Immunology and Allergy, St Helier University Hospital NHS Trust, D Block 2nd Floor, Wrythe Lane, Carshalton, SM5 1AA, UK.
J Med Case Rep. 2021 Nov 24;15(1):565. doi: 10.1186/s13256-021-03180-y.
Excipients are widely used in pharmaceuticals, detergents, food, and drink because of their properties of low toxicity and hypoallergenicity. The excipient carboxymethylcellulose is used extensively as a thickener in foods such as baked goods, ice cream, gluten free, and reduced fat products, where it may be labeled as e-number E466. However, excipients can rarely cause type 1 hypersensitivity reactions. Several publications have described systemic allergy following carboxymethylcellulose exposure in pharmaceuticals, particularly systemic corticosteroids. Furthermore, there is one reported case in the literature of anaphylaxis following food containing carboxymethylcellulose.
We identify a case of anaphylaxis in a 45-year-old atopic Caucasian woman on receiving an injectable suspension of the corticosteroid triamcinolone acetonide containing carboxymethylcellulose, and subsequent allergic symptoms on reexposure to carboxymethylcellulose in a commercial drink. Diagnosis of carboxymethylcellulose excipient allergy was confirmed through skin prick testing using Celluvisc carmellose 0.5% eye drops, which contain carboxymethylcellulose as the active ingredient.
This case highlights the importance of identifying excipients such as carboxymethylcellulose as causes of allergy, to reduce burden of further hypersensitivity reactions, not just to drugs but to other consumables.
赋形剂由于其低毒性和低过敏性的特性，被广泛应用于制药、洗涤剂、食品和饮料中。赋形剂羧甲基纤维素被广泛用作烘焙食品、冰淇淋、无麸质和低脂产品等食品的增稠剂，在这些食品中可能被标记为 E 编号 E466。然而，赋形剂很少会引起 1 型过敏反应。有几份出版物描述了羧甲基纤维素在药物中的全身过敏反应，特别是全身皮质类固醇。此外，文献中还有一例因食用含羧甲基纤维素的食物而发生过敏反应的报道。
我们发现一名 45 岁的特应性白种女性在接受含有羧甲基纤维素的皮质类固醇曲安奈德混悬剂注射后出现过敏反应，在再次接触商业饮料中的羧甲基纤维素后出现过敏症状。通过使用含有羧甲基纤维素作为活性成分的 Celluvisc 卡姆胶体 0.5%滴眼液进行皮肤点刺试验，确认了羧甲基纤维素赋形剂过敏的诊断。
本病例强调了识别羧甲基纤维素等赋形剂作为过敏原因的重要性，以减少进一步过敏反应的负担，不仅是药物，还包括其他消费品。
