Common Allergens in Massage: What Therapists Need To Know

What do you think when you hear the word “allergen”? For most people, pollen, peanut, or pet dander might come to mind. But for massage therapists, the concept of allergens takes on a whole new significance. Why? Because the products therapists commonly use to help and heal could potentially harm a client with allergies.

What is an allergen? An allergen is a substance that can cause an allergic reaction. In massage therapy, this could range from ingredients in oils and lotions, to the tools or cleaning products you use, or even the plants in your treatment room. These reactions can be as mild as a sneezing or a slight rash, or as severe as anaphylactic shock.

In this post, you’ll learn about the most common allergens that can affect a massage therapy session, how to recognize them, and best practices to minimize the risk of your clients having an allergic reaction. By reading this blog post, you’re taking a proactive step to ensure your clients’ safety and comfort. Let’s explore some key things that massage therapists need to know about allergens.

Why Allergen Awareness Matters

Every time a client steps into your treatment room, they’re placing immense trust in you. They’re looking for relief and relaxation, but a simple oversight regarding allergens could transform their experience from soothing to distressing.

So, what exactly is an allergy or allergic reaction?

An allergy is defined as a hypersensitive reaction of the immune system to substances (allergens) that are typically harmless to most people. These reactions can range from minor skin irritations to serious conditions needing medical intervention. In fact, more than half the US population is sensitive to one or more allergens¹.

As a massage therapist, being unaware of common allergens in products can put both your client’s well-being and your professional reputation at risk. Being informed about these allergens and how to avoid adverse events will help reinforce credibility and trust with your clientele, especially those with sensitive skin.

Types of Allergies

A comprehensive discussion of allergies and allergens for massage therapy begins with understanding the various types of allergies. Let’s break down the main types, along with their common triggers and symptoms, to give you a holistic overview:

Contact Allergy:

• Triggers: These are caused by direct contact with substances like latex, certain metals (like nickel), lanolin, PEG, fragrances, and ingredients in skincare products or massage oils.
• Symptoms: Redness, itching, blisters, and swelling of the skin where contact occurred.

Food Allergy:

• Triggers: Common culprits include peanuts, tree nuts, milk, eggs, wheat, soy, fish, and shellfish.
• Symptoms: Hives, shortness of breath, stomach cramps, diarrhea, and even anaphylaxis in severe cases.

Pet Allergy:

• Triggers: Pet dander, saliva, and urine from animals such as cats, dogs, and birds.
• Symptoms: Sneezing, runny or stuffy nose, red or itchy eyes, and skin rashes.

Insect Sting Allergy:

• Triggers: Stings from insects like bees, wasps, hornets, and yellow jackets.
• Symptoms: Swelling at the sting site, itching, hives, chest tightness, and, in extreme cases, anaphylactic shock.

Pollen and Mold Allergy:

• Triggers: Pollen from trees, grasses, and weeds, or spores from molds.
• Symptoms: Sneezing, runny nose, itchy eyes, and congestion.

Recognizing these types of allergies is a significant first step. For massage therapists, being mindful of contact allergies is particularly important. However, a comprehensive understanding of all allergy types can be beneficial in creating a safe and accommodating environment for every client.

Terminology Related to Allergies

When learning about allergies, there are some new terms to familiarize yourself with. The table below lists some specific terms that can help massage therapists better understand allergies and allergens that can affect their clients during a session. Check out our online glossary for a comprehensive review of of massage terminology.

Term	Definition
Allergen	Substance that triggers an allergic response. They can be found in foods, the air, and various products. Common examples include latex, nickel, and formaldehyde.
Allergist or Immunologist	Physician specially trained to diagnose, treat, and manage allergies, asthma, and other immunological disorders.
Anaphylaxis	A severe, life-threatening allergic reaction that can affect multiple body systems. It can cause difficulty breathing, swelling, hives, a potentially a drop in blood pressure and loss of consciousness (anaphylactic shock). This is potentially life threatening and requires immediate medical attention.
Antibody	Protein produced by the immune system to neutralize or destroy foreign substances. The specific antibody involved in most allergic reactions is called IgE (Immunoglobulin E).
Antihistamine	Medication that counteracts the effects of histamine, a compound released during allergic reactions. It is commonly used to treat symptoms like itching and runny nose. Common examples of antihistamines include Benadryl (Diphenhydramine), Claritin (Loratadine), Zyrtec (Cetirizine), and Allegra (Fexofenadine).
Autoimmune Disease	Autoimmune disease is a pathological condition wherein the immune system mistakenly targets and attacks the body’s own tissues.
Bronchospasm	A sudden constriction of the muscles in the walls of the bronchioles in the lungs, often seen in asthma and some severe allergic reactions.
Contact Dermatitis	Contact dermatitis is an inflammatory skin reaction that occurs when an individual’s skin comes into direct contact with an irritant or allergen. This condition can lead to symptoms like redness, itching, and blistering (vesiculation) at the site of contact.
Cross-reactivity	When someone allergic to a particular substance also reacts to a similar substance, due to shared characteristics between the two allergens.
Desensitization	A treatment process, often called immunotherapy or allergy shots, designed to reduce a person’s allergic response over time.
Epinephrine (Adrenaline)	A medication used to treat severe allergic reactions, including anaphylaxis. It can quickly reverse symptoms and is often administered via an auto-injector.
EpiPen	An EpiPen, or epinephrine auto-injector, is a device used to quickly deliver medication to someone experiencing anaphylaxis. It helps constrict blood vessels, relax muscles in the lungs, and stimulate the heartbeat.
Histamine	A compound released by cells in response to an allergen. It’s responsible for many symptoms of allergic reactions, such as itching and inflammation.
Hypersensitivity	An exaggerated immune response to substances that are typically harmless. It is a broader term encompassing various reactions, including allergic reactions.
Hypoallergenic	Hypoallergenic refers to products or substances that are less likely to cause allergic reactions in individuals. Typically, they are formulated to minimize or eliminate potential allergens and irritants.
IgE	Short for Immunoglobulin E, it’s an antibody produced by the immune system in response to an allergen. High levels are often seen in people with allergies.
Mast Cells	Cells in the immune system that release histamine and other chemicals in response to an allergen.
Patch Test	A diagnostic method where small amounts of potential allergens are applied to the skin using patches to identify contact allergens.
Sensitization	The process by which a person becomes, over time, more reactive to a substance, particularly through repeated exposure.
Urticaria	Also known as hives, these are red, itchy welts on the skin that result from an allergic reaction.

Understanding these terms is invaluable when discussing or researching allergies. As a massage therapist, you might encounter clients using some of this terminology (like on their health history form), and being in the know will only boost your credibility and ensure effective communication.

Common Allergens in Massage Products

So, you’ve got your lotions, oils, and tools at the ready, but do you know what’s actually in them? For massage therapists, being educated about the products used can be as crucial as understanding the techniques themselves. Client safety should always be first priority.

1. Essential Oils: While many essential oils offer therapeutic benefits, some people can adversely react to them (see below). This includes essential oils that contact the skin or oils that are aerosolized with a diffuser.
2. Lotions and Creams: Common allergens lurking in these products include parabens, fragrances, and certain preservatives. It’s always a smart move to choose unscented or hypoallergenic products when available.
3. Massage Oils: Be watchful of nut-based oils like sweet almond oil. Clients with nut allergies could have adverse reactions. Grape seed oil or jojoba oil may be a better option.
4. Gels and Balms: Many contain menthol or camphor, which some folks can find irritating to their skin.
5. Latex: Often found in massage therapy equipment, tools and PPE gloves. Clients with a latex allergy can develop reactions, so considering latex-free alternatives is a wise choice.
6. Towels and Linens: It’s not always the fabric, but the laundry detergent or fabric softeners used can sometimes lead to skin irritations. Opting for sensitive skin-friendly detergents can help.

Preservatives in Products

Preservatives play a crucial role in prolonging the shelf life of therapeutic products by preventing the growth of harmful microorganisms. However, for massage therapists, it’s essential to be well-informed about these additives, as some can trigger allergic reactions in clients.

Parabens, while effective preservatives, have garnered attention due to potential allergic sensitivities. Formaldehyde, another common preservative, can cause skin irritation in certain individuals. Benzyl alcohol, sorbates, and benzoates, although less notorious, can still be problematic for those with heightened sensitivities. Given these concerns, it’s best for therapists to choose massage products that do not contain these ingredients.

Be diligent about reading labels, asking suppliers, and being open with clients about the products you use. Always aim for transparency – it goes a long way in building trust and rapport, and ensuring your clients feel relaxed. And because risk can never be completely eliminated, it is a good idea to include mention of the risk of allergic reaction on the informed consent form that your clients review and sign during the intake process.

Reactions from Essential Oils

Allergic reactions to essential oils can occur due to the bioactive compounds they contain. While many essential oils are generally safe for most users when diluted properly, some have a higher risk of causing allergic reactions due to specific components they contain. Here are some of the most common culprits:

• Tea Tree Oil: Contains terpinen-4-ol, which is believed to be responsible for its antimicrobial activity. However, it’s also a common allergen, and some individuals may develop allergic contact dermatitis after using products containing tea tree oil.
• Lavender Oil: Linalool and linalyl acetate, two of the major constituents of lavender oil, can oxidize when exposed to oxygen. The oxidized compounds are more likely to cause allergic reactions than the fresh ones.
• Ylang Ylang Oil: This fragrant oil contains benzyl benzoate, benzyl acetate, and linalool, which, especially when oxidized, can be allergenic to some individuals.
• Cinnamon Bark Oil: Contains cinnamaldehyde, which can cause skin sensitization or irritation in some people, leading to allergic reactions.
• Jasmine Oil: Contains benzyl acetate, linalool, and benzyl benzoate, which can act as allergens for some individuals, especially in higher concentrations or when oxidized.
• Bergamot Oil: This oil contains bergapten, a furocoumarin that can cause phototoxic reactions. This means that when skin with bergamot oil is exposed to UV light, it can lead to severe skin burns or discolorations.
• Lemongrass Oil: Contains citral, which can be an irritant, especially when used in high concentrations. Some people may experience allergic contact dermatitis from it.
• Peppermint Oil: Menthol, the main component, can cause skin irritation in some individuals when used in high concentrations.
• Chamomile Oil: While chamomile is often considered soothing, it contains bisabolol and chamazulene which can cause allergic reactions in some people, especially those who are allergic to plants in the Asteraceae family.
• Rose Oil: Contains geraniol and citronellol, which can act as allergens for some individuals.

It’s important to remember that allergic reactions can vary among individuals. Proper dilution and patch testing before full application can help lessen the risk of an allergic reaction or other side effect. If a client suspects they have an allergy to a particular essential oil, then it is avoid any use of that oil on or around the client.

A Word About Nut Allergies

Nut allergies are among the most common and potentially severe allergies that can pose significant challenges in massage therapy. There are two main types of nut allergies: peanut allergies and tree nut allergies (almonds, hazelnuts, chestnuts, walnuts, etc.). Many massage oils and lotions contain nut-derived ingredients, such as sweet almond oil or shea butter, which could lead to an allergic reaction in susceptible clients. As part of the client assessment and intake process, massage therapists should explicitly inquire about nut allergies.

If a client indicates any nut sensitivities, therapists should opt for products labeled as “nut-free” and double-check ingredient lists to ensure no nut-derived components are present. Additionally, thorough cleaning of the workspace between sessions is crucial to prevent cross-contamination, especially if nut-based products were previously used.

Choosing the Right Products

Choosing the right oils, lotions, and other products can make the difference between a comfortable massage session and one that triggers allergies or sensitivities for your client.

1. Hypoallergenic Products: These are designed to reduce allergic reactions. Choose hypoallergenic and unscented or fragrance-free products whenever possible, including laundry detergent and hand soap. But remember, “hypoallergenic” doesn’t guarantee that an allergic reaction won’t occur; it simply means the risk is lower.

2. Reading Ingredient Lists: Be proactive and identify potential allergens before they become a problem. Ingredients to keep an eye on include fragrances, dyes, and certain preservatives.

3. Understand Labeling: Terms like “natural” or “organic” don’t necessarily mean they’re free from allergens. While they might be derived from nature, natural ingredients can still cause allergic reactions. Be informed, and always read labels cautiously.

Client Consultation and Assessment

When it comes to allergic reactions, prevention is key. Regardless of what type of massage you offer (e.g., relaxation or clinical), or where you practice (e.g. day spa, chiropractor’s office, or home office), each new massage client should complete a thorough intake process, which includes filling out an intake form. This form should have sections for medical history, allergies, and previous reactions to products, which will all provide valuable insight.

Your client assessment or consultation, should start with going over the client’s intake documentation and specifically asking about any areas of concern, including known allergies. This is an opportunity to clarify any points of confusion, identify the presence of any contraindications for massage, and further understand their relevant medical history.

Keep in mind that many clients may not be aware that they have sensitivities or allergies to certain substances. In these cases, you may not discover until later that a client will have an adverse reaction when exposed to a specific essential oil for instance. Be sure to document any adverse reactions in your massage SOAP notes. If a client has a severe adverse reaction, you should complete an incident report.

Performing a Patch Test

For each new product that you plan on using during a client’s session, start by discussing the ingredients with the client to obtain their consent. If there is any concern about an allergic reaction, then do not use the product. However, if you and the client think it should be safe to use but want to play it safe, it is a good idea to do a patch test first. Here’s how to do it:

1. Allow the client to apply a small amount of the product (~size of a quarter) at a discreet area on their skin, like the anterior forearm.
2. Leave it on for a set period, often 24 to 48 hours, to observe any reactions.
3. If redness, itching, or any other signs of irritation appear, it’s an indication that the product is not suitable for the client.

*If you’re testing an essential oil, make sure to apply it in its properly diluted form (in a carrier oil). Do not apply essential oils directly on the skin.

With the combination of comprehensive intake forms, thorough consultations, and precautionary patch tests, massage therapists can ensure a safer massage session for every client. *Before performing a patch test, be sure that it is within the massage therapy scope of practice in your state.

Best Practices for Massage Therapists

As a massage therapist, your primary focus is ensuring your client’s safety, comfort and well-being. Here are some best practices for massage therapists regarding allergens and reducing the risk of allergic reactions:

1. Know Your Products: Familiarize yourself with the ingredients of oils, lotions, and creams you’re using. Opt for hypoallergenic or fragrance-free versions to minimize allergic reactions. *If you transfer products from a bulk container to a smaller container for convenience, make sure the smaller containers are labeled correctly.
2. Client Consultation: Before starting any session, always review their health history form and previous session notes. Ask clients about their allergies again if needed. If they’ve had a new reaction, or if there are specific ingredients they’ve recently become aware of, you should be in the loop. Establishing this dialogue helps avoid unpleasant surprises and reinforces trust.
3. Clean and Sanitize: Ensure all equipment, towels, and sheets are clean. Use mild detergents and avoid those with strong fragrances or harsh chemicals.
4. Patch Test: If introducing a new product, especially essential oils, consider doing a small patch test on the client’s skin and waiting to see if there are any adverse reactions.
5. Ventilation: Ensure that your massage therapy room has good airflow. This helps dissipate any strong scents that might trigger respiratory allergies. Allow recently cleaned treatment rooms to air out before bringing a client in.
6. Responding to Allergic Reactions: Learn to identify signs and symptoms such as itching, redness, swelling, or severe symptoms like difficulty breathing. If a client shows any of these signs, stop the treatment right away, prioritize their safety, and get medical help if necessary. Have clear protocols in place for managing such scenarios.
7. Stay Educated: Regularly update your knowledge about new products and potential allergens. Be aware that product formulations change and your repeat clients may develop new allergies; so have them periodically provide you with current health / medical information.

By keeping these best practices in mind, massage therapists can provide not only a relaxing experience but also a safe environment for their clients.

Conclusion

Allergen awareness is a vital aspect of ensuring the well-being of your clients. Recognizing the significance of potential allergens in therapeutic products means you’re prioritizing client safety and elevating the quality of your service. We’ve discussed various types of allergies, emphasized the importance of thorough client assessments, highlighted the need for choosing the right products, and provided a list of best practices every therapist should adopt.

Staying informed is key to ensuring client health during relaxation sessions. Commit to continuous learning and prioritize client feedback to elevate your care, regardless of your experience level.

FAQ

How can a therapist differentiate between a skin irritation and a genuine allergic reaction during a session?

During a session, a genuine allergic reaction typically presents with symptoms like redness, itchiness, and hives or welts on the skin. Skin irritation, on the other hand, may cause mild redness but lacks the intense itching and raised skin formations. Therapists should be observant, and if any such signs emerge, immediately stop the use of the product and consult with the client.

If a client has a known skin condition like eczema or psoriasis, how does that affect the likelihood of an allergic reaction during a massage?

Clients with skin conditions like eczema or psoriasis often have a compromised skin barrier, which can increase their sensitivity to products. This heightened sensitivity means they might react to ingredients that wouldn’t typically cause issues for others. As a therapist, always use hypoallergenic products for such clients and maintain open communication about any discomfort.

How can therapists ensure their workspace is free from allergens, especially if they share their workspace with other professionals?

Therapists can maintain an allergen-free workspace by regularly cleaning and disinfecting all surfaces, equipment, and tools. If sharing a space, communicate with other professionals about allergen concerns and consider designating storage areas for hypoallergenic products. Using HEPA air purifiers can also help reduce airborne allergens.

Can essential oils commonly used in massage therapy, cause allergic reactions?

Yes, essential oils, while natural, can sometimes cause allergic reactions in sensitive individuals. Therapists should always inquire about a client’s sensitivities before using any essential oil and perform a patch test if unsure. It’s vital to dilute essential oils properly in a carrier oil and use trusted brands to minimize risks.

How should therapists handle the use of products on clients who are pregnant?

For pregnant clients, therapists should always opt for mild, hypoallergenic products and avoid those with strong fragrances or essential oils. There can be heightened skin sensitivity during pregnancy. Open communication about any past reactions or current concerns is key to ensuring both safety and comfort during the session.

Is coconut oil safe for clients with nut allergies?

Coconut is botanically classified as a fruit and not a tree nut. Some individuals might react to coconut, however most people who are allergic to tree nuts can safely eat coconut. When in doubt, always err on the side of caution.

Resources for Massage Therapists

Knowledge is power, especially when it comes to ensuring client safety. Here are some top-tier resources that can help massage professionals stay updated on allergens and ways to keep their clients protected:

1. American Massage Therapy Association (AMTA): A leading association providing detailed articles, workshops, and guidelines about the best practices in massage therapy.
2. International Federation of Aromatherapists (IFA): If you incorporate essential oils into your sessions, the IFA offers extensive guidelines on the safest use of aromatherapy products.
3. American Academy of Allergy, Asthma & Immunology (AAAAI). Trusted resource for allergies, asthma and immune deficiency disorders.
4. Environmental Working Group’s Skin Deep Database (EWG): This user-friendly database breaks down the ingredients found in numerous products, allowing you to make informed choices.

References

1. NIH/National Institute of Environmental Health Sciences. (2005, August 4). More Than Half The US Population Is Sensitive To One Or More Allergens. ScienceDaily. Retrieved September 16, 2023 from https://www.sciencedaily.com/releases/2005/08/050804122930.htm

Disclaimer: The information provided in this blog post is intended for general knowledge and educational purposes only. It is not designed to offer medical advice, diagnose, or treat any health condition. Every individual is unique, and while the content aims to provide valuable information on allergens and allergic reactions, it might not apply to everyone. If you or your clients have concerns or experience any symptoms related to allergies, it is crucial to seek advice from a medical professional or allergist. Always prioritize safety and individualized client care. The author and the website disclaim any liability arising directly or indirectly from the use of the information provided in this post.