The First Case of Erythritol-Induced Anaphylaxis in Korea

Abstract

Erythritol is a natural sugar alcohol found in some fruits and fermented foods, which is used as a dietary sweetener because it has few calories. Here, we describe a 36-year-old woman who experienced anaphylaxis upon ingestion of an erythritol-containing drink. She presented to the emergency department with dyspnea and angioedema after drinking a peach-containing diet beverage. Her blood pressure dropped to 70/40 mmHg and the symptoms improved after administration of an antihistamine, glucocorticoid, and epinephrine. After 10 days, she drank another peach-containing diet beverage and experienced urticaria. No serum-specific immunoglobulin E findings were observed, including against peach components. A skin prick test (SPT) was performed using a peach, the two ingested diet beverages, and another peach-containing beverage. The SPT results for the peach and the peach-containing product were negative, but the wheal sizes for the two diet beverages were > 3 mm. The diet beverages contained erythritol as a food additive. The SPT result was positive for erythritol. The patient was diagnosed with anaphylaxis to erythritol and was instructed to avoid foods containing erythritol. She was prescribed a self-injectable epinephrine pen. To our knowledge, this is the first case of erythritol-induced anaphylaxis in Korea. Physicians should be aware of the possibility of allergic reactions to food additives, and additives should be evaluated to prevent the recurrence of symptoms.

Re‐evaluation of erythritol (E 968) as a food additive

“…The scratch test using pure erythritol in distilled water does however provide more direct evidence for a causal link and the case can be assessed as probably related to erythritol. Kim et al (2022) described the case of a 36-years old woman presented to the emergency department (Korea) with dyspnea and angioedema after drinking a peach-based diet beverage containing erythritol. After 10 days, she drank another peach-based diet beverage and experienced urticaria.…”

“…Kim et al. ( 2022 ) described the case of a 36‐years old woman presented to the emergency department (Korea) with dyspnea and angioedema after drinking a peach‐based diet beverage containing erythritol. After 10 days, she drank another peach‐ based diet beverage and experienced urticaria.…”