PHOENIX (Nov. 12, 2026) – When people think about anaphylaxis, peanuts, shellfish, or even bee sting often come to mind. Three medically challenging cases presented at the American College of Allergy, Asthma and Immunology (ACAAI) 2026 Annual Scientific Meeting show that severe allergic reactions can come from far less obvious places: a fish ingredient hidden in an energy drink, a natural hair oil and a popular children's sensory toy.
Although the three cases are unrelated, each involved a child or teen who experienced anaphylaxis—a severe, potentially life-threatening allergic reaction—and required epinephrine. Together, the cases underscore how an allergic trigger might be identified when the cause is unclear.
Something fishy in an energy drink
Within minutes of trying a new energy drink, a 15-year-old boy developed widespread hives, wheezing and difficulty breathing. In the emergency department, he received two doses of epinephrine, as well as albuterol, an antihistamine and IV fluids, before his symptoms resolved.
The culprit was an unexpected ingredient. A review of the label showed the drink contained 5 grams of collagen derived from cod. The teen, who has eczema, asthma and allergic rhinitis, had noticed mild throat itching and lip swelling when eating canned tuna, but had eaten salmon without a problem. Skin prick tests for tuna, cod and flounder were all negative.
"This case shows how tricky fish allergy can be," said allergist Annabelle Rowland, MD, study author and ACAAI member. "Collagen from fish is showing up in a growing number of products, from drinks to supplements. 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."
Abstract title: Anaphylaxis Following Energy Drink Consumption Reveals Something Fishy
Presenter: Annabelle Rowland, MD
How castor oil is made can matter when it comes to allergic reactions
Castor oil is a common ingredient in cosmetics, hair products and laxatives. Allergy to the castor bean, from which castor oil is made, is well known. It almost always appears as a workplace allergy from breathing in bean dust. Anaphylaxis is rare from castor oil and has usually only been reported in adults exposed to the seed.
This case describes the first reported anaphylaxis in a child from castor oil applied to the skin. A 10-year-old girl with eczema on her scalp, neck and elbows used heat-pressed castor oil on her hair for years without trouble. The first time cold-pressed castor oil was applied to her scalp, she developed hives on her face and neck, wheezing and shortness of breath. She was treated in the emergency room with epinephrine, albuterol and steroids. Skin prick testing with her own products was positive for the cold-pressed oil and negative for the heat-pressed oil.
"Cold pressing keeps certain castor bean proteins intact, while the heat used in refining breaks them down," said allergist Keyun Wang, DO, lead author of the study and ACAAI member. "We believe years of applying oil to eczema-damaged skin may have caused her to develop an allergy, and the protein-rich cold-pressed oil then triggered a reaction. When evaluating allergy risk from plant oils, we must consider how the oil is processed, not just the plant source."
Abstract Title: Pediatric Anaphylaxis Due to Topical Castor Oil Application
Presenter: Keyun Wang, DO
Two squishy toys and two trips to the ER
Squishy squeeze ball toys are popular with some kids for stress relief and sensory play. Known risks include choking and skin irritation, but anaphylaxis has not been reported until now.
An 11-year-old girl with allergic rhinitis and asthma developed hives, swelling and throat tightness after handling a squishy toy at home and touching her face. She received epinephrine in the ambulance, then had a rebound of breathing symptoms that needed further treatment in the emergency department. One week later, she felt her throat tighten within an hour of using a different squishy toy at school. She used her own epinephrine and was taken to the ER again. The girl had no prior history of anaphylaxis, food allergy or latex allergy, but blood testing showed she was sensitized to latex. No other trigger was found.
"These toys are often marketed as non-toxic rubber, but they can contain a long list of chemical additives, and their exact makeup usually isn't disclosed," said Megan Marte, MD, lead author of the case report and ACAAI member. "Toy-related anaphylaxis has been linked to latex in ball pit materials, which raises the question of latex contamination or cross-reactivity in squishy toys. If a child has an unexplained severe reaction after playing with a toy, it's worth looking at the toys they've been playing with and possibly see an allergist."
Abstract Title: Anaphylaxis Following Exposure to a Squishy Squeeze Ball Toy: A Case Report
Presenter: Megan Marte, MD
Anyone with symptoms of a severe allergic reaction should seek emergency care. To learn more about anaphylaxis, and find an allergist near you, visit AllergyandAsthmaRelief.org The ACAAI Annual Scientific Meeting is Nov. 12-16. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI26.
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