DG Journal Club
AUTHORS Lisa Bagley, Anna Kordun et al.
BACKGROUND Anaphylaxis to propofol is rare, however providers face a clinical quandary as medication warnings still exist regarding propofol administration to egg-, soy-, and peanut-allergic patients.
AIMS The primary aim evaluated the rate of allergic reactions during propofol-containing anesthesia in patients listed allergic to egg, soy, or peanut compared to non-allergic patients who received propofol. The secondary aim evaluated the relationship between food allergy history and allergy testing data.
METHODS A retrospective chart review conducted between May 2012 and October 2018 identified pediatric patients listed allergic to egg, soy, and/or peanut, who received propofol. Allergy testing and results are presented. Evidence of allergic reaction to propofol during anesthesia was evaluated, and compared to a large non allergic cohort who received propofol.
RESULTS Of the 232,392 anesthetics administered, 177,360 (76%) included propofol and 11308 (6%) involved a patient listed allergic to at least 1 index food. A large number of patients had no food allergy testing (n = 6153), or negative testing (n = 2198). Of the 3435 patients listed egg-allergic, 976 tested positive; 750, negative; and 1709, had no testing. Of the 2011 patients listed soy-allergic, 322 tested positive; 585, negative; and 1104, had no testing. Additionally, 5862 patients were listed peanut-allergic; 1659, tested positive; 863, tested negative and, 3340 had no testing. One record of proven propofol anaphylaxis occurred; it was in a patient without a history of food allergies. There were 6 other cases of suspected allergy to propofol. One had a peanut and tree nut allergy and was lost to follow up; one had no testing available, while 4 patients had positive propofol allergy testing and positive allergy tests to other medications. The rate of proven propofol anaphylaxis during anesthesia in the non-allergic cohort was 0.06/10,000, the rate in egg and soy allergic patients was 0/5,446. One patient with a listed peanut allergy had a possible reaction to propofol.
CONCLUSIONS In the listed food-allergic cohort, the majority had no allergy testing or negative testing. We found no evidence of a relationship between food allergy history and perioperative propofol reaction. We suggest multiply allergic and atopic patients may have a similar likelihood of propofol reaction as with other medications.