Case of Polyethylene Glycol Allergy Confirmed with Basophil Activation Test and Oral Challenge Successfully Immunized with SARS-CoV-2 Vaccine

Maria Pasali; Styliani Taka; Caterina Chliva; Alexandros Katoulis; Michael Makris

doi:10.18502/ijaai.v22i4.13615

Maria Pasali Allergy Unit “D. Kalogeromitros”, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
Styliani Taka Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
Caterina Chliva Allergy Unit “D. Kalogeromitros”, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
Alexandros Katoulis 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
Michael Makris Allergy Unit “D. Kalogeromitros”, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece

DOI: https://doi.org/10.18502/ijaai.v22i4.13615

Keywords: Basophil activation test; COVID-19 vaccine; Drug allergy; Drug provocation test; Polyethylene glycol

Abstract

Polyethylene glycols (PEG) or macrogols are polymers of ethylene oxide widely used in drugs either as active substances or, more commonly, as excipients. We report a Caucasian 32-year-old woman with referred anaphylaxis almost instantly after oral intake of a macrogol-containing laxative. Despite an anaphylactic reaction, the patient showed negative results for both the skin test and specific IgE to the monomer, while the basophil activation test and oral challenge were positive. The patient was later successfully vaccinated with a polysorbate 80-containing SARS-CoV-2 vaccine following an additional work-up. As a result, the inactive form of PEG cannot be fully diagnosed, and it is considered a “hidden” allergen. PEG derivatives like polysorbates need special consideration due to their possible cross-reactivity.