No Evidence for Contraindications to the Use of Propofol in Adults Allergic to Egg, Soy, or Peanut

Asserhøj, Lisbeth; Mosbech, H.; Krøigaard, Mogens; Garvey, Lene Heise

doi:10.1097/01.sa.0000490336.54904.62

Cited by 29 publications

(52 citation statements)

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“…Soybean oil and egg-derived lecithin are both used during its formulation, and although it has been suggested that in patients with severe anaphylaxis to egg and/or soy should undergo allergological study or use alternative treatment [79], this drug seems to be safe in most patients. One study, including 99 patients with positive specific IgE to egg, soya or peanut (although only 44% had immediate clinical symptoms), found that none had an allergic reaction following exposure to propofol [78]. In a Spanish study, including 52 adult patients with eosinophilic esophagitis sensitized to egg, soy, or peanut, also found that no patients who received propofol before an endoscopy procedure reacted to the drug [80].…”

Section: A) Drugsmentioning

confidence: 99%

“…Propofol is the cause of 2.3-2.6% of perioperative anaphylactic reactions [20,78], most of which are IgE mediated, being the antigenic determinant the two-isopropyl groups of the molecule (2,3 diisopropylphenol). Soybean oil and egg-derived lecithin are both used during its formulation, and although it has been suggested that in patients with severe anaphylaxis to egg and/or soy should undergo allergological study or use alternative treatment [79], this drug seems to be safe in most patients.…”

Section: A) Drugsmentioning

confidence: 99%

“…The drugs that usually need to be tested are opioids, because there is no alternative and hypnotics that are essential for anaesthetic induction, particularly propofol, the most widely used agent for anaesthesia and sedation [78,80,152]. It is not recommended for muscle relaxants due to potential effects on breathing, with the exception of those cases where they are suspected to cause a reaction, and where they are absolutely necessary to perform the surgery and no alternatives exist [144].…”

Section: Drug Provocation Testsmentioning

confidence: 99%

See 2 more Smart Citations

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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Section: A) Drugsmentioning

confidence: 99%

Section: A) Drugsmentioning

confidence: 99%

Section: Drug Provocation Testsmentioning

confidence: 99%

See 1 more Smart Citation

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

View full text Add to dashboard Cite

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“…A retrospective review of egg, soy, and/or peanut allergic children who had received propofol found one child with anaphylaxis to egg who developed erythema and urticaria in the recovery room in 43 propofol exposures . Other retrospective reviews of adult patients allergic to egg, soy, or peanut reported no allergic reactions on exposure to propofol …”

Section: Anaphylaxismentioning

confidence: 99%

An update on allergy and anaphylaxis in pediatric anesthesia

Stepanovic

Sommerfield

Lucas

et al. 2019

Pediatric Anesthesia

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Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de‐labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first‐line therapeutic agents.

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“…This study included two parts—“Study A,” retrospectively examined the frequency of propofol allergy in patients being evaluated for suspected perioperative allergic reactions in the Danish Anesthesia Allergy Center, and “Study B,” retrospectively evaluated patients with known sensitivities to egg, soy, or peanut and reviewed medical records for a documented sensitivity reaction in those who were given propofol . Study A identified four patients with a positive test to propofol, none had a history of egg, soy, or peanut allergy nor did any of them test positive for IgE to egg or soy . Study B identified 544 patients evaluated by an allergist as IgE positive for egg, soy, or peanut but none of those who were also exposed to propofol had any documented concern for perioperative hypersensitivity reactions .…”

Section: Perioperative Considerationsmentioning

confidence: 99%

Perioperative considerations for the food‐allergic pediatric patient

Fernandez

Mikhael

2017

Pediatric Anesthesia

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Patients with a history of food allergy and food intolerance are common in the pediatric population and are encountered frequently in the perioperative setting by pediatric anesthesiologists. Perioperatively, food allergy can present on a spectrum ranging from minor acute urticaria to more severe hypovolemia and anaphylactic shock. Allergy to foods including fruits, fish, egg, soy, and peanut are most concerning for their potential to cross-react with perioperative medications. There is little in the anesthesia literature that focuses on the perioperative management of children with food allergies. This educational review will provide a brief overview of classic immunoglobulin E (IgE)-mediated food allergies, less common non-IgE food allergies, and present perioperative considerations for these patients. An audio summary of this topic is included as Supplementary Audio S1.

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No Evidence for Contraindications to the Use of Propofol in Adults Allergic to Egg, Soy, or Peanut

Cited by 29 publications

References 0 publications

Practical Guidelines for Perioperative Hypersensitivity Reactions

Practical Guidelines for Perioperative Hypersensitivity Reactions

An update on allergy and anaphylaxis in pediatric anesthesia

Perioperative considerations for the food‐allergic pediatric patient

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