title: No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut†.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Danish Anaesthesia Allergy Centre (DAAC), Allergy Clinic UA-816, Copenhagen University Hospital, Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark louise_smil@hotmail.com.
authors.forename: L L
authors.initials: LL
authors.lastname: Asserhøj
authors.affiliation: Danish Anaesthesia Allergy Centre (DAAC), Allergy Clinic UA-816, Copenhagen University Hospital, Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Mosbech
authors.affiliation: Danish Anaesthesia Allergy Centre (DAAC), Allergy Clinic UA-816, Copenhagen University Hospital, Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Krøigaard
authors.affiliation: Danish Anaesthesia Allergy Centre (DAAC), Allergy Clinic UA-816, Copenhagen University Hospital, Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark.
authors.forename: L H
authors.initials: LH
authors.lastname: Garvey
mesh_terms: D000328:Adult; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000097:blood / Q000150:complications* / Q000276:immunology; D021181:Egg Hypersensitivity / Q000097:blood / Q000150:complications / Q000276:immunology; D005260:Female; D005512:Food Hypersensitivity / Q000097:blood / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D021183:Peanut Hypersensitivity / Q000097:blood / Q000150:complications / Q000276:immunology; D015742:Propofol / Q000009:adverse effects*; D012189:Retrospective Studies; D012882:Skin Tests / Q000706:statistics & numerical data; D013025:Glycine max / Q000276:immunology; D055815:Young Adult
chemical_list: D015742:Propofol
keywords: anaphylaxis; egg hypersensitivity; i.v. anaesthetics, propofol; peanut hypersensitivity; soybean oil