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Urticaria associated with parenteral nutrition.
James S Scolapio1, Marcus Ferrone, Robert A Gillham
1Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA. scolapio.james@mayo.edu
JPEN. Journal of Parenteral and Enteral Nutrition
|October 15, 2005
Summary
Parenteral nutrition (PN) can cause allergic reactions like urticaria. In a short bowel syndrome patient, a multivitamin in PN triggered urticaria, highlighting a potential allergen in intravenous feeding solutions.
Area of Science:
- Clinical Medicine
- Allergology
- Gastroenterology
Background:
- Short bowel syndrome necessitates parenteral nutrition (PN) for nutritional support.
- Parenteral nutrition solutions are complex mixtures, posing potential risks for adverse reactions.
- Identifying specific allergens in PN is crucial for patient safety.
Observation:
- A 53-year-old female with short bowel syndrome developed urticaria during cyclic PN infusion.
- Urticaria onset occurred 2 hours into the infusion and resolved upon discontinuation.
- Exclusion of lipids did not prevent urticaria, but removal of multivitamins did.
Findings:
- Reintroduction of multivitamins into the PN solution precipitated recurrent urticaria.
- Skin prick testing with multivitamins was negative.
- Serum tryptase and urinary histamine levels remained unchanged during PN infusion with multivitamins.
Implications:
- Multivitamin preparations can be a source of allergic reactions during parenteral nutrition.
- This case underscores the importance of considering individual components of PN as potential allergens.
- Further investigation into PN-associated allergies is warranted to improve patient management and safety.