Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Paediatr Anaesth. 2021 May;31(5):570-577. doi: 10.1111/pan.14147. Epub 2021 Feb 18.
Anaphylaxis to propofol is rare; however, providers face a clinical quandary as medication warnings still exist regarding propofol administration to egg-, soy-, and peanut-allergic patients.
The primary aim evaluated the rate of allergic reactions during propofol-containing anesthesia in patients listed allergic to egg, soy, or peanut compared with nonallergic patients who received propofol. The secondary aim evaluated the relationship between food allergy history and allergy testing data.
A retrospective chart review conducted between May 2012 and October 2018 identified pediatric patients listed allergic to egg, soy, and/or peanut, who received propofol. Allergy testing and results are presented. Evidence of allergic reaction to propofol during anesthesia was evaluated, and compared with a large nonallergic cohort who received propofol.
Of the 232 392 anesthetics administered, 177 360 (76%) included propofol and 11308 (6%) involved a patient listed allergic to at least 1 index food. A large number of patients had no food allergy testing (n = 6153) or negative testing (n = 2198). Of the 3435 patients listed egg-allergic, 976 tested positive; 750 tested negative; and 1709 had no testing. Of the 2011 patients listed soy-allergic, 322 tested positive; 585 tested negative; and 1104 had no testing. Additionally, 5862 patients were listed peanut-allergic; 1659 tested positive; 863 tested negative and 3340 had no testing. One record of proven propofol anaphylaxis occurred; it was in a patient without a history of food allergies. There were 6 other cases of suspected allergy to propofol. One had a peanut and tree nut allergy and was lost to follow-up; one had no testing available, while 4 patients had positive propofol allergy testing and positive allergy tests to other medications. The rate of proven propofol anaphylaxis during anesthesia in the nonallergic cohort was 0.06/10 000, and the rate in egg- and soy-allergic patients was 0/5446. One patient with a listed peanut allergy had a possible reaction to propofol.
In the listed food-allergic cohort, the majority had no allergy testing or negative testing. We found no evidence of a relationship between food allergy history and perioperative propofol reaction. We suggest multiply allergic and atopic patients may have a similar likelihood of propofol reaction as with other medications.
丙泊酚过敏十分罕见；然而，由于药物警告仍然存在，即对鸡蛋、大豆和花生过敏的患者使用丙泊酚，医护人员面临着临床困境。
主要目的评估与接受丙泊酚的非过敏患者相比，列出对鸡蛋、大豆或花生过敏的患者在含有丙泊酚的麻醉期间发生过敏反应的比率。次要目的评估食物过敏史与过敏测试数据之间的关系。
2012 年 5 月至 2018 年 10 月期间进行了一项回顾性图表审查，确定了列出对鸡蛋、大豆和/或花生过敏的接受丙泊酚治疗的儿科患者。介绍了过敏测试及其结果。评估了麻醉期间丙泊酚过敏反应的证据，并与接受丙泊酚的大量非过敏队列进行了比较。
在 232392 次麻醉中，177360 次（76%）包括丙泊酚，11308 次（6%）涉及至少列出 1 种索引食物过敏的患者。大量患者没有进行食物过敏测试（n=6153）或测试结果为阴性（n=2198）。在列出鸡蛋过敏的 3435 名患者中，976 人检测结果阳性；750 人检测结果阴性；1709 人未检测。在列出大豆过敏的 2011 名患者中，322 人检测结果阳性；585 人检测结果阴性；1104 人未检测。此外，5862 名患者被列为花生过敏；1659 人检测结果阳性；863 人检测结果阴性；3340 人未检测。有 1 例丙泊酚过敏反应的确诊记录；该患者无食物过敏史。还有 6 例疑似丙泊酚过敏反应。其中 1 例对花生和坚果过敏，且随访丢失；1 例无可用测试；而 4 例患者丙泊酚过敏测试阳性，且对其他药物过敏测试阳性。非过敏组在麻醉期间丙泊酚过敏反应的确诊率为 0.06/10000，鸡蛋和大豆过敏组为 0/5446。1 例列为花生过敏的患者可能对丙泊酚有反应。
在列出的食物过敏组中，大多数患者未进行过敏测试或测试结果为阴性。我们未发现食物过敏史与围手术期丙泊酚反应之间存在关联的证据。我们建议，多发性过敏和特应性患者可能与其他药物一样，有类似的丙泊酚反应可能性。
