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Board Review

Can patients with egg allergy receive propofol anesthetic?

Q. A colleague in anesthesiology recently posed a question to me about propofol, which contains egg lecithin. Should we be concerned about patients with a history of egg allergy receiving propofol?

A. : Propofol is a lipid-soluble anesthetic agent. Given its lipophilicity, propofol must be emulsified in a lipid mixture for injection. Current preparations of propofol available in the US include a generic form and one branded as Diprivan. Diprivan includes the active component, propofol, as well as soybean oil (100 mg/mL), glycerol (22.5 mg/mL), egg lecithin (12 mg/mL), and disodium edetate (0.005%) among others1. The soybean oil and egg lecithin components have been questioned as a source of potential hypersensitivity.

Egg is one of the most common food allergens of infancy. Although it is commonly outgrown, egg allergy does exist in adulthood2. Multiple studies have confirmed that the majority of egg allergy is due to the proteins ovomucoid, ovalbumin, ovotransferrin, and lysozyme. Literature review suggests that the allergenicity of egg lecithin has not been determined. However, according to the manufacturer's product insert, egg allergy is still considered a contraindication to propofol administration1.

A 2011 study examined the potential link between egg allergy and propofol administration. Twenty-eight egg allergic children (confirmed via skin prick testing) who received propofol over an 11-year period were included. Nineteen of the patients had a history of reaction consistent with IgE-mediated allergy, only two of which were anaphylactic in nature. In 43 propofol administrations, only one of the 28 children had an immediate-hypersensitivity reaction, which occurred 15 minutes after propofol administration, and was not anaphylactic. This child had confirmed egg allergy with a skin prick test wheal of 7 mm and a history of anaphylaxis to egg3. The authors of this study concluded it is likely safe to administer propofol to patients with confirmed egg allergy, if they have not had symptoms consistent with anaphylaxis.

Overall, the prevalence of allergic reaction to propofol is approximately 2.3% and has not been shown to be associated with egg allergy4. A direct causal relationship between propofol and egg allergy has not been established. Clinical judgment for individual patient situations should prevail, but the current evidence suggests that egg allergy does not increase the risk of anaphylaxis to propofol.

  1. http://www.fda.gov/ohrms/dockets/dailys/00/may00/050900/tab0003.pdf
  2. Woods R.K., Thien F., Raven J., Walters E.H., Abramson M. Prevalence of food allergies in young adults and their relationship to asthma, nasal allergies, and eczema. (2002) Annals of Allergy, Asthma and Immunology, 88 (2) , pp. 183-189.
  3. Murphy A, Campbell DE, Baines D, Mehr S. Allergic reactions to propofol in egg-allergic children. Anesth Analg. 2011 Jul;113(1):140-4. doi: 10.1213/ANE.0b013e31821b450f. Epub 2011 Apr 5.
  4. Prematta M., Fausnight T., Craig T. Allergenic potential of propofol [abstract]. (2007) Ann Allergy Asthma Immunol. 98, A113. Abstract number 303.
 
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