Erythritol allergy diagnosed following anaphylactic shock after ingestion of the jelly drink

Abstract

Erythritol is a low-molecular-weight sugar alcohol with zero calories and it is widely used as a sweetener in beverages, confectioneries, and health foods. Although there are scattered case reports of erythritol allergy, erythritol allergy is not always easy to diagnose. A 9-year-old boy developed generalized urticaria, restlessness, hypotension, and 2 episodes of vomiting during exercise after consuming a jelly drink. Suspecting an allergy to erythritol in a jelly drink, a prick test and oral food challenge test with the jelly drink were performed, but the results were negative. Six months later, he ingested another jelly drink containing erythritol and again developed generalized urticaria. A prick test for erythritol was negative, but an intradermal test was positive. In an oral food challenge test, the patient developed generalized urticaria after consuming 2 g of erythritol. Because erythritol is a low-molecular-weight compound, not a protein, it is not easily identified as a causative allergen in patients with food allergies, and prick tests are unlikely to be positive in such allergic patients. Healthcare providers should therefore be aware that erythritol can be a food allergen.