are not limited to:

• Toilet paper, including Charmin toilet paper
• Sandpaper (102)
• Match heads (102)
• Pet food

Other Uses of Gelatin

Other products and processes for which gelatin is used include, but are not limited to:

• NCR paper and other paper (102,103)
• Photographic paper and film (102)
• Animal glue, used for woodwork, bookbinding, and in the preparation of canvasses for painters
• Pesticides (103)
• Herbicides (103)
• Paintballs (103)
• Electrochemical plating (103)
• Adhesives (103)
• Binding agent in paint (103)
• Stucco restoration (103)
• Polystyrene production (103)
• As a binder in construction (103)

Products Recommended by People with Alpha-gal Syndrome

Below are links to Amazon.com lists of products recommended by people with AGS. They should not contain gelatin or other forms of alpha-gal, but keep in mind that ingredients can change, and people can make mistakes, so you need to check the ingredients yourself before purchasing any of these items. If you suspect that any of these products is not safe for people with AGS, contact us at alphagalinformation@gmail.com.

Alpha-gal-free personal care and other products

For a list of personal care and other products recommended by people with AGS, click here.

More alpha-gal-free hair products

For additional hair products recommended by people with AGS, click here.

Alpha-gal-free cleaning products

For a list of household products recommended by people with AGS, click here.

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