A case of taurine-containing drink induced anaphylaxis
A 33-year-old female patient visited allergy clinic in Seoul National University Bundang Hospital because of an event happened on her summer vacation. The patient experienced generalized itching, urticaria, dyspnea and dizziness 10 min after ingestion of a bottle (100 mL) of energy drink ("Drink A" in below) and then she was treated in the emergency department of a nearby hospital. She had experienced similar symptoms after drinking another beverage ("Drink B" in below) which was commonly used for hangover 2 years before the event.\nWhen visiting our clinic, the patient had no remained symptom and showed no abnormality on the physical examination. Complete blood count, liver function test, renal function test and serum electrolytes were within normal limits and serum total IgE level was elevated to 685 IU/mL. History of food allergy and any other diseases were denied by the patient. There was no family member of food or respiratory allergy and she was working at a bank.\nThe first, oral challenge test with Drink B was performed to ascertain that the patient had allergic reaction actually. At 50 min after ingestion of 50 mL, the patient complained of itching on her both palms with erythema. At 90 min, she had facial itching and angioedema on her lips. We concluded that the oral challenge test was positive. We investigated the common ingredients in Drink A (synthetic taurine 20 mg/mL) and B (synthetic taurine 20 mg/mL), and found that both drinks contain synthetic taurine and nicotiniamide (the maximum dosages are 2,000 mg and 50 mg, respectively). Oral challenge test with synthetic taurine, natural taurine and nicotiniamide were performed on different days. The laboratory in the manufacturing company of Drink B offered us synthetic taurine, natural taurine and nicotiniamide in powder form. On the test with synthetic taurine, she had itching on her face and palm with erythema at 30 min after ingestion of 1,000 mg synthetic taurine. We performed oral challenge test with another taurine-containing energy drink ("Drink D" in ) which the patient never had drunken, and the result was positive. However, the patient had no symptom or sign with 1,500 mg natural taurine and 45 mg nicotiniamide as the cumulative dose. Skin prick test with synthetic taurine and natural taurine (20 mg/mL, the same concentration with Drink A) showed negative responses. Basophil activation test was performed with various concentrations of synthetic taurine (0.2-20 mg/mL), but the results were negative. The results of allergy tests were summarized in .\nAlthough we could not elucidate the mechanism of hypersensitivity reaction in this patient, the results of oral challenge test indicated that her symptoms were associated with synthetic taurine. The patient was diagnosed as synthetic taurine related anaphylaxis and advised life-long avoidance of synthetic taurine containing beverage.