Immediate hypersensitivity to COVID-19 vaccines: Focus on biological diagnosis. PG is a synthetic liquid thats a little bit thicker than water. It is unclear whether this translates into clinical crosshypersensitivity. It's used in antifreeze and brake fluid. Surprisingly for her, it was also in her salad dressing. She also reacted to PEG in shower gels, shampoos, toothpaste and mouthwash. After diagnostic evaluation, a safe COVID-19 vaccine could be offered to most patients, the remainders will await new vaccines containing different excipients. The UK Medicines and Healthcare products Regulatory Agency (MHRA) issued precautionary advice restricting access to the vaccine, Sellaturay P, Gurugama P, Harper V, Dymond T, Ewan P, Nasser S. Clin Exp Allergy. Epub 2021 Apr 28. Is propylene glycol dangerous? It's an emulsifier, which means it helps dissolve oil into water. sharing sensitive information, make sure youre on a federal In this type of allergy, a person eats a food. After that, you'll have to check any medicated creams or ointments that you have purchased OTC or been prescribed by your doctor. eCollection 2022. PG, on the other hand, is considered minimally toxic. 2021 Jun;227:108748. doi: 10.1016/j.clim.2021.108748. Disclaimer, National Library of Medicine It keeps products from clumping, so you might see it in grated cheese. Her blood pressure improved but coughing persisted, with a drop in oxygen saturation to 85%. the display of certain parts of an article in other eReaders. Mast cell tryptase level did not increase in the index reaction or in the skin testinduced anaphylaxis. doi: 10.1016/j.anai.2022.03.006. eCollection 2016. 2015 Mar;45(3):669-76. doi: 10.1111/cea.12441. Propylene glycol in foods (such as in cake mixes) can trigger a worsening of dermatitis in some patients who are allergic to this chemical in skin care products. 6 The functionality is limited to basic scrolling. Investigation of PEG allergy carries a risk of anaphylaxis and should only be undertaken in specialist drug allergy centres with full resuscitation capabilities. Her blood pressure became unrecordable although central pulse remained palpable. She had never received products such as laxatives, depoprogesterone or depomethylprednisolone containing PEG 3500. Ann Allergy Asthma Immunol. Is propylene glycol toxic to humans? One thing that is known is that there are different types of food allergies, and they can cause different types of reactions. Twelve minutes after skin testing, and 2 minutes after the skin test became positive, she developed a systemic reaction with widespread pruritus, urticaria and coughing with throat constriction. Keywords: Epub 2022 Aug 13. Odainic A, Spitzer J, Szlapa JB, Schade S, Krmer TJ, Neuberger J, Bode C, Steinhagen F, Schmithausen RM, Wilbring G, Sib E, Mutters NT, Rabenschlag F, Kettel L, Woznitza M, van Bremen K, Peers T, Medinger G, Kudaliyanage A, Kreutzenbeck M, Strube U, Johnson JM, Mattoon D, Ball AJ, Scory S, McGuire R, Putensen C, Abdullah Z, Latz C, Schmidt SV. Department of Medicine, https://www.who.int/emergencies/diseases/novelcoronavirus2019/situatio Coronavirus disease (COVID2019) situation reports. Abbreviations: MW, molecular weight; PEG, polyethylene glycol; SmPC, summary of product characteristics. This site needs JavaScript to work properly. Clipboard, Search History, and several other advanced features are temporarily unavailable. Most common primary elicitors were depot-steroids and laxatives. Please enable it to take advantage of the complete set of features! Allergol Int. She had a respiratory rate of 30/min, tachycardia of 150/min and oxygen saturation of 85%. 2022 Oct;10(10):2677-2684. doi: 10.1016/j.jaip.2022.08.010. While it takes quite a bit of detective work and assertiveness, it is possible to live without glycols. but reactions can be severe or even fatal. This might be because the severe features of the skin test reaction were predominantly respiratory as in food anaphylaxis where tryptase is often within the normal range, but does not explain the vaccine reaction. Many people don't realize how complex food allergies, and food allergy testing, can be. For example, Garvey found 3 of 10 PEGallergic patients had positive skin prick tests to polysorbate 80 at 20%. She also had blood testing for food allergy, which didn't show any reactions either. Find ways to get your health care providers the information they need to give you good care, Here are some tried and true ways to manage life with a glycol allergy, Learn how to be a label detective so you can safely avoid reactions to inactive ingredients. Adverse reactions to vaccines practice parameter 2012 update. This site is only for informational purposes and not to take the place of medical diagnosis or treatment. MeSH Epub 2022 Mar 12. Immediatetype hypersensitivity to polyethylene glycols: a review. Because there are different types of food allergies, there are different types of food allergy tests. Shavit R, Maoz-Segal R, Offengenden I, Yahia SH, Maayan DM, Lifshitz Y, Niznik S, Deutch M, Elbaz E, Genaim H, Iancovici-Kidon M, Agmon-Levin N. J Allergy Clin Immunol Pract. 2022 Oct 17;373:577988. doi: 10.1016/j.jneuroim.2022.577988. Your doctor or pharmacist can be your greatest ally if they understand. Below are some other names for propylene glycol. J Allergy Clin Immunol. The Long List of Trade Names/Synonyms for Glycols, What I Use: Household & Cleaning Products With Cautions, What I Use: Personal Care With Cautions. Online ahead of print. Encephalitis, myocarditis, and thrombocytopenia after COVID-19 mRNA vaccination: Clinical and pathophysiological considerations. 7 Epub 2021 Feb 28. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency. Eleven were offered the Johnson-Johnson vaccine; four were vaccinated successfully, seven abstained. If my patient doesnt improve after 8 weeks of avoiding PG in their topical products, then we move on to avoiding it in foods. Two patients developed anaphylaxis following intradermal test to PEG and 1 a systemic allergic reaction (without hypotension or respiratory distress) following PEG skin prick tests. Mrs. Smith had developed a particular type of food allergy called. This means checking your soaps, lotions, creams, hair care, makeup, shaving cream, and more. The .gov means its official. Please contact me if you have resources to add or questions. Smith) had a perplexing food allergy. Published by Elsevier Inc. All rights reserved. This handout has my short list of products that do not contain any propylene glycol (and also don't contain any of the common triggers of allergic skin reactions, such as synthetic and natural fragrance additives, formaldehyde preservatives, or methylisothiazolinone.). Mrs. Smith underwent prick testing, but the testing didn't reveal any food allergies. Undiagnosed PEGallergic patients are at risk of anaphylaxis to mRNA vaccines containing PEG, so should be identified before vaccination. The Bottom Line: For some patients who are allergic to propylene glycol in their skin care products or medicated creams, avoidance of propylene glycol in foods may help with their dermatitis. PMC Propylene glycol (PG) is a very interesting chemical. All are accountable and gave final manuscript approval. ], 1 2022 May 31;3:818049. doi: 10.3389/falgy.2022.818049. PEG Allergy & Colonoscopy Prep: Potential Risks, Article: Six Case Studies About Polyethylene Glycol Allergy, Links to COVID-19 Vaccine Ingredients Lists, Peer Reviewed Studies About Glycol Allergy. Drug hypersensitivity, in vitro tools, biomarkers, and burden with COVID-19 vaccines. Four of the 5 cases developed anaphylaxis to medications con It doesnt have any taste, scent, or color, which makes it easy to add to food products. Clin Immunol. First, have you noticed that processed foods seem to make your rash worse? Polyethylene glycols (PEGs) or macrogols are hydrophilic polymers found in everyday products such as foods, cosmetics, and medications. 2022 Apr;52(4):578-579. doi: 10.1111/cea.14083. Epub 2022 Mar 5. Int J Mol Sci. Online ahead of print. Flavoring packages for snow cones are often dissolved in a base of propylene glycol. The ePub format is best viewed in the iBooks reader. Even more than that, it has several important properties that make it helpful for manufacturers when creating food products. Epub 2021 May 28. That's because it can take up to eight weeks for the skin to improve, even after complete elimination from their skin care and from their diet. I Want a COVID Vaccine That Wont Kill Me! This preliminary report confirms PEG as a cause of anaphylaxis to the Pfizer/BioNTech vaccine, for the first time. Three were vaccinated before referral. I dont worry about dairy as a source of PG. Again, in the amounts commonly used, the answer is no. Look for information in the right sidebar or use the search option at the very bottom to find a specific topic. It is important to read the ingredient list to avoid accidental exposure. Even if there were trace amounts, most patients seem to be OK with trace amounts. Allergy to PEG is rare, Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2021 May 28. Polysorbate 80 is used as an excipient in many drugs (including some vaccines such as influenza) and as a food additive and is thus widely tolerated. If you think back to my patient Mrs. Smith, she had negative food testing even though she was ultimately allergic to PG. doi: 10.1016/j.anai.2022.05.014. Intradermal tests to PEG should be avoided because of the risk of inducing severe anaphylaxis. Online ahead of print. See this image and copyright information in PMC. Propylene glycol is a small, synthetic alcohol (chemical formula CH3-CHOH-CH2OH) that has the potential to cause allergic contact dermatitis in some individuals. UK, The clinical features of a PEGallergic patient may help identify atrisk patients before vaccination or if a COVID19 vaccine reaction was likely due to PEG. The .gov means its official. The cause of these vaccine anaphylaxis cases is unclear, but polyethylene glycol (PEG) is a candidate allergen. Its almost always listed. A case of recurrent fixed drug eruption following two different coronavirus disease 2019 vaccination verified through intradermal and patch tests. 2022 Jan;52(1):12-17. doi: 10.1111/cea.14064. HHS Vulnerability Disclosure, Help These are the first mRNA vaccines to be licensed in UK, so there is no prior information on allergic reactions to mRNA vaccines. 1 Keywords: Accessed December 12, 2017. She was treated in clinic with intramuscular adrenaline 0.5mg, intravenous chlorphenamine 10mg and hydrocortisone 200mg. 8 Patch testing is used to diagnose systemic contact dermatitis to different foods. This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It's also used in many skin creams, Its even found in many prescription medicated creams, such as the steroid creams that are used to treat eczema and dermatitis. We re-evaluated 19 of 21 patients diagnosed before 2021 and four new patients by skin prick tests (SPT) and Basophil Histamine Release (BaHR) for PEGs, polysorbates and approved COVID-19 vaccines as well as measurement of specific IgE (PEG 2000, 10,000). Im not a medical professional just a person with a serious allergy to a set of commonly found and often invisible ingredients. Yikes! , No, the studies to date have not found it to be a carcinogen. after they eat cinnamon, tomatoes, citrus, or other related foods. doi: 10.1016/j.jaci.2021.05.020. Cambridge There is no evidence for an alternative allergen to PEG as skin tests were negative for other excipients of the Pfizer/BioNTech vaccine. PG is generally recognized as safe and non-toxic, so manufacturers often use it in their food products. There has been a suggestion of crossreactivity between PEG and polysorbate 80 due to their similar chemical structures. 2022 Aug 1:10.1111/all.15461. Allergy. 2022 Sep 30;3:1007602. doi: 10.3389/falgy.2022.1007602. Background: During the COVID-19 pandemic focus has been on polyethylene glycol (PEG) and polysorbate as these excipients are constituents in the first vaccines and possible elicitors of allergic reactions to the vaccines. It's used in antifreeze and brake fluid. Bookshelf Su JR, Moro PL, Ng CS, Lewis PW, Said MA, Cano MV. It is unclear if all cases of reported Pfizer/BioNTech vaccine anaphylaxis are due to PEG. From experience, the amount needed to trigger a rash is different for every patient with a PG allergy. -, McNeil MM, Weintraub ES, Duffy J, et al. It's also used (surprise!) If a product contains PG, it is listed next to the product in parentheses. 6 Anaphylaxis after vaccination reported to the vaccine adverse event reporting system, 19902016. For some food allergies, we know the exact immune system pathway that's involved. 11 Bethesda, MD 20894, Web Policies Four of the 5 cases developed anaphylaxis to medications containing PEGs, with 1 near-fatal case resulting in cardiac arrest. To the Editor, On the first day of the UK vaccination campaign with the coronavirus disease 2019 (COVID19) vaccine . Methods: FOIA This chemical was in several of her skin care products. Show This to Your Doctor: Proof of Glycol Allergies, 11 Ways to Make Your Life With Glycol Allergies Easier, Resources for Finding Trade Names & Synonyms, Is it PEG? Below are some other names for propylene glycol. Although some sources state that dairy cows may be treated with PG, its unclear if the resulting milk contains trace amounts of the compound. Assessment of Immediate Allergic Reactions After Immunization With the Pfizer BNT162b2 Vaccine Using Intradermal Skin Testing With the COVID-19 Vaccines. She gave a history of allergic reactions to multiple products including drug anaphylaxis. Crown Copyright 2020. Propylene glycol is another trigger for systemic contact dermatitis, Nickel in foods can also be a trigger, especially for some patients with hand eczema. Snack foods such as French-fried onions or potato sticks, As a base for flavoring additives in baking. Because her rash was so persistent, she finally had patch testing done. 2022 Jul;129(1):88-94.e1. Immune Response in Regard to Hypersensitivity Reactions after COVID-19 Vaccination. Propylene glycol (PG) is a very interesting chemical. Epub 2021 Dec 9. How will I wash my hair now? Mrs. Smith had developed a particular type of food allergy called systemic contact dermatitis. Tryptase levels measured immediately, 1 hour and 3 hours after this episode were 5.5, 5.5 and 4ng/ml, respectively. Some of my patients are able to ingest capsules of medication (that contain PG) without any problems. The patch testing showed that she was allergic to a particular chemical called propylene glycol (PG). Again, the response seems to vary quite a bit from patient to patient. Federal government websites often end in .gov or .mil. It is used in the manufacturing of medications such as tablets, capsules, creams, and ointments. official website and that any information you provide is encrypted In general, propylene glycol will be listed as an ingredient. Priya Sellaturay involved in conceptualization, project administration, resources, investigation, data collection, writing original draft, review and editing; Shuaib Nasser involved in conceptualization, project administration, resources, review and editing; Sabita Islam resources involved in review and editing; Padmalal Gurugama resources involved in review and editing; Pamela Ewan involved in conceptualization, project administration, resources, writing original draft, review and editing. Hypersensitivity to excipients in COVID-19 vaccines constitutes a risk to patients with allergy to PEG or polysorbates. Risk of anaphylaxis after vaccination in children and adults. and transmitted securely. Some of these patients will react to balsam of peru and will then experience a worsening of their rash after they eat cinnamon, tomatoes, citrus, or other related foods. BruusgaardMouritsen MA, Johansen JD, Garvey LH. For some people, a food allergy may cause lip swelling. Please enable it to take advantage of the complete set of features! Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients, Diagnostic value of tryptase in food allergic reactions: a prospective study of 160 adult peanut challenges. HHS Vulnerability Disclosure, Help and therefore likely to injure public confidence. PEG That Reaction: A Case Series of Allergy to Polyethylene Glycol. The site is secure. Does propylene glycol turn into formaldehyde? Anaphylaxis to the first COVID19 vaccine: is polyethylene glycol (PEG) the culprit? Others notice that certain capsules with PG seem to make their rash worse. Immediateonset (minutes) severe systemic allergic reaction to an mRNA COVID19 vaccine. Before 8600 Rockville Pike 2016;46:907922. Department of Allergy, The easiest way to search for propylene glycol in a product is to read the ingredient list. No, PG is not a steroid. Because there are multiple types of food allergies and multiple types of food allergy tests. Careers. An extensive diagnostic workup including skin prick tests, intradermal tests (IDT) and a double-blind oral challenge was performed to identify the trigger of . One of my patients (lets call her Mrs. . Cambridge University Hospitals NHS Foundation Trust, The site is secure. An algorithm is proposed to safely investigate suspected PEG allergy, with guidance on PEG molecular weights and skin test dilutions to minimize the risk of systemic allergic reaction. Although the Pfizer/BioNTech vaccine contains a number of excipients, PEG 2000 is the only one reported to cause anaphylaxis. The answer to this question is almost always. 6 Anaphylaxis associated with the mRNA COVID-19 vaccines: Approach to allergy investigation. Careers. official website and that any information you provide is encrypted Before diagnosis, all 5 patients were mislabeled as allergic to multiple medications and their clinical management had become increasingly challenging. 2022 Jul 8;10(7):1641. doi: 10.3390/biomedicines10071641. J Allergy Clin Immunol. If you'd like to see some products that are free of propylene glycol, please see my handout. UK, 3 2022 The Authors. Also, it is widely used in makeup and cosmetics such as skin care, and hair care products. That makes it perfect for keeping salad dressings in a bottle from separating.. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID19 vaccine, The Pfizer/BioNTech COVID19 vaccine can cause severe anaphylaxis of unknown cause, Here, we show polyethylene glycol allergy caused one of the first cases of anaphylaxis to the Pfizer/BioNTech COVID19 vaccine, Allergy skin prick testing with polyethylene glycol triggered anaphylaxis, highlighting the importance of safety procedures during investigation. Graded-dosing immunization in adults at risk for immediate-type reactions to mRNA SARS-CoV-2 vaccines. For my patients, Ill create a list of skin care products that they can use that completely eliminates their exposure to PG. Skin testing for immediate hypersensitivity to corticosteroids: a case series and literature review. Epub 2022 Mar 24. The Polysorbate containing AstraZeneca COVID-19 vaccine is tolerated by polyethylene glycol (PEG) allergic patients. What this means is that if you're highly sensitive to PG, you'll need to watch out for foods that list natural flavors, natural flavorings, artificial flavors, or artificial flavorings. Systolic blood pressure dropped from 137mmHg to 107mmHg. -, Su JR, Moro PL, Ng CS, Lewis PW, Said MA, Cano MV. Clipboard, Search History, and several other advanced features are temporarily unavailable. In the amounts used in creams and in processed foods, the answer is no. Other patients have told me that even a small amount of PG in their foods seems to aggravate their rash. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology. Clin Exp Allergy. Generating an ePub file may take a long time, please be patient. Hours, or even days later, a rash begins on their skin. Background: arp torque specs Though it can be a bit tricky to avoid all Propylene-glycol products due to their wide range of usages like hair conditioners, shampoos, and deodorants patients with this allergy. Our patient's history of multiple drug allergic reactions with suddenonset anaphylaxis supported a diagnosis of PEG allergy. Bruusgaard-Mouritsen MA, Jensen BM, Poulsen LK, Duus Johansen J, Garvey LH. However, there are a few exceptions. Before This site is for people with allergies to glycol compounds, for health care practitioners, and for anyone wanting to know about life with an allergy to ubiquitous, invisible ingredients. This type of allergy is mediated by a part of the immune system called T cells. Polyethylene glycols (PEGs) or macrogols are polyether compounds and are widely used as additives in pharmaceuticals, cosmetics, and food. With thousands of medications containing either PEGs or structurally similar polysorbates, Cosby A. Polyethylene glycol (PEG) sounds like it would be very similar to propylene glycol, but its chemically very different. PEG skin prick tests may become positive slightly later from 1030 minutes. Further data are needed, including on possible crossreactivity with polysorbate 80 due to the presence of this excipient in the AstraZeneca vaccine and whether both skin prick and intradermal tests would be required to formally exclude allergy to polysorbate 80. 8600 Rockville Pike Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. #propyleneglycol #saladdressings #systemiccontactdermatitis #foodallergy, HEALTHIER SKIN WITH FOOD, SKINCARE, AND LIFESTYLE. Coronavirus disease 2019 vaccine administration in patients with reported reactions to polyethylene glycol- and polysorbate-containing therapeutics. The authors declare no conflict of interest. Its often used as a carrier, because it can help dissolve other additives such as flavorings or dyes. ALMuhizi F, Fein M, Gabrielli S, Gilbert L, Tsoukas C, Ben-Shoshan M, Copaescu AM, Isabwe GAC. How to Survive Major Surgery with Glycol Allergies: It Can Be Done! Do not stop any medications without your doctors approval. Its often used to help the mouthfeel of a food, for example to make it feel thicker and more substantial. Its almost always listed. 2021 Jun; 51(6): 861863. As with so much in medicine, everyone's different. 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. Anaphylaxis after vaccination reported to the vaccine adverse event reporting system, 19902016, COVID19: people with history of significant allergic reactions should not receive Pfizer vaccine, says regulator. She described urticaria with shampoos, conditioners, shower gels containing PEG and immediate burning of the mouth with toothpastes and mouthwash containing PEG. Is propylene glycol a steroid? The allergy medicine companies didn't respond back when we emailed to ask the source of the ingredients. Accessibility Its used because of its special properties, which include the ability to help active ingredients penetrate into the skin more effectively. The authors are grateful to Dr Lene Garvey for advice which informed the development of our original PEG skin test protocol. PG is found in many different types of processed foods because of all of these helpful manufacturing properties. In addition, you can find PEG in foods and food additives. PEG allergy was diagnosed as the cause of her Pfizer/BioNTech vaccine anaphylaxis. 2022 Aug;77(8):2292-2312. doi: 10.1111/all.15241. Why did her food allergy testing not pick up on this allergy? During the COVID-19 pandemic focus has been on polyethylene glycol (PEG) and polysorbate as these excipients are constituents in the first vaccines and possible elicitors of allergic reactions to the vaccines. [For a full listing of other names for PG, please see this list.]. Welcome to Life Without Glycols! At this time, we don't have extensive data on how many people who are allergic to PG on their skin will also react to PG in foods. There's a lot we still don't know about food allergies. Kounis NG, Mplani V, Dousdampanis P, Plotas P, Koniari I. J Neuroimmunol. We are experimenting with display styles that make it easier to read articles in PMC. 2022 Oct 22:S1323-8930(22)00117-4. doi: 10.1016/j.alit.2022.10.001. already built in. This list of hypoallergenic skin care products has multiple options that patients can use. She was not known to be PEG allergic prior to vaccination, but due to the severity of her reaction and previous history we suspected PEG allergy. PG is generally recognized as safe and non-toxic, so manufacturers often use it in their food products. The https:// ensures that you are connecting to the , Its an emulsifier, which means it helps dissolve oil into water. Many of my patients who are allergic to PG in skin creams and medicated creams don't have any issues with PG in foods at all. We have investigated 3 other cases with systemic reactions suspected to be anaphylaxis and treated with adrenaline, in whom skin tests were negative. Its in my shampoo! 10 Towards the best approach to PEG allergy. Although these polymers are usually safe, mild to life-threatening immediate-type hypersensitivity reactions have been reported. If youre highly sensitive, you need to be aware of the exceptions. Stehlin F, Mahdi-Aljedani R, Canton L, Monzambani-Banderet V, Miauton A, Girard C, Kammermann K, Meylan S, Ribi C, Harr T, Yerly D, Muller YD. Clin Exp Allergy. Other patients react when they eat foods that contain PG: their rash gets worse when they eat these foods. Other mRNA COVID19 vaccines are in development. Flow charge of the evaluation of the included patients from primary evaluation to, MeSH mRNA vaccines to prevent COVID19 disease and reported allergic reactions: current evidence and suggested approach, Immediatetype hypersensitivity to polyethylene glycols: a review, Polyethylene glycol induced systemic allergic reactions (anaphylaxis), Roseingrave L. Verdict of medical misadventure in case of fatal allergic reaction. For example, certain food allergies are IgE-mediated, which means that skin prick tests or blood tests can identify the culprits. But some of these same patients can't handle certain foods. government site. eCollection 2022. Three were confirmed with positive skin prick test result to PEG, 1 confirmed with a positive intradermal test result, and 1 confirmed after positive oral challenge. Polyethylene glycol (PEG) is a synthetic polymer that is widely used in numerous products. We also tested the Pfizer/BioNTech vaccine, excipients of the vaccine (1,2distearoylsnglycero3phosphocholine and cholesterol; SigmaAldrich Co), and the AstraZeneca COVID19 vaccine. Some people experience a single symptom, while others experience a combination of symptoms.