Three cases of anaphylaxis following injection of a depot corticosteroid with evidence of IgE sensitization to macrogols rather than the active steroid

Brandt, Nicolaj; Garvey, Lene Heise; Bindslev-Jensen, U.; Kjær, Henrik Fomsgaard; Bindslev‐Jensen, Carsten; Mørtz, Charlotte G.

doi:10.1186/s13601-016-0138-3

Cited by 16 publications

(21 citation statements)

References 8 publications

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“…Due to widespread use of PEG in over‐the‐counter medication such as analgesics, antacids and laxatives, most patients in our cohort had several allergic reactions to PEGs before diagnosis. Similar findings have been described in numerous case reports 2,12‐17 . The median time to diagnosis was two years, emphasizing the difficulty in making the diagnosis of PEG allergy.…”

Section: Discussionsupporting

confidence: 87%

“…When PEG allergy is suspected, several actions should be taken in order to help the patient (Table 4). In general, investigation, diagnosis and follow‐up of patients with allergy to PEGs is challenging due to the lack of standardized test method for PEGs and the need for special expertize and comprehensive follow‐up by an allergist with specific knowledge about PEG allergy 13 . Most patients in this cohort have had several contacts to the Allergy Department, after the diagnosis was made, asking advice about medication they were prescribed.…”

Section: Discussionmentioning

confidence: 99%

“…Similar findings have been described in numerous case reports. 2,[12][13][14][15][16][17] The median time to diagnosis was two years, emphasizing the difficulty TA B L E 1 Products suspected by PEG allergic patients to induce allergic symptoms. None of the patients in our study were aware of PEGs or PEG allergy until the diagnosis was made during allergy investigations.…”

Section: Discussionmentioning

confidence: 99%

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Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients

Bruusgaard‐Mouritsen

Johansen

Garvey

2021

Clin Experimental Allergy

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Background Polyethylene glycols (PEGs) are widely used as excipients in drugs, cosmetics and household products. Immediate‐type allergy to PEGs including anaphylaxis is rare. The recent introduction of the mRNA‐based COVID‐19 vaccines has led to an increased focus on PEG as a possible culprit of allergic reactions to the vaccines. A low awareness of the allergenic potential of PEG among consumers, manufacturers and doctors leads to under‐diagnosis and under‐reporting of allergy to PEGs, putting patients at risk of repeated severe reactions. Objectives To investigate clinical manifestations, time to diagnosis and impact of a PEG allergy diagnosis on the daily life of patients diagnosed with allergy to PEG from 2010 to 2019. Method Ten patients diagnosed with allergy to PEG were included. Detailed clinical history was obtained, and allergy investigations had been performed at the time of diagnosis. All patients were contacted and asked to retrospectively complete a questionnaire about causes and impact on daily life of an allergy to PEG, scored on a likert scale (0–10) before and after diagnosis. Results Eight patients had experienced at least one anaphylactic reaction requiring adrenaline treatment. Anaphylaxis was primarily caused by antibiotic/analgesic tablets, depot‐steroids, antacids and laxatives. Seven patients reported repeated reactions before diagnosis (median 3, range 2–6). Median time from first reaction to diagnosis was 20 months (range 2–120). None of the patients experienced severe allergic reactions after the diagnosis. Median likert score of the impact on daily life before diagnosis was 7 compared with 4 after diagnosis. Conclusion and clinical relevance The clinical manifestations of PEG allergy are often dramatic. Improved awareness about the clinical presentation and common culprits, clear product labelling and a standardized nomenclature is needed to ensure the timely diagnosis of PEG allergy to prevent repeated anaphylactic reactions with severe impact on patients’ lives.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients

Bruusgaard‐Mouritsen

Johansen

Garvey

2021

Clin Experimental Allergy

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“…glycol/macrogol undiluted [21]; 4000 0.1% [42]; 3350 0.01 to 10% and undiluted [43,63]; 6000 undiluted [45]; 4000 0.01% [46]; 4000 0.1 to 10% [66]; 400 (Escitalopram) 20 mg/mL, 3350 (Micralax 1.18 g/mL), 4000 (Casenglicol) 254 mg/mL, 400/6000 (Stada metformin) 170 mg/mL [69]; 6000 0.01% [72]; 400, 4000 and 6000 0.01 to 100 mg/mL [76] Poly(oxyethylene)-poly 0.01% [72] (oxypropylene) glycol Polysorbate 20…”

Section: Cremophormentioning

confidence: 99%

“…Anaphylaxis was recorded following intraarticular or intramuscular injection of methylprednisolone acetate (Depo-Medrol), with evidence of sensitization to macrogol 3350 [42][43][44][45].…”

Section: Macrogol 3350mentioning

confidence: 99%

Immediate Hypersensitivity Reactions Caused by Drug Excipients: A Literature Review

Caballero¹,

Quirce²

2020

J Investig Allergol Clin Immunol

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The European Medicines Agency defines excipients as the constituents of a pharmaceutical form apart from the active substance. Immediate hypersensitivity reactions (IHRs) caused by excipients contained in the formulation of medications have been described. However, there are no data on the prevalence of IHRs due to drug excipients. Clinical manifestations of allergy to excipients can range from skin disorders to life-threatening systemic reactions. The aim of this study was to review the literature on allergy to pharmaceutical excipients and to record the IHRs described with various types of medications, specifically reactions due to the excipients contained in their formulations. The cases reported were sorted alphabetically by type of medication and excipient in order to obtain a list of the excipients most frequently involved for each type of medication.

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Allergy to polyethylene glycol and polysorbates in a patient cohort: Diagnostic work‐up and decision points for vaccination during the COVID‐19 pandemic

Mørtz

Kjær

Rasmussen

et al. 2022

Clinical & Translational All

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Background During the COVID‐19 pandemic focus has been on polyethylene glycol (PEG) and polysorbate as these excipients are constituents in the first vaccines and possible elicitors of allergic reactions to the vaccines. We aimed to evaluate the possibility of vaccinating patients with PEG and/or polysorbate allergy against COVID‐19. Methods Twenty‐five patients with a history of an allergic reaction to drugs, vaccines and mouth hygiene products containing PEG or polysorbate and sensitization (skin test or in vitro test) or a positive challenge were included. We re‐evaluated 19 of 21 patients diagnosed before 2021 and four new patients by skin prick tests (SPT) and Basophil Histamine Release (BaHR) for PEGs, polysorbates and approved COVID‐19 vaccines as well as measurement of specific IgE (PEG 2000, 10,000). Patients were offered vaccination based on decision points from the primary diagnosis and re‐evaluation. Results Most common primary elicitors were depot‐steroids and laxatives. Most patients had experienced more than one reaction. SPT was superior to BaHR test although many SPTs became negative over time. After careful re‐evaluation three patients were successfully vaccinated with the Pfizer/BioNTech vaccine. Three were vaccinated before referral. Eleven were offered the Johnson‐Johnson vaccine; four were vaccinated successfully, seven abstained. Six patients could not be vaccinated with PEG or polysorbate containing vaccines. Conclusion Hypersensitivity to excipients in COVID‐19 vaccines constitutes a risk to patients with allergy to PEG or polysorbates. After diagnostic evaluation, a safe COVID‐19 vaccine could be offered to most patients, the remainders will await new vaccines containing different excipients.

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Three cases of anaphylaxis following injection of a depot corticosteroid with evidence of IgE sensitization to macrogols rather than the active steroid

Cited by 16 publications

References 8 publications

Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients

Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients

Immediate Hypersensitivity Reactions Caused by Drug Excipients: A Literature Review

Allergy to polyethylene glycol and polysorbates in a patient cohort: Diagnostic work‐up and decision points for vaccination during the COVID‐19 pandemic

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