S3906 A Case of Pegylated-Polyethylene Glycol (PEG)-Induced Anaphylaxis: A Cautionary Case for the Gastroenterologist in the Era of COVID
Notice bibliographique
Résumé
Introduction: Polyethylene glycol (PEG) has widespread use as a bulking and stabilizing agent and is used as an excipient in many medications, cosmetics and food products. Sensitization to PEG has been described in case reports. Interestingly, PEG was also used as an excipient in the Pfizer - BioNTech and Moderna vaccine for COVID-19. The COVID vaccines differ from previous common vaccines in this regard. Case Description/Methods: A 37-year-old female was admitted to ICU after sustaining a cardiac arrest in the community. The patient had an uneventful delivery by C-section. She developed post-operative constipation. She had treated constipation effectively 3 years earlier with over the counter polyethylene glycol 3350. She tolerated the product well and decided to again use it. Fifteen minutes after ingestion she developed hand swelling which over minutes progressed to trouble with breathing and swallowing. Paramedics were called and found the patient to be hypotensive and hypoxic. Anaphylaxis was suspected and the patient was treated with a total of 5 mg of epinephrine while transported to hospital. Systematic circulation was re-established at minute 45. The allergy service was consulted. Anaphylaxis was suspected by the presentation and confirmed after detailed exposure and ingestion history, as well as, an acute tryptase rise (34 mcg/L on presentation) with subsequent normalization (1 mcg/L 6 days later). The Allergy service documented 4 potential drug exposures; pegylated-PEG, labetalol, acetaminophen, and COVID-19 vaccination. Skin testing was not pursued early due to the risk of anergy and negative testing. Delayed testing could not be pursued due to the patient’s clinical deterioration with intercurrent complications. The temporal relationship between the ingestion of PEG and the onset of symptoms make PEG the most likely culprit. Discussion: PEG is ubiquitous in our environment. Sensitization may be on the increase as our society undertakes mass scale vaccination with PEG containing vaccines, however, GI physicians may see this class of products as inert due to its frequent and over the counter use. Although the reaction is rare and there are no specific guidelines as to how to screen patients before using PEG, it would be wise for the GI physician to be aware that patients can develop allergies to PEG. If a patient reports allergic type symptoms during PEG use, the symptoms should not be dismissed as intolerances but rather, allergy to PEG warrants consideration.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,012 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».