Immediate allergic reactions by polyethylene glycol 4000: two cases

Abstract

The evacuant solution (ES) is a drug that has been used to clean the colon. The most common described side effects when using this drug are abdominal symptoms; skin rash is rare. We report on two patients who presented urticaria and angioedem after the intake of an evacuant solution to make a rectoscopy. We performed allergy studies: skin prick tests with common inhalants, pure ES and the components (polyethylene glycol 4000 (PEG 4000), KCI, NaCO3, NaPO3, NaSO3, NaCI, neohesperydine, potasic acesulfam and orange flavouring), intradermic test, total serum IgE and single-blind placebo oral challenge with ES and the components. We report on the first cases of immediate allergy reactions (type1) caused by oral intake of a drug containing PEG 4000 which were demonstrated by intradermic tests and oral challenge.

Hypersensitivity to Polyethylene Glycols

“…Anton Gironés et al described 2 additional cases of immediate reactions to PEG‐4000 and confirmed these by oral challenge . Interestingly, both patients had negative skin prick testing to PEG‐4000, and after a positive challenge, the authors then performed intradermal testing, which was positive . Other reports have suggested systemic reactions to PEG.…”

“…Fisher et al described 2 cases of immediate reactions to PEG 300 and 400 that produced negative patch testing, but rubbing the respecting agents on the patients— forearms produced an urticarial reaction within 15 minutes . Anton Gironés et al described 2 additional cases of immediate reactions to PEG‐4000 and confirmed these by oral challenge . Interestingly, both patients had negative skin prick testing to PEG‐4000, and after a positive challenge, the authors then performed intradermal testing, which was positive .…”

Anaphylactoid reaction to paliperidone palmitate extended-release injectable suspension in a patient tolerant of oral risperidone

“…1 Polyethylene glycol 4000 has been associated with anaphylactic reactions and may have been the causative factor in the case reported here. 5 Anaphylactic reactions to long-acting injectable antipsychotics in patients with established tolerance of oral formulations, although rare, have been reported and attributed to ingredients of the injectable formulations. 6 One published case report described an anaphylactic reaction, manifesting as rash and wheezing, after the first dose of long-acting injectable risperidone in a patient with confirmed tolerance of oral risperidone; the report's authors attributed the reaction to the polymer that encapsulated the risperidone in the long-acting injection.…”

Macrogol (polyethylene glycol) 4000 without electrolytes in the symptomatic treatment of chronic constipation: a profile of its use

“…Cases of anaphylaxis following the use of HMW macrogols have been reported, with most being related to their use as lavage solutions for bowel preparation [ 63 – 66 ]. The Allergy Vigilance Network recorded five cases of severe macrogol-related anaphylaxis from 2010 to 2012, including two cases with macrogol 4000 (one presenting as generalized urticaria following treatment with 10 g, and one as anaphylactic shock following treatment with 20 g) [ 64 ].…”