According to the drug reaction article “PEG That Reaction: A Case Series of Allergy to Polyethylene Glycol” published in The Journal of Clinical Pharmacology 2021, Polyethylene Glycol (PEG), also called macrogol, is an excipient used in severe health care products, medications, vaccines, cosmetics, and food products. PEG functions as an inert stabilizing or bulking agent. Despite PEG’s popularity, the knowledge of PEG allergies is low.
The article reports on six cases highlighting the seriousness of this rare, potentially deadly allergy. In one case, a woman suffered anaphylaxis after receiving an intramuscular Depo-Provera administered by her doctor. The report states that the patient developed rapid-onset symptoms, including rhinorrhea, sneezing, profound hypotension, urticaria, and chest tightness. Her anaphylactic shock was treated with steroids, nebulized salbutamol, and two intramuscular adrenaline doses. Although her symptoms improved, six hours later, the woman suffered additional urticaria. The patient had a history of tolerating similar progesterone used in other oral contraceptive medications. The acute allergic reaction was blamed on the PEG-3350 contained in the intramuscular Depo-Provera medication. Skin-prick testing showed that the woman was allergic to the PEG.
Another patient experienced angioedema and acute urticaria after consuming ibuprofen and esomeprazole. Initially, treating physicians believed the patient had a sensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). However, upon further investigation, this patient suffered angioedema, hypotension, and urticaria after ingesting small amounts of the osmotic laxative Movi-Prep. Movi-Prep contains PEG. The patient also suffered urticaria while using certain types of cosmetics. It was reported that PEG was the common trigger.
The third case described in the report states that a patient suffered urticaria and syncope a few minutes after taking effervescent vitamin C and suffered urticaria, throat tightness, and angioedema after consuming the osmotic laxative Klean- Prep. The patient also presented a history of urticaria linked with Vimovo and during a dental procedure. All of the agents she took contained high-molecular-weight (HMW)-PEG.
Fortunately, the identification of PEG-related allergic reactions is increasing. Recently, there have been reports of immediate hypersensitivity in health care workers following COVID-19 vaccinations. Several COVID mRNA vaccines contain PEG-2000 and allergy experts have engaged with regulatory agencies to consider PEG as a likely allergen in mRNA vaccines and to permit an objective investigation.
The authors of the article recommend increasing awareness of PEG allergies amongst the medical community. Moreover, early identification and prompt referral to allergy diagnostic centers are needed to prove the diagnosis and manage this dangerous drug allergy.
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