pISSN 2233-8276 · eISSN 2233-8268
Asia Pac Allergy 2013;3:70-73
A case of taurine-containing drink induced
Seung-Eun Lee1,2,3, Suh-Young Lee1,2,3, Eun-Jung Jo1,2,3, Mi-Young Kim1,2,3, Min-Suk Yang1,2,4, Yoon-Seok Chang1,2,3,
and Sae-Hoon Kim1,2,3,*
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
2Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea
3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-802, Korea
4Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul 156-707, Korea
Taurine is one of most abundant free amino acids in mammalian tissue. It has been used for various health functional foods as a main
ingredient in food industry. A 33-year-old female patient repeatedly experienced generalized itching, urticaria, dyspnea and dizziness
after drinking taurine-containing drinks. The patient showed positive response to oral challenge tests with taurine-containing drinks.
The patient also showed positive response with synthetic taurine but not with natural taurine. Skin prick test and basophil activation
test with the synthetic taurine were negative. To our knowledge, there has been no report of taurine-induced hypersensitivity
reactions. We herein report the first case of taurine-containing drink induced anaphylaxis, especially by synthetic taurine.
Key words: Anaphylaxis; Taurine; Energy drinks
Since 19th century taurine was originally isolated from ox
bile, many investigators have made an effort to elucidate the
physiologic role of taurine and its beneficial effects . It has been
reported that taurine was associated with lower cardiovascular
disease risks, prevention of hypertension and therapeutic
benefit in hypercholesterolemia on several epidemiologic and
experimental studies . Because of the variable evidence for the
beneficial effects of taurine supplementation, taurine has been
used extensively for health functional foods. The combination
of taurine and caffeine in energy drinks has been known to have
synergic effect on cognitive performance . To our knowledge,
there has been no report of taurine-containing energy drink
induced allergy to date. Here, we report a case of taurine-
containing drink induced anaphylaxis, which was confirmed
Correspondence: Sae-Hoon Kim
Department of Internal Medicine, Seoul National University
Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu,
Seongnam 463-802, Korea
Received: December 11, 2012
Accepted: December 19, 2012
This is an Open Access article distributed under the terms of the Creative
Commons Attribution. Non-Commercial License (http://creativecommons.
org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original work is
Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology.
Anaphylaxis to taurine-containing drink
by oral provocation with taurine-containing drinks and also with
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.
When 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
The 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 Table 1) 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 Table 1.
Although 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.
Table 1. Summary of the patient’s allergy test results
Skin prick test
Oral provocation test
(Synthetic taurine 20 mg/mL)
(Synthetic taurine 4 mg/mL)
ResultSymptom and sign
Wheal size 1 × 1 mm, flare (-), (Histamine 3 × 3 mm)
Wheal size 0 × 0 mm, flare (-)
PositiveAt 50 min after drinking 50 mL (1,000 mg of synthetic taurine), itching and erythema at palms
At 90 min, facial itching and lips angioedema
At 30 min after drinking 250 mL (1,000 mg of synthetic taurine), whole body itching
At 90 min, lips angioedema and dyspnea
At 30 min after ingestion of 1,000 mg, itching on face and palm with erythema
At 60 min, itching on face and chest discomfort
No symptom and sign (up to ingestion of 1,000 mg)
No symptom and sign (up to ingestion of 25 mg)
*20 mg/mL in normal saline. †Drink D: another energy drink containing synthetic taurine which the patient never had drunken.
Lee SE, et al.
Taurine is one of the most abundant free amino acids in
all mammalian tissue, and it is not an amino acid in the usual
meaning as a component of protein, called an amino acid in the
meaning of an acid containing amino group [4, 5]. Taurine is mainly
biosynthesized from cysteine in the liver, known to have many
important roles such as conjugation of bile acids, antioxidation,
osmoregulation, detoxification, membrane stabilization and
modulation of calcium reflux [4, 6]. Also, it contributes to
cardiovascular function, and development and function of skeletal
muscle, retina and central nervous system .
Taurine presents naturally in food, especially in meat and
seafood. Although the mean daily intake from diet was reported
to be less than 400 mg/day in several studies [8, 9], the European
Food Safety Authority reported that up to 1,000 mg/kg/day of
taurine have no adverse effects. In Korea, popular energy drinks
generally contain 2,000 mg taurine in one bottle (100 mL). Most
energy drinks sold in worldwide contain 1,000 mg taurine. By
literature searching, there is no available data about toxicity or
hypersensitivity of taurine in human. Only a few studies reported
that excess dosage of taurine led to haemosiderine deposition
in the lung  or fatty infiltration of the live  on animal
Our patients showed hypersensitivity reaction with synthetic
taurine, but in the test of natural taurine, she had no symptom. We
could not find other case of anaphyalxis to synthetic amino acid.
There are just a few reports on anaphylaxis caused by compound
amino acid solutions. Although the authors could not elucidate
the mechanism of anaphylaxis, they suggested the additives for
stabilization of amino acid like sulfites, butylates hydroxyanisole,
butylated hydroxytoluene, polysorbate emulsifier could be
the cause of symptoms [12, 13]. As an example of difference in
synthetic and natural materials, Smith et al.  reported a case of
recurrent anaphylaxis only to synthetic folic acid, but not to dietary
folates. They postulated that synthetic folic acid acted as a hapten
with different mechanism from dietary folates. Although taurine
is only small molecular weight of amino acid, not a peptide, it
seems that only synthetic taurine is intolerable to our patient by
unknown mechanism. Our patient showed positive responses
in oral challenge test with synthetic taurine-containing drinks
and synthetic taurine, but skin prick test and basophil activation
test with synthetic taurine were negative. Most synthetic taurine
used in the food products and drinks are prepared by amination
at elevated pressure of isothionic acid salt from ethylene oxide
and sodium hydrosulfite . Synthetic taurine might be slightly
different from original natural taurine through its industrial
processing and some hidden materials happened to be contained
within it. However, as far as we know, synthetic taurine is not
different from natural taurine in its molecular structure, and the
purity of synthetic taurine we used was nearly 100%.
Hence we postulated that anaphylaxis in this patient was caused
by non-immunologic mechanism or by haptenization. Recently,
as the consumption of energy drinks increase, the safety of
ingredients of energy drinks has been of concern worldwide. We
hereby reported the first case of taurine-containing drinks induced
anaphylaxis, especially by synthetic taurine.
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