S3906 A Case of Pegylated-Polyethylene Glycol (PEG)-Induced Anaphylaxis: A Cautionary Case for the Gastroenterologist in the Era of COVID
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.012 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".