Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized
Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized
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DOI：
10.1016/j.jaip.2018.12.003
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发表时间：
2019-05-01
影响因子：
9.4
通讯作者：
Phillips, Elizabeth J.
中科院分区：
文献类型：
--
作者：
Stone, Cosby A., Jr.;Liu, Yiwei;Phillips, Elizabeth J.
背景技术背景：最常见的聚乙二醇速发型超敏反应与聚乙二醇（PEG）3350有关;然而，流行病学、机制和交叉反应性尚不清楚。数以千计的药物含有聚乙二醇或结构相似的polysorbates.Objective：我们的目的是更好地了解机制，交叉反应，和范围的PEG hypersensitivity.METHODS：两个案件与过去的历史，速发型超敏反应，含PEG的药物被用来研究潜在的机制和交叉反应的速发型反应PEG 3350。采用皮肤试验和含PEG和聚山梨醇酯制剂的口服激发试验，以确定2种过敏原之间的临床反应性和交叉反应性。用酶联免疫吸附试验（ELISA）和电化学发光免疫分析法分别检测2例患者和6例PEG 3350耐受者的抗PEG特异性IgG和IgE。我们搜索了美国食品和药物管理局（FDA）的不良事件报告的即时反应PEG 3350，以确定这一问题在美国的潜在范围。结果：在这两种情况下，PEG 3350和聚山梨酯80的皮肤和激发试验表现出症状反应。仅在某些情况下，血浆样本的抗PEG特异性IgE和IgG抗体呈阳性，并且结合率与检测的PEG分子量成正比。FDA的不良事件报告显示，53个额外的情况下，可能的PEG 3350过敏性反应。结论：速发型超敏反应PEG 3350与交叉反应聚山梨酯80超敏反应可能在临床实践中认识不足，可以检测到临床皮肤试验。我们的研究提出了在某些情况下IgE介导的I型超敏反应机制的可能性。(C)2018年美国过敏、哮喘和免疫学会
BACKGROUND: The most common immediate hypersensitivity to macrogols is associated with polyethylene glycol (PEG) 3350; however, the epidemiology, mechanisms, and cross-reactivity are poorly understood. Thousands of medications contain either PEGs or structurally similar polysorbates.OBJECTIVE: Our objective was to better understand the mechanism, cross-reactivity, and scope of PEG hypersensitivity.METHODS: Two cases with a past history of immediate hypersensitivity to PEG-containing medications were used to study potential mechanisms and cross-reactivity of immediate reactions to PEG 3350. Skin testing and oral challenges with PEG and polysorbate-containing agents were employed to determine clinical reactivity and cross-reactivity between the 2 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 2 cases and 6 PEG 3350 tolerant controls. We searched US Food and Drug Administration (FDA) adverse event reports for immediate reactions to PEG 3350 to determine the potential scope of this problem in the United States.RESULTS: Skin and provocation testing demonstrated symptomatic reactivity in both cases to PEG 3350 and polysorbate 80. Plasma samples were positive for anti-PEGspecific IgE and IgG antibodies only in cases and binding increased directly proportional to the molecular weight of PEG tested. FDA adverse event reports revealed 53 additional cases of possible PEG 3350 anaphylaxis.CONCLUSIONS: Immediate hypersensitivity to PEG 3350 with cross-reactive polysorbate 80 hypersensitivity may be underrecognized in clinical practice and can be detected with clinical skin testing. Our studies raise the possibility of an IgE-mediated type I hypersensitivity mechanism in some cases. (C) 2018 American Academy of Allergy, Asthma & Immunology