Allergic reactions to propofol in adult patients with egg or soybean allergy: a retrospective cohort study from a large database of a single institute

Masaki Iwakiri, Reo Inoue, Kanji Uchida, Masaki Iwakiri, Reo Inoue, Kanji Uchida

Abstract

Background: In recent years, many reports have indicated that propofol is safe to administer to patients with egg/soybean allergy in Western countries. Egg allergy is more frequent in Asia, but there are limited reports regarding allergic reactions to propofol use among adults. This study aimed to determine whether propofol causes allergic reactions in patients with egg/soybean allergy.

Methods: Adult patients who underwent surgery involving anesthesiologists from 2018 to 2021 were included. In all patients, we reviewed food allergy information in their electronic medical record and extracted anesthetics. Patients with egg/soybean allergy were subdivided into two groups on the basis of intraoperative use of propofol. We evaluated each group for allergic reactions within 24 h after the induction of anesthesia. The primary outcome was a relative risk of allergic reactions after propofol use for patients with egg/soybean allergy.

Results: In total, 22,111 patients with 28,710 anesthesia records were identified. Among patients with egg/soybean allergy, 173 (0.8%) patients and 237 (0.8%) anesthesia records were included in the study. Among the records of egg-/soybean-allergic patients, 151 were administered propofol, and 86 were not. The relative risk of allergic reactions after propofol use for patients with egg/soybean allergy was 1.14 (95% confidence interval, 0.10-12.4; p = 0.74).

Conclusion: The use of propofol in patients with egg/soybean allergy does not significantly increase the relative risk of allergic reactions. Therefore, anesthesiologists can appropriately determine the indication for propofol, even in patients with egg/soybean allergy.

Trial registration: UMIN-CTN, UMIN000049321 registered 26 October 2022 - retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000056167.

Keywords: Drug allergy; Egg allergy; Propofol; Soybean allergy.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the study. ECT, electroconvulsive therapy

References

    1. Takazawa T, Yamaura K, Hara T, Yorozu T, Mitsuhata H, Morimatsu H, et al. Practical guidelines for the response to perioperative anaphylaxis. J Anesth. 2021;35:778–793. doi: 10.1007/s00540-021-03005-8.
    1. Hepner DL, Castells MC. Anaphylaxis during the perioperative period. Anesthesia Analgesia. 2003;97:1381–1395. doi: 10.1213/01.ANE.0000082993.84883.7D.
    1. Horiuchi T, Takazawa T, Orihara M, Sakamoto S, Nagumo K, Saito S. Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study. J Anesth. 2021;35:154–160. doi: 10.1007/s00540-020-02886-5.
    1. Baker MT, Naguib M, Warltier DC. Propofol. Anesthesiology. 2005;103:860–876. doi: 10.1097/00000542-200510000-00026.
    1. Tashkandi J. My patient is allergic to eggs, can i use propofol? A case report and review. Saudi J Anaesth. 2010;4:207–208. doi: 10.4103/1658-354X.71581.
    1. Hofer KN, McCarthy MW, Buck ML, Hendrick AE. Possible anaphylaxis after propofol in a child with food allergy. Ann Pharmacother. 2003;37:398–401. doi: 10.1345/aph.1C227.
    1. Richard C, Beaudouin E, Moneret-Vautrin DA, Kohler C, Nguyen-Grosjean VM, Jacquenet S. Severe anaphylaxis to propofol: first case of evidence of sensitization to soy oil. Eur Ann Allergy Clin Immunol. 2016;48(3):103–106.
    1. Murphy A, Campbell DE, Baines D, Mehr S. Allergic reactions to propofol in egg-allergic children. Anesthesia Analgesia. 2011;113:140–144. doi: 10.1213/ANE.0b013e31821b450f.
    1. anesthesiologists J society of. Guidelines for the use of anesthetics and anesthetic-related drugs, Third Edition [Internet]. [cited 2022 Feb 26]. Available from:
    1. Loh W, Tang MLK. The epidemiology of food allergy in the global context. Int J Environ Res Pu. 2018;15:2043. doi: 10.3390/ijerph15092043.
    1. Lee AJ, Thalayasingam M, Lee BW. Food allergy in Asia: how does it compare? Asia Pac Allergy. 2013;3:3–14. doi: 10.5415/apallergy.2013.3.1.3.
    1. Yamamoto-Hanada K, Pak K, Saito-Abe M, Yang L, Sato M, Irahara M, et al. Allergy and immunology in young children of Japan: the JECS cohort. World Allergy Organization J. 2020;13:100479. doi: 10.1016/j.waojou.2020.100479.
    1. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–458. doi: 10.1038/bmt.2012.244.
    1. Motohiro E, WG G to FAT 2020. Guide to food allergy treatment 2020 [Internet]. [cited 2022 Feb 26]. Available from:
    1. Dewachter P, Mouton-Faivre C, Castells MC, Hepner DL. Anesthesia in the patient with multiple drug allergies: are all allergies the same? Curr Opin Anaesthesiol. 2011;24:320–325. doi: 10.1097/ACO.0b013e3283466c13.
    1. Molina-Infante J, Arias A, Vara-Brenes D, Prados-Manzano R, Gonzalez-Cervera J, Alvarado-Arenas M, et al. Propofol administration is safe in adult eosinophilic esophagitis patients sensitized to egg, soy, or peanut. Allergy. 2014;69:388–394. doi: 10.1111/all.12360.
    1. Dewachter P, Kopac P, Laguna JJ, Mertes PM, Sabato V, Volcheck GW, et al. Anaesthetic management of patients with pre-existing allergic conditions: a narrative review. Brit J Anaesth. 2019;123:e65–e81. doi: 10.1016/j.bja.2019.01.020.
    1. MacPherson RD. Pharmaceutics for the anaesthetist. Anaesthesia. 2001;56(10):965–979. doi: 10.1046/j.1365-2044.2001.02216.x.
    1. Chui J, Mariappan R, Mehta J, Manninen P, Venkatraghavan L. Comparison of propofol and volatile agents for maintenance of anesthesia during elective craniotomy procedures: systematic review and meta-analysis. Can J Anesthesia J Can D’anesthésie. 2014;61:347–356. doi: 10.1007/s12630-014-0118-9.
    1. Kawaguchi M, Iida H, Tanaka S, Fukuoka N, Hayashi H, et al. A practical guide for anesthetic management during intraoperative motor evoked potential monitoring. J Anesth. 2020;34:5–28. doi: 10.1007/s00540-019-02698-2.
    1. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia Analgesia. 2020;131:411–448. doi: 10.1213/ANE.0000000000004833.

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