egg-white and Drug-Hypersensitivity

Egg and/or soy allergy are often cited as contraindications to propofol administration. Our aim was to determine whether children with an immunoglobulin (Ig)E-mediated egg and/or soy allergy had an allergic reaction after propofol use.. We performed a retrospective case review over an 11-year period (1999-2010) of children with IgE-mediated egg and/or soy allergy who had propofol administered to them at the Children's Hospital Westmead, Sydney.. Twenty-eight egg-allergic patients with 43 propofol administrations were identified. No child with a soy allergy who had propofol was identified. Twenty-one children (75%) were male, the median age at anesthesia was 2.4 years (range, 1-15 years), and the presence of other atopic disease was common (eczema 61%, asthma 32%, peanut allergy 43%). Most children (n = 19, 68%) had a history of an IgE-mediated clinical reaction to egg with evidence of a significantly positive egg white skin prick test (SPT) reaction (≥7 mm). Two of these had a history of egg anaphylaxis. The remaining children (n = 9, 32%) had never ingested egg because of significantly positive SPT (≥7 mm). All SPTs to egg were performed within 12 months of propofol administration. There was one nonanaphylactic immediate allergic reaction (n = 1 of 43, 2%) that occurred 15 minutes after propofol administration in a 7-year-old boy with a history of egg anaphylaxis and multiple other IgE-mediated food allergies (cow's milk, nut, and sesame). SPT to propofol was positive at 3 mm. No other egg-allergic child reacted to propofol.. Despite current Australian labeling warnings, propofol was frequently administered to egg-allergic children. Propofol is likely to be safe in the majority of egg-allergic children who do not have a history of egg anaphylaxis.

Topics: Adolescent; Anaphylaxis; Child; Child, Preschool; Drug Hypersensitivity; Egg Hypersensitivity; Egg White; Female; Humans; Immunoglobulin E; Infant; Male; Propofol; Retrospective Studies; Skin Tests

Seven patients who received a lysozyme, nystatin, and tetracycline containing vaginal suppository because of suspected vaginal infection, developed local or systemic allergic reactions. The coincidence of the symptoms with the repeated use of the suppository as well as skin and lymphocyte transformation tests indicated that the lysozyme in the suppository was responsible for the allergic reactions. This lysozyme preparation contained additional egg proteins, which contributed to the allergic reaction in certain patients: three patients with a previous history of egg allergy and serologic and/or skin test evidence for egg-white sensitization developed the allergic reaction after the first suppository. Four patients had urticaria or anaphylaxis after treatment for at least three days; none of these four patients developed egg allergy. Five of seven individuals had positive skin tests (prick or scratch) to ovomucoid and lysozyme, but none of the patients had lysozyme-specific IgE in the circulation. All seven patients, with or without egg allergy, showed vigorous T cell responses to purified lysozyme and partly to other egg-white proteins in the lymphocyte transformation test, which was absent in controls. Vaginal suppositories that contain lysozyme and other contaminating egg white proteins can either elicit allergic reactions in patients with a preexisting egg white allergy or induce sensitization to lysozyme and other egg white components.

Topics: Adult; Antibody Specificity; Drug Hypersensitivity; Egg White; Female; Humans; Immunoglobulin E; Lymphocyte Activation; Middle Aged; Muramidase; Skin Tests; Suppositories; Vagina

The mode of reaction of benzylpenicillin with two proteins was studied, with particular reference to the allergenicity of penicillin. These reactions, with pig insulin, and with hen's-egg-white lysozyme, were carried out in neutral solution at 37 degrees C. High concentrations of penicillin are needed to label the proteins, owing to concurrent hydrolysis of penicillin. Evidence has been obtained that the penicillin-reactive sites on the insulin molecule are the alpha-amino group at the N-terminus of the A chain and the epsilon-amino group of the lysine residue; whereas a site of reaction with lysozyme appears to be the epsilon-amino group of lysine-116.

Topics: Amino Acids; Animals; Binding Sites; Chickens; Drug Hypersensitivity; Egg White; Humans; Insulin; Kinetics; Muramidase; Penicillin G; Peptide Fragments; Protein Binding; Swine

Topics: Animals; Chick Embryo; Child, Preschool; Drug Hypersensitivity; Egg White; Eggs; Food Hypersensitivity; Humans; Male; Measles Vaccine; Skin Tests; Vaccination; Virus Cultivation

Topics: Adrenalectomy; Anaphylaxis; Blood Glucose; Chlorpropamide; Dextrans; Drug Hypersensitivity; Drug Synergism; Edema; Egg White; Genetics; Histamine; Hypersensitivity; Insulin; Pharmacogenetics; Pharmacology; Rats; Research; Toxicology; Triiodothyronine