Polyethylene glycol allergy
I have a patient who came in with three episodes of anaphylaxis to three different substances/meds all containing macrogols. This was the common ingredient in all instances. First was to GoLytely, second was to miralax and the final was to possibly the lubrication used during a colonoscopy or propofol. In all three reactions, the patient had hives, throat closing, wheezing, bronchoconstriction. The episode during the colonoscopy led to intubation and hospitalization x three days. The patient does not have any known allergies or PMH. My question is how to test for a potential allergic response to macrogols/polyethylene glycol/propylene glycol. Would this be performed through skin testing? Is there any protocol in place to follow for this type of allergy?
I asked Dr. Eric Macy for assistance with the response. He stated that Polyethylene Glycol (PEG) is a very rare allergy. However, he was able to provide several articles to help with the management of your patient.
Skin testing has been described by Wylon et al (1).
Further, a recent RCT in children by DiNardo et al (2) suggests that a non-PEG bowel prep may be a good alternative and safe approach for your patient.
1. Wylon, K., S. Dolle, and M. Worm. "Polyethylene Glycol as a Cause of Anaphylaxis." Allergy Asthma Clin Immunol 12 (2016): 67.
2. Di Nardo, G., M. Aloi, S. Cucchiara, C. Spada, C. Hassan, F. Civitelli, F. Nuti, et al. "Bowel Preparations for Colonoscopy: An Rct." Pediatrics 134, no. 2 (Aug 2014): 249-56.
I hope you find this helpful.
Daniel J. Jackson, MD, FAAAAI