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

Abstract

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.

Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID‐19 vaccine

“…For example, Garvey found 3 of 10 PEG-allergic patients had positive skin prick tests to polysorbate 80 at 20%. 10 It is unclear whether this translates into clinical cross-hypersensitivity.…”

PEG That Reaction: A Case Series of Allergy to Polyethylene Glycol

“…Patients experienced an average of 3 allergic episodes before a formal diagnosis consistent with other case series. 1 Reactions were distressing for patients and objectively severe. Media reports of a case of fatal anaphylaxis in a patient with an established diagnosis of PEG allergy highlight the significance of this emerging problem.…”

“…Interestingly, more recent case reports demonstrate a younger median age of diagnosis compared with older publications. 1,5 This is likely multifactorial and may be influenced by improved awareness of drug, and specifically PEG allergy, improved access to specialist allergy services, and potentially earlier or greater opportunity for sensitization. This is something that can only be speculated on because of limited clinical data.…”

“…A female predominance was noted in our case series, but has not been universally observed. 1,4 Overall, the literature reports equal incidence between sexes. Interestingly, more recent case reports demonstrate a younger median age of diagnosis compared with older publications.…”

“…Bruusgaard-Mouritsen et al (2021) similarly highlighted analgesics, depo injections, and laxatives as common triggers in their cohort, as well noting antacids and antibiotics as culprits. 1 We recommend that an adrenaline autoinjector be prescribed to those with PEG allergy because of an ongoing risk of accidental exposure. Unfortunately, comprehensive avoidance list cannot be provided, as medical preparations frequently change; thus, awareness is key.…”