New evidence demonstrates more clearly that it is possible to develop severe immediate hypersensitivity to macrogols, of which the most familiar form to most physicians is polyethylene glycol (PEG) 3350. With thousands of medications containing either PEGs or structurally similar polysorbates, Cosby A. Stone Jr., MD, MPH, and colleagues at Vanderbilt University School of Medicine sought to better understand the mechanism, cross-reactivity, and scope of PEG hypersensitivity for a study published in The Journal of Allergy and Clinical Immunology: In Practice. “The need to study this problem arose directly from encounters we had with two patients in our dedicated drug allergy clinic who had anaphylaxis after receiving injectable steroid medications and when trying to take their ‘prep’ for colonoscopies,” explains Dr. Stone. The main ingredient (PEG 3350) in the preps was also present in the steroids to which the patients reacted.
Dr. Stone and colleagues used skin testing and oral challenges with PEG and polysorbate-containing agents to determine clinical reactivity and cross-reactivity between the two allergens. Enzyme-linked immunosorbent assay and electrochemiluminescent immunoassay were used to detect anti-PEG specific IgG and IgE, respectively, using PEGylated protein or PEG alone as antigens in two cases and six PEG 3350-tolerant controls. “It was immediately clear that these patients were truly allergic when they had strongly positive skin tests to polyethylene glycol 3350 in the form of Miralax, to steroids containing the same ingredient and to steroids containing polysorbate 80,” says Dr. Stone. Plasma samples were positive for anti-PEG specific IgE and IgG antibodies only in cases, and binding increased directly proportional to the molecular weight of PEG tested.
To determine the potential scope of this allergy in the US, the study teams searched FDA adverse event reports for immediate reactions to PEG 3350 and found an average of four cases per year were reported. “We would tend to think that self-reports to the FDA might underestimate the problem, given the lack of recognition that this can be an allergy, and the wide number of medications that contain these ingredients,” notes Dr. Stone. “Having shown that allergy to PEGs and polysorbates are true allergies by the classical IgE mechanism, the most important finding for another physician to be aware of is our patients’ histories. Without an awareness of this allergy and how it would present, affected patients are potentially at risk of anaphylaxis from a wide variety of medications, in a wide number of settings. Physicians treating patients with such a history should know how to confirm a diagnosis (or refer) and how to read ingredient labels using the NIH Daily Med website to keep patients safe during their routine healthcare encounters and prescriptions.”
References
Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized
https://www.sciencedirect.com/science/article/pii/S2213219818308237
Rebecca Rice
I’m allergic to PEG had three live threatening reactions.
My question is what vaccine can I take I’m 74?
I actually had no idea I was allergic to PEG and Polysorbate. I actually have an allergy to the TB test but noone ever told me what was in it that i was allergic to. I was asked at work if I wanted to get the covid test and said yes after researching and realized there were no ingredients that were the same between the TB test and the Covid test. My first dose was terrible and i really didnt pay attention to much to the symptoms because everyone kept saying oh it couldn’t affect you that quickly. The second dose was when i realized i had an allergy. About 2 hours after the vaccine my eyes and lips started swelling, my heart was racing, i was flushed, i had difficulty swallowing and was short of breath. I was very lucky being in the medical field and knowing what to look for i immediately took benadryl and called my doctor. Luckily i was able to control my symptoms at home, but i was terrified. Noone really knew what to do. After researching the allergy my whole life made sense. Doctors always told me I was lactose intolerant. I had a reaction to eyelash glue, every medication I’ve ever had a reaction too had these ingredients. It’s a shame this is such an underdiagnosed allergy.
I recently came across the importance of recognizing polysorbate allergy.
I perform clinical research. A potential participant had, in the past, a instant total body rash after and intra-articular injection of Depo medrol and benzocaine. I was curious to see if she may be allergic to the incipient (exclusionary of course) and was concerned there might be the same incipient in the Investigational product. Sure enough, both medications had polysorbate 80 in them.
Fortunately, the patient had been treated with Dupixent, a biological eczema drug. She was getting that every two weeks and tolerating it fine. It had polysorbate 80 in it, so I could be confident she did not have a polysorbate allergy.
She was looking forward to participating in the research very much and this allowed her to participate.
I’m independently researching the ingredients in the new Covid19 vaccine and was happy to come across this article from 2019. The ingredient in the new vaxx that sticks out to me (besides the obvious mRNA spike protein) is the polyethylene glycol. With several people having anaphylactic reactions to this new vaccine, I’m wondering if it can be from PEG?
So it is my problem as well. What do we do? I was looking the internet trying to find out if there was any reason to see an allergist. Can they treat someone with this allergy? My doctor suggested I try to find someone to help me, as they would have to search the internet to.
I have a PEG anaphylactic response, tested positive to 3350 at John’s Hopkins. I have, over the years, made this issue known to the FDA, the NIH, Congress, and of course all of my treating physicians. My research indicates a growing percentage of the population has antibodies to PEG. It is a very big problem because of PEG’s ubiquity. Hospitals are not prepared to treat patients with such allergies. I needed surgery due to a snapped quadriceps tendon. I very nearly could not find a hospital to conduct it because if my allergy. As some e cigarettes use PEG as a fluid emulsifier, I have to very careful in public to avoid vapor’s. My doctor will only say, I want to prescribe you this, but you check it for PEG. As it is considered biologically inert/inactive, drug makers in many cases are not required to label it. Now I find out that one of the top contenders for a SARS Cov2 vaccine uses pegylated lipid nanoparticles to deliver the mRNA to cause cells to produce the spike protein antigen. The use of PEG in the field of medicine and pharmacology is both widespread and bug business. This is a huge problem for me, and a growing problem for our entire population.
Mr. Harold, it seems that your prediction in May about the “use of PEG in the field of medicine…is a huge problem for me and a growing problem for our entire population” was a correct analysis. If world governments had listened to you, then perhaps they could’ve saved those people a traumatic scare and an epipen injection who have now had anaphylactic reactions to the recently approved SARS CoV2 vaccine. The world may be more apt to listen now.