SonoVue® (Bracco; Milan, Italy) is an ultrasound contrast medium which contains polyethylene glycol (PEG) or macrogol, an excipient responsible for severe allergic reactions, especially through the parenteral route, and widely used, especially in the health field. We present an adult patient who experienced an IgE-mediated anaphylactic shock due to macrogol contained in SonoVue®, as demonstrates the skin tests realized. The allergy study has been useful in our case because it has guided us in the preventive measures to advice to the patient, who has to avoid not only SonoVue® but also other products that contain macrogol. We consider this case of interest because it is an allergic adverse reaction to SonoVue® in which its excipient, macrogol, has acted like the allergen responsible. We have to add SonoVue® to the list of the products that contain macrogol in their composition and keep in mind the possible allergenic capacity of this excipient for suspecting its responsibility, especially in those patients with multiple drug allergy and/or reactions to products of different natures like ultrasound gels, topical products (e.g. toothpastes, antiseptics, sunscreens, etc.), plasma expanders and others.

Chronic spontaneous urticaria (CSU) is defined as the spontaneous appearance of wheals, angioedema, or both, for at least 6 weeks, due to known or unknown causes [1]. In some patients who present a CSU with daily or almost daily symptoms a type I allergy could be the underlying cause. We present one adult patient with chronic urticaria who was finally diagnosed as a non-occupational case of IgE-mediated wheat allergy manifested following exposure by 3 different routes: inhalation (rhinitis and bronchial asthma), dermal absorption (contact urticaria) and ingestion (systemic chronic urticaria). We were able to detect the culprit proteins by immunoblotting. Serum IgE binds mainly to alpha-amylase/trypsin inhibitors and, to a lesser extent, to other proteins associated with food allergy to grains (e.g. beta-glucanase, serpin, peroxidase). In our opinion, skin prick tests with a food standard battery could help in the etiological diagnosis of chronic urticaria. The identification of responsible allergens could be difficult because only a few complex in vitro techniques allow detecting the allergy to several proteins.

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