A llergies to J ewish P ractices

S A N D R A K N O L L

G-d tells us in Leviticus 18:5 to “observe My decrees are neither dairy nor meat, need not be separated.
and My laws, which man shall carry out and by which he People who are allergic to milk, or have specific IgE
shall live.” The Torah here is setting a standard for one to antibodies to milk [2], need to eat meat or non-dairy foods,
live by G-d’s laws, but not jeopardize one’s life in trying to otherwise they will undergo severe anaphylaxis due to an IgE
fulfill them. This limitation is prevalent in many contexts, antibody response. This IgE antibody response is classified
one of which is where an individual suffers adverse allergic as a type I allergic reaction, involving mast cells, which
reactions that make it hard to fulfill his or her religious are immune cells that release toxic agents and cytokines
obligations without posing a risk to his or her health. Our when an allergen binds to them. These toxic agents cause
sages and leaders struggle to find solutions that accommodate more immune cells to leave the blood and fight the allergen
an individual’s health needs while at the same time allow leading to inflammation. They also cause smooth muscle
him or her to remain committed to Torah obligations and to contract leading to coughing and wheezing, and mucus
lifestyle. to be secreted, while cytokines stimulate a further immune
An allergic reaction is an overreaction of the body’s response [1].
immune system. Allergies may result from inhaled materials
such as pollen or dust, injected materials such as drugs or
venom, ingested materials such as food or drugs, or contacted There have been incidents where
materials such as metals or plants [1]. Normally, these types
of substances are harmless; however, in some people they young children have eaten foods
can create a state of hypersensitivity. Hypersensitivity to
dairy products can present a serious problem in those cases
marked pareve, or non-dairy,
where Jewish law does not require the designation of “dairy”. assumed these foods were safe
In some cases, hypersensitivity to metals can cause health
side effects that result from the Jewish practices of adorning to eat, and then have gone into
tefillin and head coverings.
Halacha forbids the eating of milk and meat together.
anaphylactic shock.
The origin of this prohibition can be traced to three
sources in the Torah, Exodus 23:19, Exodus 34:26, and There have been incidents where young children have
Deuteronomy 14:21, where it is written “Don’t boil a kid in eaten foods marked pareve, or non-dairy [2,3], assumed these
its mother’s milk.” The Shulchan Aruch (Yoreh Deah, Hilchot foods were safe to eat, and then have gone into anaphylactic
Basar Vechalav, 77:1) explains that this statement prohibits shock. Subsequently, these foods were analyzed and shown
not only cooking, but also eating and deriving benefit from, to contain traces amounts of dairy. At first glance, one would
a meat and milk mixture. In addition, an individual must assume that eating these foods with meat would be a violation
abstain from eating dairy foods for a certain period of time, of the halacha, however, this is not the case. The Shulchan
according to one’s custom, after eating meat because the Aruch describes a case where a small amount of meat falls
meaty foods tend to leave a flavor and stick to the mouth into a vat of milk and vice versa. In such a situation, the
(Turei Zahav, Yoreh Deah, Hilchot Basar Vechalav, 79:1). Shulchan Aruch explains, one should give the food to a non-
Jewish law treats the separation of meat and dairy as a very Jew to taste. If the taste remains the same despite the small
strict prohibition. Orthodox Jewish families have separate amount of meat or milk, depending on the scenario, then
utensils and dishes for meat and dairy to avoid the possibility the food retains its kosher status (Shulchan Aruch, Yoreh
of contact between the two. Only pareve foods, foods that Deah, Hilchot Basar Vechalav, 92:1-2). Rav Moshe Iserlis,

40 Derech HaTeva
in his commentary on the Shulchan Aruch, wrote that we a result of tefillin is caused by potassium dichromate [7],
do not rely on the opinion of a gentile, rather, if the meat a metal antifungal agent in which the leather straps are
or milk that fell in the dish is a sixtieth or less of the rest of dipped to make them last ten years instead of eight [8]. It
the food’s volume, then the food is kosher and if more than is not unusual to develop allergic contact dermatitis from
a sixtieth fell in, it is not kosher. Therefore, an item may exposure to metals and it is also more common for men to
still be considered pareve or meat even if it contains 3 to 4 be sensitive to chromate than women.
parts per million of dairy particles, enough to cause a severe As of 2005, only eight men are known to have developed
allergic reaction [4]. This would explain why those children contact dermatitis from wearing tefillin [7-9]. The allergy
underwent anaphylactic shock even though the foods they to tefillin is proposed to be more uncommon because of
were eating were not marked as dairy. the short time period in which the tefillin are worn, usually
One area where this problem is prevalent is in the less than an hour a day [9]. The amount of time is relevant
packaging of food. Packing food does not constitute cooking, because in a type IV hypersensitivity reaction a lot more
as there is no heat. Therefore, dairy as well as pareve foods allergen must be present to stimulate a response. Therefore,
can be packaged using the same packing equipment. The many chromate ions would need to penetrate into the skin
equipment needs only to be cleaned [5]. The problem with and then be processed by immune cells [1]. There are
packing equipment is that particles from dairy products build three halachic solutions for these few men who are allergic
up on the equipment and, even though the equipment is to their tefillin. The first solution is to buy tefillin made
cleaned before being used for pareve items, the insignificant without chromium, like vegetable tanned leather tefillin [7].
amount of dairy particles remaining on the equipment, The second alternative is to smear oil on the inside of the
though negligible according to halacha, are potentially leather strap. This solution, which is supported by Rav Yakov
dangerous for people allergic to dairy [5]. 0.1 to 7.5% of Meir Stern, is suitable as oil is not a chazitza, a halachically
children are allergic to dairy [3]. Rabbinic organizations, forbidden barrier, between the skin and tefillin [8]. Another
like the Orthodox Union (OU), have addressed this issue option is to do as one man did, and keep putting on the
and have started to identify products that have potential tefillin despite the blisters and crusting [7].
to stimulate an allergic reaction by marking them (OU)D, A third area in which allergic reactions and halacha
meaning dairy, instead of the traditional (OU)D.E., signifying interface is regards to the custom of wearing a head covering,
that cleansed dairy equipment was used [4]. either a kippa for males or a tichel for married women. In
Allergic reactions can also interfere with the Shir Hashirim (2:14 and 4:1), a woman’s voice and hair are
commandment to adorn tefillin, two black leather boxes praised. The gemara thus assumes that a woman’s voice and
that contain parchment. The Torah commands men to, hair are provocative and must, therefore, not be heard or
“bind them [tefillin] as a sign upon your arm and let them be seen by a man who is not that woman’s husband (Brachot
ornaments between your eyes” (Devarim 6:8). As such, men 24a). As a result, Jewish tradition is that in public a married
wear tefillin on their arm and forehead during the morning woman covers her hair.
prayers, except on the Sabbath and holidays. Tefillin contain A kippa, on the other hand, is the head covering
leather straps to hold them in place on the head and on the adorned by Orthodox Jewish men. Men cover their heads
arm. Allergic contact dermatitis, skin inflammation upon for a different reason than women, namely to show that G-d
direct contact with an allergen [6], has occurred on the left is above them (Kiddushin 31a). Originally called a sudra in
arm and on the neck of men when performing the mitzvah the Talmud, the kippa was to be worn only by those who
of tefillin. feared G-d (Kiddushin 29a) and on occasions where more
Contact dermatitis can result from exposure to many respect for G-d was necessary, such as at court decisions
items, such as makeup, perfumes, fabrics, plants, antibiotics, (Shabbos 10a), religious ceremonies (Kiddushin 8a), and
metals, and essentially anything else skin may touch [6]. grace after meals (Brachot 51a) [10]. Rav Huna the son of
The condition can have symptoms ranging from just itching Rav Yehoshua, however, would not walk four amos, a distance
and inflammation (hotness, redness, swelling, and fluid [1]), of between 6 and 8 feet, without a head covering (Shabbos
to skin lesions that have blisters and may ooze, crust, and 118b). Rav Yosef Karo argued in Beit Yosef O.C. 8 that head
become scaly. It is considered a type IV allergic reaction in coverings are mandatory for all men, all the time, while Rav
which symptoms do not develop until 1-3 days after initial Shlomo Luria and the Vilna Gaon argued that kippot are not
allergenic contact, which is unlike a type I allergic reaction always mandatory [10]. Today there are many Italian and
where a response is immediate [1]. Contact dermatitis as Moroccan Jews who do not have the custom of wearing a

Derech HaTeva 41
kippa, and Rav Moshe Feinstein allowed American Jews to the clip is not always in direct contact with their skin [11].
take off their kippot for work only (Igrot Moshe O.C. 4:2), so A clinical study was performed by Yosefy et al. [11] on
as not to jeopardize their ability to earn a living [10]. 37 Orthodox Jewish patients with pseudo alopecia areata.
Those Jews with the custom of covering their head might Patients were tested with pharmacological methods, irritants,
possibly experience an allergic reaction. Pseudo alopecia immune inhibitors, cyclosporin A, immune enhancers, and
areata is the term given to Jewish religious patients who have others. These methods normally work to help regrow hair 10-
a hair loss that is similar to those individuals with alopecia 30% of the time [11], however, they did not work on these
areata. Alopecia areata either is an inherited disease or is religious patients. Non-pharmacological methods, such
an autoimmune disease and causes round patches of hair as changing the clip to a non-metal one or using a larger,
loss [6]. Pseudo alopecia areata is different, in that the hair less sharp, clip facilitated hair regrowth [11]. So the best
loss only occurs in the area where hair pins/clips that keep a solution to covering one’s head despite having this kind of
tichel or kippa on the head are placed and lesions develop on allergy is just to change the clip. An alternate solution is to
the irritated skin [11]. The lesions result partially from the take advantage of Rav Moshe Feinstein’s leniency regarding
sharp-ended metal pin holders and partially from the type the requirement to wear a kippa.
IV allergic reaction to the metal clips, just as with tefillin. Religious Jews have always made their faith their
However a kipa or a tichel, unlike tefillin, are worn most number one priority. Sometimes, however, Judaism can
of the time so it is more common for people to get pseudo create situations in which following the commandments
alopecia areata than for men who wear tefillin to get contact strictly can lead to adverse health effects. As a result, the
dermatitis. It is also more common for men than women to rabbis throughout history have formulated solutions that
develop pseudo alopecia areata. Women have more options accommodate both the need to observe the religion and to
as to where to place a clip and they also have more hair so preserve one’s health.

A CKN O W LED G EMENTS

R E F E REN C ES
[1] Parham, P. (2004). The Immune System, 2nd edition. Garland Science, Taylor & Friends Group. New York, NY.
[2] Jones, R.T., Squillace, D.L., and Yunginger, J.W. (1992). Anaphylaxis in a milk-allergic child after ingestion of
milk-contaminated kosher-pareve-labeled “dairy-free” dessert. Ann. Allergy. 68:223-227.
[3] Gern, J.E., Yang, E, Evrard, H.M., and Sampson, H.A. (1991) Allergic reactions to milk-contaminated “nondairy”
products. New Engl. J. Med.. 324:976-979.
[4] Ou Kosher. Kashrus FAQ. http://www.oukosher.org/index.php/articles/single_print/5313 (retrieved January 18,
2009).
[5] Bistricer, D. (2008) Allergens. Hamodia Magazine. p. 6-7.
[6] Medline Plus, A.D.A.M Medical Encyclopedia. http://www.nlm.nih.gov/medlineplus/encyclopedia.html (retrieved
January 15, 2009).
[7] Ross, B. and Brancaccio, R.R. (1994). Allergic contact dermatitis to religious articles. Amer. J. Contact Dermat.
5:160-161.
[8] Study: some skin infections could be linked to certain chemicals in tefillin. (2005). Hamodia, p. 4.
[9] Gilead, L., Vardy, D.A., and Schamroth, J. (1995). Tefillin dermatitis (a phylacteric phenomenon). J. Amer. Acad.
Dermatol..32: 812-813.
[10] Brody, S. (2009). Ask the rabbi: the way you wear your hat. Jerusalem Post http://www.jpost.com/servlet/Satellite?pa
gename=JPost%2FJPArticle%2FShowFull&cid=1231167313350 (retrieved January 9, 2009).
[11] Yosefy, C., Ronnen, M., and Edelstein, D. (2003). Pseudo alopecia areata caused by skull-caps with metal pin
fasteners used by orthodox Jews in Israel, Israel Clin. Dev. Immunol. 10:193-195.

42 Derech HaTeva