Propofol and egg allergies

[Nursonegreat]

Is there any contraindications when using propofol when a patient has an egg allergy??? thanks for any answers.

[tvccrn, ASN, RN]

According http://www.nursingcenter.com/prodev/ce_article.asp?tid=520014 :

Contraindications for Propofol

Allergies to propofol, egg lecithin, or soybean oil are contraindications for administration of this drug ( AstraZeneca, 2001 ). Anaphylaxis has been reported following the administration of propofol ( Hofer, McCarthy, Buck, & Hendrick, 2003 ). Hofer and associates' case report identified a 14-year-old boy with documented allergy to eggs and peanut oil as having developed an anaphylactic reaction following a single dose of propofol. The incident validates the importance of the preprocedure history to document both food and drug allergies in addition to any complications encountered with previous sedatives or anesthetic agents.

tvccrn

[augigi, CNS]

If I were you, I would look up a reputable drug book or package insert from the manufacturer.

[NRSKarenRN, BSN, RN]

propofol is a lipid-based oil-in-water emulsion of egg lecithin, glycerol, and soybean oil ([color=#33007f] astrazeneca, 2001 ).

[color=#030303]contraindications for propofol

[color=#030303]allergies to propofol, egg lecithin, or soybean oil are contraindications for administration of this drug ([color=#33007f] astrazeneca, 2001[color=#030303] ).

[color=#030303]

http://www.astrazeneca-us.com/pi/diprivan.pdf

[Nursonegreat]

thanks for the input guys. i am never in a position to give it as my backround now is pre-op/PACU...but was just wondering...i have never heard of it but a friend of mine was reading the insert a few days ago....do all CRNA's and anesthesiologists evaluate specifically for an egg allergy if they know they will be giving propofol, do u think? thanks again for the input guys!

[louloubell1]

thanks for the input guys. i am never in a position to give it as my backround now is pre-op/PACU...but was just wondering...i have never heard of it but a friend of mine was reading the insert a few days ago....do all CRNA's and anesthesiologists evaluate specifically for an egg allergy if they know they will be giving propofol, do u think? thanks again for the input guys!

I always ask patients if they are allergic to any medications, foods, or anything in the environment. There are other food allergies that have some implications for anesthesia and patient care, so I feel like its an important assessment.

[Ozymandias]

The Hofer et al. Article was in a 2003 edition of The Annals of Pharmacotherapy, and was based on a case report involving a 14 month (not year) old infant with asthma and an "egg" allergy. The patient required urgent intubation for respiratory distress and received BOTH propofol AND rocuronium. As I'm sure you are all aware, the single most common category of drug administered in the OR leading to allergic reaction is neuromuscular blockers, roc and sux being # 1 & 2, respectively. The Ann. Pharm. article did not even give ONE WORD of consideration to the possibility that the hypotensive events which took place could have been attributed to the rocuronium, let alone the child's worsening medical condition. I pride myself on being an exceptionally good clinician, and I am a pi**- poor academic, but that article, upon which MUCH of the current medico-legal discussions on the egg allergy / propofol discussions pivot, is a STUNNINGLY deficient piece of "scholarly" work, and I would not hesitate to use propofol for a patient who reports an "egg" allergy, short of demonstrating objective evidence of an egg LECITHIN allergy.

[Ozymandias]

Let me further elaborate: when a patient claims to have an egg allergy, they are reporting allergy to EGG PROTEIN (ovalbumin, about a 45 Dalton molecule, distinct from human serum albumin, a 69 Dalton molecule), and that is found in the egg white. Food and dietary issues teach that they should avoid foods containing any kind of egg, but the manufacture of propofol does 'a bit more' to remove the egg PROTEIN containing white from the yolk than does the cook in the Walmart bakery. In summary, the package insert does indeed say not to give propofol to those allergic to egg lecithin, but your patient in preop who says they're allergic to eggs is NOT allergic to egg lecithin; they're allergic to egg PROTEIN (ovalbumin).

[BCRNA]

I have never worked somewhere where propofol was not given to someone with an egg allergy. The general view is that the proteins are not present. The manufacturer adds the warning to cover themselves legally. A lot of the warnings on drugs are their for legal, not medical, reasons.