A case of anaphylaxis caused by polyethylene glycol analogues

Abstract

PEGs and polysorbates are found in many pharmaceuticals, cosmetics, and foods (1, 2). We report the first patient with anaphylaxis caused by PEGs and polysorbate 80 that were cross-reactive with hydroxyethyl starch.A 33-year-old man had undergone surgery for lumbar disc herniation. He went into anaphylactic shock a few minutes after the application of povidone-iodine gel to the dead space resulting from the surgery. He was successfully treated with intravenous corticosteroids and adrenaline. He reported a history of wheezing after using shampoo containing phenothirin. We performed prick tests with the constituents of the povidone-iodine gel and the phenothirin shampoo. A negative saline control and a positive histamine (10 mg/ml) control test were included. The positive wheal was 7 × 5 mm, and the negative

Polyethylene glycol as a cause of anaphylaxis

“…Our case supports the assumption of cross-reactivity between PEGs of different molecular weights and polyethylene glycol analogues [7, 8]. Like other authors have previously shown, the positive intradermal test suggests an IgE-dependent mechanism, although no control tests were performed on healthy individuals to rule out unspecific reactivity [9].…”

Immediate‐type hypersensitivity to polyethylene glycols: a review

“…Polymerization and molecular structure of polyethylene glycol ( PEG ) and PEG derivatives. Two chemical moieties, –( OCH 2 CH 2 )‐ and – OCH 2 CH 2 OH , are shared by both PEG s and some PEG derivatives, making cross‐sensitization theoretically possible .…”

“…Symptoms associated with immediate‐type PEG hypersensitivity were often severe and rapid in onset. Of the 37 cases identified, 28 (76%) described HSRs that fulfilled criteria for anaphylaxis . Common manifestations were pruritus, tingling, flushing, urticaria, angioedema, hypotension and bronchospasm.…”

A case of probable macrogol allergy in urticaria/angioedema patient

“…Cross-reactivity with macrogol analogies, as in this case, macrogol 6000 and polysorbate 80 (a macrogol-derivative), has been reported 8 . Clinical allergy may also be dependent on both dose and route of administration.…”

“…1b). Finally, since cross-reactivity has been suggested in the literature 8 , prick testing with polysorbate 20, polysorbate 80 and povidone were done; polysorbate 80 was positive (weal diameter 6mm, histamine weal 5-mm). Intradermal testing or oral challenge was not done for safety reasons, as systemic anaphylactic reactions have been reported following similar testing 4 .…”