Energy Drink, Castor Oil and Squishy Toy: Three Unexpected Anaphylaxis Triggers in Young Patients

Within minutes of trying a new energy drink, a 15-year-old boy broke out in widespread hives, began wheezing and struggled to breathe. In the emergency department he needed two doses of epinephrine, plus albuterol, an antihistamine and IV fluids, before his symptoms settled. It is one of three unrelated pediatric cases presented at the 2026 Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI), each involving a child or teenager with anaphylaxis from a source well outside the usual list of peanuts, shellfish and bee stings.

The boy's trigger turned up on the drink's label: 5 grams of collagen derived from cod. He has eczema, asthma and allergic rhinitis, and had previously noticed mild throat itching and lip swelling after eating canned tuna, though he had eaten salmon without trouble. Skin prick tests for tuna, cod and flounder all came back negative. Allergist Annabelle Rowland, MD, who authored the report, explained that standard fish allergy tests mostly look for a different fish protein and contain very little collagen, so a person can test negative and still react. She noted that fish collagen is appearing in a growing number of products, from drinks to supplements.

The second case involved castor oil, a common ingredient in cosmetics, hair products and laxatives. Allergy to the castor bean is well known, but it almost always appears as a workplace allergy from inhaling bean dust, and anaphylaxis from the oil is rare, usually reported only in adults exposed to the seed. This report describes what the authors say is the first anaphylaxis in a child from castor oil applied to the skin.

The patient was a 10-year-old girl with eczema on her scalp, neck and elbows. For years she had used heat-pressed castor oil on her hair without problems. The first time cold-pressed castor oil was applied to her scalp, hives appeared on her face and neck, and she developed wheezing and shortness of breath. She was treated in the emergency room with epinephrine, albuterol and steroids. Skin prick tests using her own products were positive for the cold-pressed oil and negative for the heat-pressed one.

Lead author Keyun Wang, DO, said cold pressing keeps certain castor bean proteins intact, while the heat used in refining breaks them down. The team believes years of applying oil to eczema-damaged skin may have sensitized the girl, and that the protein-rich cold-pressed oil then provoked the reaction. Wang's takeaway: when assessing allergy risk from plant oils, how the oil is processed matters, not just which plant it comes from.

The third case involved a squishy squeeze ball, the kind some children use for stress relief and sensory play. Choking and skin irritation are known risks, but anaphylaxis had not been reported until now. An 11-year-old girl with allergic rhinitis and asthma developed hives, swelling and throat tightness after handling one at home and touching her face. She received epinephrine in the ambulance, then had a rebound of breathing symptoms that required more treatment in the emergency department.

A week later, within an hour of using a different squishy toy at school, she felt her throat tighten again. She used her own epinephrine and went back to the ER. She had no history of anaphylaxis, food allergy or latex allergy, but blood testing showed she was sensitized to latex, and no other trigger was found.

Lead author Megan Marte, MD, pointed out that these toys are often marketed as non-toxic rubber yet can contain a long list of chemical additives, and their exact makeup usually is not disclosed. Toy-related anaphylaxis has been linked to latex in ball pit materials, which raises the possibility of latex contamination or cross-reactivity in squishy toys. Her advice: if a child has an unexplained severe reaction after playing with a toy, look at the toys involved and consider seeing an allergist.

Taken together, the cases suggest that when a child's anaphylaxis has no obvious cause, clinicians may need to look at unlisted or hidden ingredients, how a product was processed, and latex sensitization. Anyone with symptoms of a severe allergic reaction should seek emergency care.