PEG allergy - A COVID-19 pandemic-made problem? A German perspective

Background

Polyethylene glycol (PEG) has been used for decades, but only caused allergic reactions exceptionally. Introduction of PEG-containing COVID-19 vaccines might have fostered public interest beyond medical reasoning.

Objectives

To investigate the impact of the SARS-CoV-2 pandemic on the public interest in PEG allergy in Germany and the published PEG allergy cases worldwide.

Methods

A retrospective longitudinal study was conducted to measure public interest in PEG allergy analyzing Google search volume in Germany from February 2018 to January 2022. Medically confirmed “PEG allergy” cases were analyzed by looking at the numbers of PubMed case reports and case series from 1977 until January 2022.

Results

Web results in Germany before COVID-19 show search volumes related to “PEG allergy/testing” was negligible, with 10 search queries per month. The pandemic led to a >200-fold increase from 250 queries 2 years before to 55 720 queries 2 years thereafter, reflecting tremendous public interest. Additionally, the maximum monthly search volume from before to during the pandemic increased immensely for “vaccination” (57-fold), “vaccination and adverse effects” (85-fold), “vaccination and allergy” (71-fold). In contrast, the increase of publication numbers for the search term “PEG allergy” was small from 2019 to 2021 (2.5-fold). Only a very low number of 211 cases with “PEG allergy” worldwide since 1977 could be identified.

Conclusion

PEG allergy became a topic of major public interest because of COVID-19 vaccination. Scientific publications have increased to a lesser extent, probably promoted by public awareness. Conversely, the overall number of cases published with PEG allergy remain very low. The current high demand for COVID-19 vaccination allergy testing is triggered by public interest instead of medical reasoning.

Anaphylaxis to drug excipients

In addition to the therapeutic agent, drugs contain excipients such as stabilizers, preservatives, solubilizers, or dyes, some of which are identical to additives in foods. Anaphylaxis to these excipients is probably an underestimated problem. After the first descriptions of anaphylactic reactions to drug excipients appeared more than 30 years ago, the number of corresponding reports has increased significantly over the years. However, a diagnostic gap exists in the clarification of drug allergic reactions when the index product is not known and/or is not available for testing. In the present work, individual excipients are presented as examples for which publications on anaphylaxis are available. Furthermore, the options of allergological testing both in vivo and in vitro are discussed. The pathogenesis of such reactions is still unresolved in many cases, and current concepts are briefly presented in the conclusion. With increasing knowledge about anaphylaxis to drug excipients, it is assumed that these can then be recognized more often and diagnostically clarified.

Anaphylaxie auf Hilfsstoffe in Arzneimitteln

Neben dem therapeutischen Agens enthalten Arzneimittel Hilfsstoffe als beispielsweise Stabilisatoren, Konservierungsstoffe, Löslichkeitsvermittler oder Farbstoffe, die teilweise identisch mit Zusatzstoffen in Nahrungsmitteln sind. Anaphylaxien auf diese Hilfsstoffe sind ein vermutlich unterschätztes Problem. Nachdem erste Beschreibungen anaphylaktischer Reaktionen auf Arzneimittelhilfsstoffe bereits vor über 30 Jahren auftauchten, hat die Zahl entsprechender Berichte in den letzten Jahren deutlich zugenommen. Eine diagnostische Lücke besteht allerdings in der Abklärung arzneimittelallergischer Reaktionen, wenn das Indexpräparat nicht bekannt ist und/oder nicht als Originalpräparat für Testungen zur Verfügung steht. In der vorliegenden Arbeit werden einzelne Hilfsstoffe exemplarisch vorgestellt, für die Publikationen zu Anaphylaxien vorliegen. Des Weiteren werden die Optionen allergologischer Testungen sowohl in vivo als auch in vitro besprochen. Die Pathogenese derartiger Reaktionen ist vielfach noch unklar, hier werden abschließend aktuelle Konzepte kurz vorgestellt. Mit zunehmendem Wissen über Anaphylaxien auf Arzneimittelhilfsstoffe ist davon auszugehen, dass diese auch vermehrt wahrgenommen und diagnostisch aufgeklärt werden können.

Zitierweise: Pfützner W. Anaphylaxis to drug excipients. Allergo J Int 2022;31:137-40

https://doi.org/10.1007/s40629-022-00214-9