Is propofol safe in patients with egg anaphylaxis?
Date First Published:
December 18, 2010
Last Updated:
April 15, 2013
Report by:
Janos Peter Baombe, Senior Emergency Trainee (Manchester Royal Infirmary)
Search checked by:
Khuram Parvez, Manchester Royal Infirmary
Three-Part Question:
[In patients with documented egg anaphylaxis], is [the use of propofol as a sedative/anaesthetic agent] likely to result in an [allergic/anaphylactic reaction]?
Clinical Scenario:
As you prepare one of your patients for conscious sedation in the emergency department she tells you that she has been allergic to eggs since childhood. Your colleague states that a documented egg allergy is a contraindication for the use of propofol but you have your doubts. You wonder if there is any published evidence or whether this is another medical myth.
Search Strategy:
Ovid MEDLINE(R) 1946–October week 3 2012: (propofol.mp) OR (exp propofol/)] AND [(allergy.mp) OR (exp hypersensitivity/) OR (allerg$.mp) OR (exp anaphylaxis/) OR (anaphylaxis.mp) OR (anaphyl$.mp) OR (egg allergy.mp). OR (exp egg hypersensitivity/)]. Limit to English language and humans only.
Embase 1980–2012 week 42: [exp propofol/] AND [(exp egg allergy/) OR (exp food allergy/) OR (exp allergy/) OR (exp anaphylaxis/) OR (exp allergic reaction/)]. Limit to English language and humans only.
Cochrane Library Issue 10 of 12, October 2012: MeSH descriptor: (Egg Hypersensitivity) explode all trees.
Embase 1980–2012 week 42: [exp propofol/] AND [(exp egg allergy/) OR (exp food allergy/) OR (exp allergy/) OR (exp anaphylaxis/) OR (exp allergic reaction/)]. Limit to English language and humans only.
Cochrane Library Issue 10 of 12, October 2012: MeSH descriptor: (Egg Hypersensitivity) explode all trees.
Outcome:
Ninety-two papers were found in Medline using the stated search strategy, of which two were relevant. Ninety-five papers were found in Embase and 17 in the Cochrane Library.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Possible anaphylaxis after propofol in a child with food allergy. Hofer KN. McCarthy MW. Buck ML et al. 2003, USA | Single Infant | Case report | Anaphylaxis t | Case report that implies that the observed anaphylactic reaction was attributable to a pre-existing allergies | |
| Allergic reactions to propofol in egg allergic children. Murphy A, Campbell DE, Baines D, et al. 2011, Australia | 28 Egg allergic children (aged 1–15 years) with 43 propofol administrations identified through an 11-year retrospective review. Two children had had egg anaphylaxis, the rest had a positive skin prick test to egg white | Case series | Anaphylaxis | Retrospective study | |
| Allergic reaction | One—in a child with previous egg anaphylaxis |
Author Commentary:
The main triggers for egg anaphylaxis are the ovoalbumin, ovomucoid and conalbumin proteins contained in the egg white. Propofol contains a purified egg phosphatide but is not thought to be problematical for patients who are allergic to eggs. Reactions to propofol have been shown to be triggered by the iso-propyl or phenol groups rather than the lipid vehicle itself (De Leon-Casasola et al, Laxenaire et al).
Bottom Line:
The use of propofol in patients with simple egg allergy is likely to be safe. A previous egg anaphylaxis is traditionally taught to be a contraindication. The final decision remains at the discretion of the physician after a cautious risk–benefit assessment.
References:
- Hofer KN. McCarthy MW. Buck ML et al.. Possible anaphylaxis after propofol in a child with food allergy.
- Murphy A, Campbell DE, Baines D, et al. . Allergic reactions to propofol in egg allergic children.
- De Leon-Casasola OA, Weiss A, Lema MJ.. Anaphylaxis due to propofol. Anesthesiology
- Laxenaire MC, Mata-Bermejo E, Moneret-Vautrin DA, et al.. Life threatening anaphylactoid reactions to propofol (Diprivan).