Immediate-type hypersensitivity to polyethylene glycols: a review - PubMed

Review

Immediate-type hypersensitivity to polyethylene glycols: a review

E Wenande et al. Clin Exp Allergy. 2016 Jul.

Abstract

Polyethylene glycols (PEGs) or macrogols are polyether compounds widely used in medical and household products. Although generally considered biologically inert, cases of mild to life-threatening immediate-type PEG hypersensitivity are reported with increasing frequency. Nevertheless, awareness of PEG's allergenic potential remains low, due to a general lack of suspicion towards excipients and insufficient product labelling. Information on immediate-type reactions to PEG is limited to anecdotal reports, and the potential for PEG sensitization and cross-sensitization to PEGylated drugs and structurally related derivatives is likely underestimated. Most healthcare professionals have no knowledge of PEG and thus do not suspect PEG's as culprit agents in hypersensitivity reactions. In consequence, patients are at risk of misdiagnosis and commonly present with a history of repeated, severe reactions to a range of unrelated products in hospital and at home. Increased awareness of PEG prevalence, PEG hypersensitivity, and improved access to PEG allergy testing, should facilitate earlier diagnosis and reduce the risk of inadvertent re-exposure. This first comprehensive review provides practical information for allergists and other healthcare professionals by describing the clinical picture of 37 reported cases of PEG hypersensitivity since 1977, summarizing instances where PEG hypersensitivity should be considered and proposing an algorithm for diagnostic management.

Similar articles

• Hidden Dangers: Recognizing Excipients as Potential Causes of Drug and Vaccine Hypersensitivity Reactions.

  Caballero ML, Krantz MS, Quirce S, Phillips EJ, Stone CA Jr. Caballero ML, et al. J Allergy Clin Immunol Pract. 2021 Aug;9(8):2968-2982. doi: 10.1016/j.jaip.2021.03.002. Epub 2021 Mar 15. J Allergy Clin Immunol Pract. 2021. PMID: 33737254 Free PMC article. Review.

• Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized.

  Stone CA Jr, Liu Y, Relling MV, Krantz MS, Pratt AL, Abreo A, Hemler JA, Phillips EJ. Stone CA Jr, et al. J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1533-1540.e8. doi: 10.1016/j.jaip.2018.12.003. Epub 2018 Dec 14. J Allergy Clin Immunol Pract. 2019. PMID: 30557713 Free PMC article.

• Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients.

  Bruusgaard-Mouritsen MA, Johansen JD, Garvey LH. Bruusgaard-Mouritsen MA, et al. Clin Exp Allergy. 2021 Mar;51(3):463-470. doi: 10.1111/cea.13822. Epub 2021 Jan 15. Clin Exp Allergy. 2021. PMID: 33394522

• Polyethylene glycols (PEG) and related structures: overlooked allergens in the perioperative setting.

  Wenande E, Kroigaard M, Mosbech H, Garvey LH. Wenande E, et al. A A Case Rep. 2015 Mar 1;4(5):61-4. doi: 10.1213/XAA.0000000000000126. A A Case Rep. 2015. PMID: 25730412

• Safety assessment on polyethylene glycols (PEGs) and their derivatives as used in cosmetic products.

  Fruijtier-Pölloth C. Fruijtier-Pölloth C. Toxicology. 2005 Oct 15;214(1-2):1-38. doi: 10.1016/j.tox.2005.06.001. Toxicology. 2005. PMID: 16011869 Review.

Cited by

• Hypersensitivity to different polyethylene glycol-containing products.

  Khalid MB, Bundy V. Khalid MB, et al. Ann Allergy Asthma Immunol. 2021 Jun;126(6):734-735. doi: 10.1016/j.anai.2021.03.004. Epub 2021 Mar 11. Ann Allergy Asthma Immunol. 2021. PMID: 33716148 Free PMC article. No abstract available.

• Hidden Dangers: Recognizing Excipients as Potential Causes of Drug and Vaccine Hypersensitivity Reactions.

  Caballero ML, Krantz MS, Quirce S, Phillips EJ, Stone CA Jr. Caballero ML, et al. J Allergy Clin Immunol Pract. 2021 Aug;9(8):2968-2982. doi: 10.1016/j.jaip.2021.03.002. Epub 2021 Mar 15. J Allergy Clin Immunol Pract. 2021. PMID: 33737254 Free PMC article. Review.

• SARS-CoV-2 Vaccination and Anaphylaxis: Recommendations of the French Allergy Community and the Montpellier World Health Organization Collaborating Center.

  Tanno LK, Berard F, Beaudoin E, Didier A, Demoly P. Tanno LK, et al. Vaccines (Basel). 2021 May 27;9(6):560. doi: 10.3390/vaccines9060560. Vaccines (Basel). 2021. PMID: 34072058 Free PMC article. Review.

• Skin Testing and Basophil Activation Testing Is Useful for Assessing Immediate Reactions to Polyethylene Glycol-Containing Vaccines.

  Li J, Weir C, Fulton R, Fernando SL. Li J, et al. Vaccines (Basel). 2023 Jan 23;11(2):252. doi: 10.3390/vaccines11020252. Vaccines (Basel). 2023. PMID: 36851130 Free PMC article.

• Disposable FFP2 and Type IIR Medical-Grade Face Masks: An Exhaustive Analysis into the Leaching of Micro- and Nanoparticles and Chemical Pollutants Linked to the COVID-19 Pandemic.

  Delgado-Gallardo J, Sullivan GL, Tokaryk M, Russell JE, Davies GR, Johns KV, Hunter AP, Watson TM, Sarp S. Delgado-Gallardo J, et al. ACS ES T Water. 2022 Apr 8;2(4):527-538. doi: 10.1021/acsestwater.1c00319. Epub 2022 Mar 23. ACS ES T Water. 2022. PMID: 35403122 Free PMC article.

Publication types

MeSH terms

Substances

LinkOut - more resources

• Full Text Sources

  • Ovid Technologies, Inc.
  • Wiley

• Other Literature Sources

  • The Lens - Patent Citations Database
  • scite Smart Citations