Erythritol allergy presenting with anaphylactic shock in children: 2 cases diagnosed by oral food challenge

Erythritol is a natural sugar alcohol that has been widely used as a food additive in recent years. Erythritol allergy incidence has been increasing in Japan and other countries, and may sometimes be a cause of anaphylactic shock. An oral food challenge (OFC) test is recommended to obtain a definitive diagnosis; however, it is often avoided in patients with severe anaphylactic shock. We report the cases of 2 girls with OFC-confirmed erythritol allergy and a history of anaphylactic shock. Two girls, aged 14 and 8 years, experienced anaphylactic shock after consuming low-calorie jelly. Thereafter, they were suspected to have an erythritol allergy; however, skin-prick tests were negative in both patients. The erythritol content of the jelly consumed by each girl was determined based on the amount ingested during the anaphylactic shock episodes. A predicted prethreshold was established, and the challenge dose for the OFC was adjusted accordingly. Both patients tested positive on the OFC before progressing to severe symptoms, confirming the diagnosis of erythritol allergy. Erythritol allergies can cause anaphylactic shock, requiring caution. Even in the event of anaphylactic shock, a diagnosis can be made by predicting the prethreshold based on the erythritol content and carefully adjusting the challenge dose.