Propofol use in children with allergies to egg, peanut, soybean or other legumes

Abstract

Summary Propofol is the most commonly administered intravenous agent for anaesthesia in children. However, there are concerns that the emulsified preparation may not be safe in children with an allergy to egg, peanut, soybean or other legumes. We conducted a retrospective study of children with immunologically confirmed egg, peanut, soybean or legume allergy and who underwent general anaesthesia at Princess Margaret Hospital for Children between 2005 and 2015. We extracted details regarding allergy diagnosis, each anaesthetic administered and any adverse events or signs of an allergic reaction in the peri‐operative period. A convenience sample of patients without any known food allergies was identified from our prospective anaesthesia research database and acted as a control group. We identified 304 food‐allergic children and 649 procedures where propofol was administered. Of these, 201 (66%) had an egg allergy, 226 (74%) had a peanut allergy, 28 (9%) had a soybean allergy and 12 (4%) had a legume allergy. These were compared with 892 allergy‐free patients who were exposed to propofol. In 10 (3%) allergy patients and 124 (14%) allergy‐free patients, criteria for a possible allergic reaction were met. In nine of the food‐allergic children and in all the controls valid non‐allergic explanations for the clinical symptoms were found. One likely mild allergic reaction was experienced by a child with a previous history of intralipid allergy. We conclude that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.

Food, fads, allergies and anaphylaxis with propofol

“…If a 2% incidence of allergy is assumed, then the denominator in NAP6 would have been 2% of 2.4 million, that is, 1: 48,000 children. This current study is simply supportive of such a statement, given an improved understanding of the nature of food allergies, denatured constituents of propofol and alternative triggers causing symptoms after propofol administration.…”

“…Somerfield et al. conducted a retrospective 10‐year review of children with a known positive skin prick test or elevated IgE concentrations to egg, soy, peanut or legumes, who were given propofol. Propofol datasheets warn about soy and egg allergy, and some also warn about peanut allergy in both Australia and New Zealand (e.g.…”

“…There is little evidence for the practice of choosing alternatives to propofol in patients with egg, peanut or soy allergy and Sommerfield et al. are quite justified to continue their practice of administering propofol in the presence of food allergy.…”

“…Somerfield et al. report their exploration of the relationship between propofol and food allergies relating to egg, soy and peanuts in children in this issue of Anaesthesia . The issue is complex and their practice review goes some way to unravelling those complexities, allaying fears of an interaction.…”

An update on allergy and anaphylaxis in pediatric anesthesia

“…The potential small amount of soy protein remaining in soy oil after the refining process is thought to be insufficient, even in a sensitized individual, to trigger a reaction, however, no data exist on a threshold dose of contamination below which no allergic patient is likely to experience symptoms . A retrospective review did not find an association between food allergy and allergic reaction to propofol in children …”