No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut†

Br J Anaesth. 2016 Jan;116(1):77-82. doi: 10.1093/bja/aev360.

Abstract

Background: Propofol is thought to be a potential cause of allergic reactions in patients allergic to egg, soy or peanut, since current formulations contain an emulsion that includes egg lecithin and soybean oil. However, other than six case reports lacking in confirmatory evidence of an allergic reaction, there is no evidence linking the two types of allergies. The aim of this study was to examine the frequency of propofol allergy and to investigate if patients with specific immunoglobulin E (IgE) to egg, soy or peanut tolerated propofol.

Methods: Study A examined the frequency of propofol allergy in 273 patients systematically investigated for suspected perioperative allergic reactions. Of these, 153 had been exposed to propofol and underwent skin tests and intravenous provocation. Study B retrospectively investigated propofol exposure and tolerance in 520 adult patients with a positive specific IgE to egg, soy or peanut.

Results: Four of the 153 propofol-exposed patients (2.6%) investigated in study A were diagnosed with propofol allergy. Of these, three tested positive only on intravenous provocation. None of the four had allergic symptoms when eating egg, soy or peanut and none had detectable levels of specific IgE to egg or soy in their serum. In study B we found no signs of allergic reactions towards propofol in 171 retrieved anaesthetic charts from 99 patients with specific IgE to egg, soy or peanut.

Conclusion: No connection between allergy to propofol and allergy to egg, soy or peanut was found. The present practice of choosing alternatives to propofol in patients with this kind of food allergy is not evidence based and should be reconsidered.

Keywords: anaphylaxis; egg hypersensitivity; i.v. anaesthetics, propofol; peanut hypersensitivity; soybean oil.

MeSH terms

  • Adult
  • Anesthesia, Intravenous / adverse effects*
  • Drug Hypersensitivity / blood
  • Drug Hypersensitivity / complications*
  • Drug Hypersensitivity / immunology
  • Egg Hypersensitivity / blood
  • Egg Hypersensitivity / complications
  • Egg Hypersensitivity / immunology
  • Female
  • Food Hypersensitivity / blood
  • Food Hypersensitivity / complications*
  • Food Hypersensitivity / immunology
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Peanut Hypersensitivity / blood
  • Peanut Hypersensitivity / complications
  • Peanut Hypersensitivity / immunology
  • Propofol / adverse effects*
  • Retrospective Studies
  • Skin Tests / statistics & numerical data
  • Soybeans / immunology
  • Young Adult

Substances

  • Propofol