1/2. Possible anaphylaxis after propofol in a child with food allergy.OBJECTIVE: To report a case of anaphylaxis due to propofol in a child with allergies to egg and peanut oil. CASE SUMMARY: A 14-month-old boy with a history of reactive airway disease was hospitalized for treatment of respiratory symptoms. The patient had documented allergies to egg, peanut oil, and mold. Within the first few hours after admission, acute respiratory decompensation occurred, and arrangements were made to transfer the patient to our tertiary-care hospital. Prior to transfer, he was emergently intubated under sedation and paralysis with propofol and rocuronium. When emergency air transport arrived, the patient was hypotensive and tachycardic. His symptoms of anaphylaxis were managed throughout the flight and, upon arrival at our institution, the patient was admitted to the Pediatric intensive care Unit. He improved over a 5-day hospital course, and his caregivers were instructed to avoid propofol in the future. The patient's anaphylactic reaction following propofol was rated as a possible adverse drug reaction using the Naranjo probability scale. DISCUSSION: The use of propofol in pediatric patients for procedural sedation has gained increased favor. Since the propofol formulation contains both egg lecithin and soybean oil, its use is contraindicated in patients with hypersensitivities to these components. Several other drugs have a food component, resulting in contraindications and warnings in product labeling. CONCLUSIONS: propofol should be avoided in patients with allergies to egg and/or soybean oil, if possible. Clinicians should consider the potential for adverse drug events in patients with select food allergies.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
2/2. Possible modes of allergen-specific sensitization and boosting in an atopic child.Several studies document that allergen-specific IgE levels are boosted by allergen contact via the respiratory tract in allergic patients. Only few data are available on whether other routes of allergen contact have an influence on systemic IgE responses. We report the case of a boy who developed egg allergy after heavy consumption of eggs by the mother during pregnancy and breast feeding. In contrast to other children who outgrow egg allergy during the first years of life, the boy experienced further dramatic increases in hen egg-specific IgE antibodies after prolonged consumption of ostrich eggs containing cross-reactive allergens. IgE antibodies to most of the important respiratory allergens remained either low or not detectable. The dramatic increases in hen egg-specific IgE antibody levels after oral intake of allergens demonstrate that systemic IgE responses in allergic patients can be strongly boosted by allergen contact via routes other than the respiratory tract.- - - - - - - - - - ranking = 0.5keywords = allergy (Clic here for more details about this article) |