Is propofol safe for people with peanut, soya or egg allergy?

“A lie can run around the world before the truth has got its boots on” – Terry Pratchett

No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut. Asserhøj et al. Br J Anaesth (2015) 116 (1): 77-82. DOI: https://doi.org/10.1093/bja/aev360

This study investigated whether there is a contraindication to the use of propofol in patients known to be being allergic to egg, soy or peanut. Propofol is marketed as an emulsion containing soybean oil, egg lecithin and glycerol. In recent years in propofol product leaflets have advised against its use in patients with the aforementioned allergies. Propofol allergies are rare with an incidence of 1:60,000 exposures. The only evidence of a propofol allergy link to egg, soy or peanut are six case reports.

This study consisted of two independent analyses.

Study A examined 273 patients from the Danish Anaesthesia Allergy Centre during 2004-11, who had a suspected perioperative allergic reaction. Of these, 153 (56%) had been exposed to propofol. The investigations performed on all these patients consisted of: Serum tryptase, and for each of potential allergen: specific IgE, skin prick test, intradermal test, and intravenous provocation tests. Only 4 of the 153 patients exposed to propofol had a positive hypersensitivity reaction of a combination of a rash, flushing, hypotension and, bronchospasm. None of these four patients had any allergic symptoms when eating egg, soy or peanut, nor did they have any specific IgE associated with these in their blood.
Study B examined all patients >= 16 yr of age who had been tested for specific IgE to egg, soy or peanut as part of investigations for suspected food allergy from a single allergy clinic from 2004-2012. Of the 1290 patients tested, 544 patients had a positive specific IgE for egg and/or soy and/or peanut. Of these patients, 99 had an anaesthetic with propofol (excluding: those who did not take part in the study (no reply to questionnaire), their anaesthetic chart was unavailable and those who did not have a propofol anaesthetic). These 99 patients had 171 separate anaesthetic procedures, none of which were associated with any sort of allergic reaction.
Thus, this dual study found no evidence of a connection between an allergy to egg, soy or peanut and allergy to propofol. The authors recommendation was that choosing an alternative to propofol based purely on a history of food allergy was not evidence based.
Summary by Dr Vishal Nangalia

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