Polyethylene glycols (PEGs) or macrogols are hydrophilic polymers found in everyday
products such as foods, cosmetics, and medications. We present 5 cases of confirmed
PEG allergy, which to our knowledge is the largest case series to date. Four of the
5 cases developed anaphylaxis to medications containing PEGs, with 1 near-fatal case
resulting in cardiac arrest. Skin tests were undertaken to the index medications and
to PEGs of different molecular weights. Three were confirmed with positive skin prick
test result to PEG, 1 confirmed with a positive intradermal test result, and 1 confirmed
after positive oral challenge. Two patients developed anaphylaxis following intradermal
test to PEG and 1 a systemic allergic reaction (without hypotension or respiratory
distress) following PEG skin prick tests. Before diagnosis, all 5 patients were mislabeled
as allergic to multiple medications and their clinical management had become increasingly
challenging. An algorithm is proposed to safely investigate suspected PEG allergy,
with guidance on PEG molecular weights and skin test dilutions to minimize the risk
of systemic allergic reaction. Investigation carries considerable risk without knowledge
and informed planning so should only be conducted in a specialist drug allergy center.
Key words
Abbreviations used:
IDT (Intradermal test), IM (Intramuscularly), IV (Intavenous), MW (Molecular weight), PEG (Polyethylene glycol), SAR (Systemic allergic reaction), SPT (Skin prick test)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: October 01, 2020
Accepted:
September 13,
2020
Received in revised form:
September 7,
2020
Received:
May 17,
2019
Footnotes
Conflicts of interest: The authors declare that they have no relevant conflicts of interest.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
