Danish Anaesthesia Allergy Centre (DAAC), Allergy Clinic UA-816, Copenhagen University Hospital, Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
Danish Anaesthesia Allergy Centre (DAAC), Allergy Clinic UA-816, Copenhagen University Hospital, Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark.
Br J Anaesth. 2016 Jan;116(1):77-82. doi: 10.1093/bja/aev360.
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.
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.
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.
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.
由于目前的制剂含有包含蛋黄卵磷脂和大豆油的乳剂，因此，对鸡蛋、大豆或花生过敏的患者可能会对丙泊酚产生过敏反应。然而，除了缺乏过敏反应确证证据的 6 例病例报告外，尚无证据将这两种过敏反应联系起来。本研究旨在检查丙泊酚过敏的频率，并研究是否对鸡蛋、大豆或花生特异性免疫球蛋白 E（IgE）阳性的患者耐受丙泊酚。
研究 A 检查了 273 例疑似围手术期过敏反应的患者中丙泊酚过敏的频率。其中，153 例患者曾接触过丙泊酚，并进行了皮肤测试和静脉内激发试验。研究 B 回顾性调查了 520 例对鸡蛋、大豆或花生有阳性特异性 IgE 的成年患者中丙泊酚的暴露和耐受性。
在研究 A 中，对 153 例接受丙泊酚暴露的患者进行调查，其中 4 例（2.6%）被诊断为丙泊酚过敏。其中，3 例仅在静脉内激发试验中呈阳性。这 4 例患者在食用鸡蛋、大豆或花生时均无过敏症状，且血清中均未检测到特异性 IgE 至鸡蛋或大豆。在研究 B 中，我们从 99 例对鸡蛋、大豆或花生有特异性 IgE 的患者中检索到 171 份麻醉记录，均未发现丙泊酚过敏的迹象。
未发现丙泊酚过敏与鸡蛋、大豆或花生过敏之间存在关联。目前，对这种食物过敏的患者选择丙泊酚替代物的做法没有依据，应重新考虑。
