Correspondence
Anaphylaxis from Inulin in Vegetables and Processed Food
N Engl J Med 2000; 342:1372May 4, 2000
- Article
To the Editor:
Inulin is a fructan and storage carbohydrate found in more than 36,000 kinds of plants, including chicory, artichokes, and salsify. Inulin has been used as a food ingredient for many years, but it is only recently that the use of inulin and oligofructose, a hydrolysate of inulin, has increased considerably owing to their many postulated health benefits and their documented properties, such as a dietary-fiber effect and their ability to increase the levels of certain enteric bacteria, including bifidobacteria.1 These fructans are now being added to an increasing number of industrially processed foods, such as candies, beverages, yogurts, ice cream, chocolate, butter, and breakfast cereals.
We describe a 39-year-old butcher who had four episodes of anaphylaxis (generalized wheal-and-flare reaction, laryngeal edema, nasal itching, cough, and breathing difficulties) a few minutes after the ingestion of salsify, artichoke leaves, a margarine (Brunch, Migros, Geneva) containing inulin extracted from chicory (Raftiline HP, Orafti, Tienen, Belgium), and a candy (Actilife Toffee orange–carrot, Migros) containing inulin (Raftiline HP) or oligofructose (Raftilose P95). He also had local wheal-and-flare reactions after touching artichokes. All four episodes occurred within a two-year period.
Skin-prick testing, in which the lancet is first stuck in the material suspected of causing immediate hypersensitivity and then into the patient's skin, disclosed a very strong reaction (diameter of wheal, 12 by 20 mm) to inulin (Raftiline HP) and strong reactions to salsify, artichoke, a margarine containing inulin (Brunch), candy (Actilife Toffee), and oligofructose (Raftilose P95). The reactions to intradermally injected undiluted inulin for tests of renal function (Inutest 25%) and oligofructose (Raftilose P95) were strongly positive. The results of skin-prick tests with inulin extract (Raftiline HP) in 10 control subjects and intradermal tests with Inutest 25% and oligofructose (Raftilose P95) in 3 controls were negative. In a double-blind, placebo-controlled food challenge, generalized urticaria, rhinoconjunctivitis, and a 20 percent drop in the peak expiratory flow rate occurred within 10 minutes after the ingestion of 10 g of inulin (Raftiline HP) in mint syrup containing rice flour, but not after the ingestion of mint syrup containing rice flour alone. The patient received 8 mg of acrivastine, and the symptoms regressed. An open oral challenge with 40 g of oligofructose (Raftilose P95) was negative in the patient.
Inulin and oligofructose are classified as food ingredients (not as additives) and are considered to be safe to eat. The labeling laws of most countries require the declaration of inulin and oligofructose in processed foods. We are unaware of other reports of anaphylaxis from inulin, including inulin used for renal-clearance studies, but because of its expanding use in processed foods, allergic reactions to this dietary ingredient may be or may become more frequent than currently recognized. The identification of an association with allergic reactions to natural foods with high inulin content or to inulin with a high degree of polymerization may provide a lead in such cases.
1 ReferencesFabienne Gay-Crosier, M.D.
University Hospital, CH-1211 Geneva 14, SwitzerlandGeorges Schreiber, M.D.
9, rue F. David, F-74100 Annemasse, FranceConrad Hauser, M.D.
University Hospital, CH-1211 Geneva 14, Switzerland1
Nutritional and health benefits of inulin and oligofructose: proceedings of a conference, Bethesda, Maryland, USA, May 18-19, 1998. J Nutr 1999;129:Suppl:1395S-1502S
Web of Science | Medline
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