Polyethylene glycol as a cause of anaphylaxis

Wylon, K.; Dölle, Sabine; Worm, Margitta

doi:10.1186/s13223-016-0172-7

Cited by 76 publications

(75 citation statements)

References 9 publications

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“…1 PEG of MW between 3350 and 6000 are frequently used as excipients in many liquid and solid formulations of medications. 2, 3 PEG of MW 5000 is used in conjugated enzyme therapeutics, such as PEG-asparaginase and PEG-adenosine deaminase, to improve drug pharmacokinetics and lower immunogenicity. PEG of MW 3350 is the primary ingredient in commonly used oral bowel preparations for colonoscopy procedures in the United States.…”

Section: Introductionmentioning

confidence: 99%

Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized

Stone

Liu

Relling

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

295

409

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Background: The most common immediate hypersensitivity to macrogols is associated with PEG 3350, however the epidemiology, mechanisms and cross-reactivity are poorly understood. Thousands of medications contain either PEGs or structurally similar polysorbates. Objective: Our objective was to better understand the mechanism, cross-reactivity and scope of PEG hypersensitivity. Methods: Two cases with a past history of immediate hypersensitivity to PEG-containing medications were used to study potential mechanisms and cross-reactivity of immediate reactions to PEG 3350. Skin testing and oral challenges with PEG and polysorbate-containing agents were employed to determine clinical reactivity and cross-reactivity between the two allergens. Enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescent immunoassay were used to detect anti-PEG specific IgG and IgE respectively, using PEGylated protein or PEG alone as antigens in two cases and six PEG 3350 tolerant controls. We searched FDA adverse event reports for immediate reactions to PEG 3350 to determine the potential scope of this problem in the United States. Results: Skin and provocation testing demonstrated symptomatic reactivity in both cases to PEG 3350 and polysorbate 80. Plasma samples were positive for anti-PEG specific IgE and IgG antibodies only in cases and binding increased directly proportional to the molecular weight of PEG tested. FDA adverse event reports revealed 53 additional cases of possible PEG 3350 anaphylaxis. Conclusions: Immediate hypersensitivity to PEG 3350 with cross-reactive polysorbate 80 hypersensitivity may be under recognized in clinical practice and can be detected with clinical skin testing. Our studies raise the possibility of an IgE mediated Type I hypersensitivity mechanism in some cases.

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Section: Introductionmentioning

confidence: 99%

Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized

Stone

Liu

Relling

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

295

409

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“…7 However, immediate-type PEG hypersensitivity has been reported, and a literature review documented 37 clinical cases of hypersensitivity related to PEG exposure via various routes. 8,9 Prior to use, the two valves on the fill polymer kit are opened, and the fill polymer is mixed. The fill syringe is then connected to the fill polymer injection port on the aortic body delivery system.…”

Section: Discussionmentioning

confidence: 99%

Polymer leak with the Ovation Abdominal Stent Graft System: Early recognition and treatment

et al. 2019

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Objective Endovascular aneurysm repair can be performed using multiple commercially available stent graft systems, each with their own unique design features and potential complications. This study evaluated the incidence, risk factors and outcomes of patients who developed an anaphylactic reaction following systemic exposure to the polymer used with the Ovation Abdominal Stent Graft System (Endologix Inc., Irvine, CA). Methods We reviewed all reports related to polymer leak with the device received by the manufacturer (formerly known as TriVascular, Santa Rosa, CA). Patients who developed an anaphylactic or hypersensitivity reaction were evaluated for root cause. The manufacturer was contacted to assemble all available data and outcomes related to the case reports. Results Between November 2009 and August 2016, polymer leak was reported in 26 patients (mean age, 77, range 61–100 years) from approximately 10,000 device implants (reported incidence, 0.26%). Symptoms occurred in 24 patients, with hypotension being the primary symptom. Treatment was in accordance for an anaphylactic reaction. There were no deaths, and the aneurysm sac remained unexcluded in three patients at the end of the case. Of these, one patient underwent successful endovascular re-intervention, one was converted to open surgical repair and one patient continued to be monitored. Factors that appear to contribute to the risk of polymer leak include initial manufacturing process for the device, excessive graft manipulation, early ballooning prior to complete polymer cure and lower body temperature, which can slow the polymer cure rate. Conclusion Although polymer leak and anaphylaxis appear to be an infrequent event associated with use of the Ovation graft, awareness of this complication and prompt recognition can allow for timely treatment. Returning the patient to hemodynamic stability can allow for completion of the procedure and successful exclusion of the aneurysm sac.

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“…They are generally regarded as weak contact sensitizers in comparison with their widespread presence in various topical preparations such as topical drugs or cosmetics. Oral and parenteral administration of some products containing high molecular weight PEGs may cause immediate‐type hypersensitivity reactions (, ). Contact sensitization is mainly reported with low molecular weight PEGs, for example PEG 200 to PEG 400 ().…”

Section: Discussionmentioning

confidence: 99%

Polyethylene glycol as marker for nitrofurazone allergy: 20 years of experience from Turkey

Özkaya

Kılıç

2017

Contact Dermatitis

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Polyethylene glycol as a cause of anaphylaxis

Cited by 76 publications

References 9 publications

Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized

Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized

Polymer leak with the Ovation Abdominal Stent Graft System: Early recognition and treatment

Polyethylene glycol as marker for nitrofurazone allergy: 20 years of experience from Turkey

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