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Ana Rodríguez Trabado [1] and Carmen Cámara Hijón [2] and José Antonio García-Trujillo [2] and Irene Magriz Trascón [2] and Luis Miguel Fernández Pereira [2]

Academic Editor: Bettina Wedi

1, Allergy Department, Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain, areasaludtalavera.es

2, Immunology Department, San Pedro de Alcántara Hospital, Avda. Pablo Naranjo, S/N, 10002 Cáceres, Spain

Received May 9, 2017; Revised Jun 30, 2017; Accepted Jul 13, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Background

Maltitol (4-O-α-glucopyranosyl-D-sorbitol) is a sugar alcohol (polyol) that is produced by hydrogenation of maltose obtained from starch (Figure 1). It is frequently used as a noncaloric sweetener because it has half the calories of sucrose (table sugar). It is also used as an excipient in drugs, a plasticizer in gelatin capsules, and an emollient.

[figure omitted; refer to PDF]

Sugar alcohols rarely cause hypersensitivity reactions, although there have been reports of reactions to mannitol [1–4] and erythritol [5]. Maltitol has not been previously described as an agent involved in immediate hypersensitivity reactions.

2. Patients and Methods

We report the case of a 60-year-old man with a history of hypothyroidism and cutaneous psoriasis. He reported an acute episode of dyspnea, facial flushing, and pharyngeal occlusion (anaphylaxis grade 2 of Ring and Messmer) immediately after licking a candy (Virginia’s Coffee Candies®, Rodríguez S. A. Industries, Reus, Spain). He spat the candy out without swallowing and reported spontaneous improvement after 15 minutes. The candy was composed of maltitol syrup, hydrogenated fatty acids, and coffee. The patient reported that he usually ate the mentioned kind of candies and assessed good tolerance to one of the same candies five hours before the episode and to four units the day before. After the adverse reaction, the patient referred good tolerance to coffee and the other foods taken during the hours preceding the episode.

Prick testing was performed for common inhalants, Anisakis, Pru p 3, and a complete battery of foods, including egg, milk, nuts, fruits, legumes, fish, seafood, flour, and spices.

Prick-to-prick testing was first performed with the candy implicated in the adverse reaction.
 
     
   
   
     
 
 
     
 
 
     
 
 

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