Case Report
 

Case of Polyethylene Glycol Allergy Confirmed with Basophil Activation Test and Oral Challenge Successfully Immunized with SARS-CoV-2 Vaccine

Abstract

Polyethylene glycols (PEG) or macrogols are polymers of ethylene oxide widely used in drugs either as active substances or, more commonly, as excipients. We report a Caucasian 32-year-old woman with referred anaphylaxis almost instantly after oral intake of a macrogol-containing laxative. Despite an anaphylactic reaction, the patient showed negative results for both the skin test and specific IgE to monomer, while the basophil activation test and oral challenge were positive. The patient was later successfully vaccinated with a polysorbate 80-containing SARS-CoV-2 vaccine following an additional work-up. As a result, the inactive form of PEG cannot be fully diagnosed, and it is considered a “hidden” allergen. Allergens like polysorbates need special consideration due to their possible cross-reactivity by their specific derivatives.

1. Wenande E, Garvey L. Immediate-type hypersensitivity to polyethylene glycols: a review. Clin Exp Allergy. 2016;46(7):907-22.
2. Bruusgaard-Mouritsen M, Johansen J, Garvey L. Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients. Clin Exp Allergy. 2021;51(3):463-70.
3. Sellaturay P, Nasser S, Ewan P. Polyethylene Glycol–Induced Systemic Allergic Reactions (Anaphylaxis). J Allergy Clin Immunol Pract. 2021;9(2):670-5.
4. Zhou Z, Stone C, Jakubovic B, Phillips E, Sussman G, Park J et al. Anti-PEG IgE in anaphylaxis associated with polyethylene glycol. J Allergy Clin Immunol Pract. 2021;9(4):1731-3.e3.
5. Mohamed M, Abu Lila A, Shimizu T, Alaaeldin E, Hussein A, Sarhan H et al. PEGylated liposomes: immunological responses. Sci Technol Adv Mater. 2019;20(1):710-724.
6. Jover Cerdá V, Rodríguez Pacheco R, Doménech Witek J, Marco de la Calle F, de la Sen Fernández M. Immediate hypersensitivity to polyethylene glycols in unrelated products: when standardization in the nomenclature of the components of drugs, cosmetics, and food becomes necessary. Allergy Asthma Clin Immunol. 2019;15(1).
7. Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan P. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861-3.
8. Freire Haddad H, Burke J, Scott E, Ameer G. Clinical Relevance of Pre-Existing and Treatment-Induced Anti-Poly (Ethylene Glycol) Antibodies. Regen Eng Transl Med. 2021;1-11.
9. Liu Y, Smith C, Payton M, Jenkins D, Janke L, Relling M. An injectable excipient prevents anti-polyethylene glycol antibody-mediated hypersensitivity. Allergy. 2021;76(9):2902-4.
10. Ieven T, Van Weyenbergh T, Vandebotermet M, Devolder D, Breynaert C, Schrijvers R. Tolerability of polysorbate 80–containing COVID-19 vaccines in confirmed polyethylene glycol–allergic patients. J Allergy Clin Immunol Pract. 2021;9(12):4470-2.e1.
Files
IssueVol 22 No 4 (2023) QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/ijaai.v22i4.13615
Keywords
Basophil activation test COVID-19 vaccine Drug allergy Drug provocation test Polyethylene glycol

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Pasali M, Taka S, Chliva C, Katoulis A, Makris M. Case of Polyethylene Glycol Allergy Confirmed with Basophil Activation Test and Oral Challenge Successfully Immunized with SARS-CoV-2 Vaccine. Iran J Allergy Asthma Immunol. 2023;22(4):409-412.