Pang Steph A, Eintracht Shaun, Schwartz Jesse M, Lobo Belinda, MacNamara Elizabeth
1Faculty of Medicine, McGill University, 3655 Promenade Sir-William-Osler, Montreal, QC H3G 1Y6 Canada.
2Division of Medical Biochemistry, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada.
Allergy Asthma Clin Immunol. 2019 Aug 30;15:51. doi: 10.1186/s13223-019-0364-z. eCollection 2019.
The full range of allergic reactions to Total Parenteral Nutrition (TPN) remains unknown. Additionally, beyond individual allergens, there may be other factors contributing to TPN hypersensitivity reactions.
We present a case of a patient with negative skin testing to common TPN allergens who had recurrent urticarial reactions to TPN. Her skin reactions resolved once TPN was stopped. Following a literature review, we postulated that the reactions could be due to the high osmolality of her TPN. Consequently, lowering her TPN from 2785 to 1928 mOsm/kg and premedicating with cetirizine resulted in resolution of her urticaria.
When looking at patients who have hypersensitivity reactions to TPN, one must consider that their reactions may be due to factors other than allergens. More studies are needed to clarify the relationship between high osmolality TPN infusions and non-IgE mediated hypersensitivity reactions.
全胃肠外营养（TPN）过敏反应的全貌尚不清楚。此外，除了个别过敏原外，可能还有其他因素导致TPN过敏反应。
我们报告一例对常见TPN过敏原皮肤试验呈阴性的患者，该患者对TPN反复出现荨麻疹反应。停用TPN后，她的皮肤反应消失。经过文献回顾，我们推测这些反应可能是由于她的TPN渗透压过高所致。因此，将她的TPN渗透压从2785降至1928mOsm/kg，并预先使用西替利嗪治疗，使她的荨麻疹得到缓解。
在观察对TPN有过敏反应的患者时，必须考虑到他们的反应可能是由过敏原以外的因素引起的。需要更多的研究来阐明高渗TPN输注与非IgE介导的过敏反应之间的关系。
