The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleImmediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized
Section snippets
Clinical surveillance
Cases were recruited through a dedicated drug allergy clinic at Vanderbilt University Medical Center. A detailed clinical case description was obtained from patients whose history suggested an immediate reaction to PEG 3350-containing colonoscopy preparations, laxatives, or injected corticosteroids during a 3-year period. This study was done under institutional review board (IRB) approved protocols from Vanderbilt University (Vanderbilt IRB #61455).
Skin testing and challenges
To determine clinical reactivity to macrogols,
Description of cases
During our 3-year period of surveillance, we encountered 2 patients with a history of anaphylaxis during preparation for colonoscopy and after methylprednisolone acetate injections.
The first such patient was a 57-year-old white man with an occupational history as a mechanic and electrician, who presented to our clinic for evaluation of suspected medication allergies causing anaphylaxis. Five years before presentation, he noted that while preparing for a colonoscopy, taking oral Colyte brand
Discussion
The most commonly known clinical use of macrogols such as PEG 3350 is in colonoscopy preparation or constipation treatment.5, 23, 25, 26 However, a review of common products and the literature demonstrates that PEG and structurally similar polysorbate compounds can be found in vascular graft materials,10 surgical gels,27 PEGylated medications,28, 29, 30 household and industrial compounds,1 and as an excipient in a multitude of other medications both injectable and oral.4, 31 In these settings,
Conclusions
High-molecular-weight PEGs are common excipients in a wide variety of medications, household products, and industrial products that may provide a vehicle for sensitization in a subset of susceptible individuals. Allergists should be aware that cross-reactive immediate hypersensitivity to polyether-containing compounds such as macrogols/PEGs and polysorbates can occur, that they may occur via a type I hypersensitivity mechanism, and that they may be underrecognized.
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C. A. Stone received funding support related to this project from National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute T32 HL87738 and NIH/National Institute of General Medical Sciences (NIGMS) T32 GM007569. M. V. Relling received funding related to this project from NIH/National Cancer Institute CA 142665, CA 21765, and NIH/NIGMS GM 115279. E. J. Phillips received funding related to this project from NIH (1P50GM115305-01, 1R01AI103348-01, 1P30AI110527-01A1), National Health and Medical Research Foundation of Australia, and the Australian Centre for HIV and Hepatitis Virology Research.
Conflicts of interest: The authors declare that they have no relevant conflicts of interest.