{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:10:33Z","timestamp":1777554633211,"version":"3.51.4"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2004,10,12]],"date-time":"2004-10-12T00:00:00Z","timestamp":1097539200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2004,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Background\n\t\t\t\t\t<\/jats:bold> Anaphylaxis to mannitol present naturally in pomegranate and cultivated mushroom in a sensitized subject has been described recently, and an IgE\u2010mediated mechanism to this sugar alcohol has been proposed. The same subject also experienced severe allergic reactions to a chewable pharmaceutical (cisapride drug).<\/jats:p><jats:p><jats:bold>Objective\n\t\t\t\t\t<\/jats:bold> The purpose of the study was to identify allergenic component in the pharmaceutical preparation, and also, to understand the mechanism of immediate hypersensitivity to mannitol.<\/jats:p><jats:p><jats:bold>Methods\n\t\t\t\t\t<\/jats:bold> Methodology involved skin prick tests (SPTs), high\u2010performance liquid chromatographic (HPLC) analysis of pharmaceutical preparations, separation of mannitol by Ca<jats:sup>++<\/jats:sup>\u2010ion\u2010moderated cation\u2010exchange chromatography, preparation of alditol\u2013protein conjugates by reductive amination, SPT using the conjugates, hapten affinity purification of the allergic serum on <jats:sc>d<\/jats:sc>\u2010mannitol\u2013keyhole limpet haemocyanin (KLH)\u2013Sepharose CL\u20106B, and detection of serum mannitol\u2010specific IgE by ELISA.<\/jats:p><jats:p><jats:bold>Results\n\t\t\t\t\t<\/jats:bold> Component testing by SPT, and HPLC analysis of various pharmaceuticals indicated that the excipient mannitol is the causative allergen. Mannitol separated from Cisapid MPS showed allergenic activity by SPT. Among the several conjugates tested by SPT, <jats:sc>d<\/jats:sc>\u2010mannitol\u2013bovine serum albumin and <jats:sc>d<\/jats:sc>\u2010mannitol\u2013KLH showed positive weal\/flare reaction, demonstrating the presence of cell\u2010bound mannitol\u2010specific IgE <jats:italic>in vivo<\/jats:italic>. Negative results with <jats:sc>d<\/jats:sc>\u2010glucitol, <jats:sc>d<\/jats:sc>\u2010galactitol, <jats:italic>meso<\/jats:italic>\u2010erythritol, and <jats:sc>l<\/jats:sc>\u2010mannitol protein conjugates clearly showed that the mannitol\u2010specific human IgE is very specific to the <jats:sc>d<\/jats:sc>\u2010isomer of mannitol. ELISA using the hapten affinity\u2010purified allergic serum was positive, demonstrating the presence of mannitol\u2010specific serum IgE in the allergic subject.<\/jats:p><jats:p><jats:bold>Conclusion\n\t\t\t\t\t<\/jats:bold> Mannitol, which is widely used as a food and drug additive (excipient), can rarely cause IgE\u2010mediated anaphylaxis. This study is the first one to demonstrate the presence of mannitol\u2010specific human IgE in a sensitized allergic subject to validate an IgE\u2010mediated hypersensitivity mechanism for mannitol.<\/jats:p>","DOI":"10.1111\/j.1365-2222.2004.02079.x","type":"journal-article","created":{"date-parts":[[2004,10,12]],"date-time":"2004-10-12T09:10:51Z","timestamp":1097572251000},"page":"1602-1609","source":"Crossref","is-referenced-by-count":57,"title":["Anaphylaxis to excipient mannitol: evidence for an immunoglobulin E\u2010mediated mechanism"],"prefix":"10.1111","volume":"34","author":[{"given":"V. 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