Allergic reactions after ingestion of erythritol-containing foods and beverages.

To The editor Erythritol (ERT; 1,2,3,4-butanetetrol) is a 4-carbon sugar alcohol prepared from glucose by fermentation,1 ERT occurs naturally in certain foods (mushroom, watermelon, pear, grape, wine, beer, soy sauce, cheese) at levels up to 0.13%. ERT is used to sweeten beverages and snack foods in Japan, where more than 125 million people consume more than 5 billion servings of ERT-sweetened foods annually. Anecdotal and unconfirmed reports of adverse reactions to ERT-containing products (estimated prevalence, <1 per million people) have appeared.2 To clarify the pathophysiology of these reactions, we studied 2 Japanese volunteers who had experienced multiple reactions to ERT-containing foods.