Gelatin

A Guide for People with Alpha-gal Syndrome

What Is Gelatin?

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.

Routes of Exposure

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.

People who tolerate gelatin in foods, supplements, and some oral medications, may experience severe and sudden-onset symptoms, including anaphylaxis, after some medical exposures. These include the injection or intravenous administration of medical products containing gelatin (6,28,52,57).

Gelatin in Drugs and Other Medical Products

“Due to the parenteral route of administration, allergists consider alpha-gal-containing drugs even more dangerous for allergic patients than mammalian meat.” (91)

Jörg Fischer, et al.

Drugs and other medical products that may contain gelatin

There are numerous medications and other medical products that contain gelatin and other forms of alpha-gal. The risks they pose varies enormously from product to product. The use of some products is advised against for all patients with AGS. Other products are well-tolerated by many patients. In many cases, there is insufficient data to fully assess the risk. Decisions about whether or not to use medications and other medical products that contain gelatin can be nuanced and involve weighing potential benefits against potential risks. Please seek the advice of informed healthcare providers about all medical decisions.

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.

Gelatin in Foods

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)

When used as an incidental additive or as a processing aid in insignificant amounts, gelatin is exempt from food labeling requirements. This is the case when gelatin is used as a clarifying agent in wine, beer, or juice or used as a carrier in juice or soft drinks (103).

Jeanne Yacoubou, MS

The Vegetarian Resource Group

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

Examples of Foods That May Contain Gelatin

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

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.

 

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Contains gelatin

⚠ Usually contains gelatin

⚠ Often clarified with gelatin

⚠ Sometime contains gelatin (turkey lunch meat)

⚠ Sometime contains gelatin (frosting)

⚠ Sometimes contains gelatin

⚠ Sometimes contains gelatin (soup)

⚠ Sometimes contains gelatin (espuma)

Try These Substitutes

 Regular marshmallows

(made with gelatin from pigs or cows)

←Instead of this

Try this→

Most marshmallows are made with gelatin from pigs or cows. Paskesz marshmallows are made with fish gelatin instead.

Note that Paskesz marshmallows contain “natural and artificial flavors.” Manufacturers usually cannot verify that products made with “natural flavors” do not contain mammal-derived ingredients. Thus, we can’t guarantee that these marshmallows are completely mammal free, but many people with AGS eat them without reacting.

Marshmallow Fluff is also gelatin-free. Note that the strawberry version contains “natural flavors.”

Beware of vegan marshmallows, like Dandies. They often contain carrageenan, which is not from a mammal, but which also contains alpha-gal.

✅ Paskesz Marshmallows (made with fish gelatin)

 Haribo Gold-Bears Gummi Candy

(made with gelatin from pigs or cows)

←Instead of this

Try this→

Most gummi bears are made with gelatin from mammals.

Try Annie’s Bunny Fruit Snacks instead.  

See PETA’s Ultimate List of Surprisingly Vegan Candy for more vegan candy ideas. Check candy ingredient list yourself before you buy them, keeping the following in mind:

1. Many of the products on this list contain “natural flavors” and may contain mammal-derived ingredients, despite PETA’s claim. You may need to avoid these.

2. Manufacturers can change ingredients at any time.

3. Some vegan foods contain carrageenan, which is not from a mammal but also contains alpha-gal (54).

 

✅ Annie’s Organic Bunny Fruit Snacks

 Altoids

(made with gelatin from pigs or cows)

←Instead of this

Try this→

Most Altoids are made with gelatin from pigs or cows.

Try Newman’s Own Organic Peppermints instead.

Check out additional recommendations for vegan mints from PETA here, but remember to check the ingredient list for “natural flavors” and carrageenan, if you react to it.

 

✅ Newman’s Own Organics Peppermints

 Frosted Poptarts

(made with gelatin from pigs or cows)

←Instead of this

Try this→

 

Frosted Poptarts are made with pig or cow gelatin. Luckily, at least some unfrosted Poptarts are not. Try an unfrosted Poptart, but first check the label and make sure it doesn’t contain some other form of alpha-gal. Buy some vegan icing to spread on it or make your own vegan icing.

✅ Some Unfrosted Poptarts

 Planters Dry Roasted Peanuts

(made with gelatin from pigs or cows)

←Instead of this

Try this→

Planters Dry Roasted Peanuts are coated with gelatin to make the salt stick.

Try Costco’s Kirkland Signature Super Extra-Large Roasted and Salted Peanuts instead.

Lots of peanuts and tree nuts, including some Planters products, do not contain gelatin. Just check the label before you buy them.

✅ Kirkland Signature Roasted and Salted Super Extra-Large Peanuts

 Kellogg’s Frosted Mini Wheats

(made with gelatin from pigs or cows)

←Instead of this

Try this→

Kellogg’s Frosted Mini Wheats are made with gelatin from pigs or cows.

Try Kashi Autumn Wheat Organic Whole Wheat Biscuits instead.

 

✅ Kashi Autumn Wheat Organic Whole Wheat Biscuits

 Knox Original Gelatine

(made with gelatin from pigs or cows)

←Instead of this

Try this→

 

Knox gelatine is made from mammals. Try using fish gelatin instead.

✅ Fish Gelatin

Personal Care, Household, and Other Products That May Contain 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)

Resources

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.

Smart Label

SmartLabel® is a tool that gives consumers a way to digitally access more detailed product information than could ever fit on a package label about a wide range of food, beverage, supplement, household, pet care, personal care, and over-the-counter products. It is fast and easy to use, with a consistent digital format that shares accurate data directly from the manufacturer in real-time.

Consumers will be able to find detailed information about products in several different ways. They can access SmartLabel® by searching the web; visiting a participating company’s or brand’s website; scanning a SmartLabel® QR or digital code on packages; or using the SmartLabel® Product Search on this site. There is also a certified app to access SmartLabel® information, which can be downloaded on your smartphone. Simply go to your app store, and search for “SmartLabel®.” The SmartLabel® app will be the first result to pop up. People can access SmartLabel® and its information whether they are in the store, at home, or at work, and by using a smart phone, tablet or desktop computer.

Environmental Working Group: Skin Deep Database

References

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