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Immediate-type hypersensitivity reaction to Mannitol as drug excipient (E421): a case report
G F Calogiuri1, L Muratore2, E Nettis3
1Pneumology Department, Hospital Ninetto Melli, San Pietro Vernotico, Brindisi, Italy. Section of Allergology and Clinical Immunology, Department of Internal Medicine and Infectious Diseases, University of Bari Medical School, Bari, Italy.
Summary
Allergic reactions to mannitol, a common excipient, are rare. This report details a rare case of immediate hypersensitivity to oral mannitol in a patient with pollen allergies, highlighting potential risk factors.
Area of Science:
- Allergy and Immunology
- Pharmacology
- Food Science
Background:
- Mannitol is widely utilized as a pharmaceutical excipient and food additive.
- Allergic reactions to mannitol are infrequently documented in medical literature.
- Immediate type hypersensitivity reactions are a significant concern in drug safety.
Observation:
- A 42-year-old male patient with a history of olive tree pollen rhinitis experienced an immediate hypersensitivity reaction.
- The reaction was triggered by the oral administration of mannitol, used as a drug excipient.
- This represents the first reported instance of oral mannitol acting as an excipient to induce immediate hypersensitivity.
Findings:
- The case highlights mannitol as a potential allergen, even when used at low concentrations as an excipient.
- Specific patient factors, such as pre-existing allergic rhinitis, may increase susceptibility to mannitol hypersensitivity.
- The study examines previously unrecognized or underestimated risk factors for adverse reactions to mannitol.
Implications:
- Clinicians should consider mannitol as a potential cause of immediate hypersensitivity reactions, particularly in allergic individuals.
- Further research is warranted to elucidate the mechanisms and identify all risk factors for mannitol-induced allergies.
- This case underscores the importance of thorough allergen identification in drug-induced hypersensitivity.