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Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized
Cosby A Stone1, Yiwei Liu2, Mary V Relling2
1Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
The Journal of Allergy and Clinical Immunology. in Practice
|December 18, 2018
Summary
Immediate hypersensitivity to polyethylene glycol (PEG) 3350 and polysorbate 80 is underrecognized. Skin testing can detect this cross-reactivity, suggesting a potential IgE-mediated mechanism in some patients.
Area of Science:
- Immunology
- Pharmacology
Background:
- Immediate hypersensitivity reactions to polyethylene glycol (PEG) 3350 are common but poorly understood.
- Many medications contain PEG or similar polysorbates, highlighting the need to investigate PEG hypersensitivity.
Observation:
- Two cases of immediate hypersensitivity to PEG-containing medications were studied.
- Skin testing and oral challenges were used to assess reactivity to PEG 3350 and polysorbate 80.
- Blood samples were analyzed for anti-PEG specific IgE and IgG antibodies.
Findings:
- Both cases showed symptomatic reactions to PEG 3350 and polysorbate 80 upon testing.
- Patients had detectable anti-PEG IgE and IgG antibodies, with binding increasing with PEG molecular weight.
- US FDA reports identified 53 additional potential cases of PEG 3350 anaphylaxis.
Implications:
- PEG 3350 hypersensitivity with cross-reactivity to polysorbate 80 may be underdiagnosed.
- Clinical skin testing can identify these hypersensitivities.
- An IgE-mediated type I hypersensitivity mechanism is possible in some individuals.
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