Can you use Propofol (propofol) in patients with an egg allergy?

From the Guidelines

Propofol can be used in patients with an egg allergy, but caution is advised, especially in those with a history of severe or anaphylactic reactions. The manufacturing process of propofol likely removes or denatures the proteins responsible for egg allergy, as it contains purified egg phosphatide and soya-bean oil 1. Key considerations include:

• The current formulations of propofol do not contain egg proteins that typically cause allergic reactions, such as albumin or ovalbumin.
• True egg allergies involve reactions to these proteins, which are not present in propofol.
• Caution is still warranted in patients with severe or anaphylactic egg allergies, and pre-treatment with antihistamines or corticosteroids may be considered.
• Alternative anesthetic agents like etomidate, ketamine, or midazolam may be considered if there are significant concerns.
• It's essential to distinguish between true egg allergies and egg intolerance, as the latter poses no increased risk with propofol.
• Clinical evidence shows that propofol-related allergic reactions are rare and typically due to the isopropyl or phenol components rather than the egg-derived ingredients 1. When using propofol in patients with egg allergies, it's crucial to:
• Monitor closely during administration
• Have emergency medications readily available
• Consider the patient's medical history and the severity of their egg allergy before making a decision.

From the FDA Drug Label

Propofol injectable emulsion is contraindicated in patients with allergies to eggs, egg products, soybeans or soy products. The answer is no, you cannot use Propofol in patients with an egg allergy, as it is contraindicated due to the presence of egg lecithin in the formulation 2.

• Key components of Propofol include egg lecithin, which is an allergen of concern for patients with egg allergies.
• The use of Propofol in patients with egg allergies is not recommended due to the risk of an allergic reaction.

From the Research

Propofol Use in Patients with Egg Allergy

• Propofol is a commonly used intravenous anesthetic that contains soybean oil, purified egg phosphatide, and egg lecithin, leading to concerns about its use in patients with egg allergies 3, 4, 5.
• Studies have shown that the risk of an allergic reaction to propofol in patients with egg allergies is low, with one study finding that only 1.6% of patients with confirmed food allergies had a positive propofol skin test 3.
• The majority of evidence suggests that propofol can be safely administered to patients with egg allergies, with no increased risk of anaphylaxis or other adverse reactions 3, 4, 5, 6.
• However, some studies recommend caution when using propofol in patients with a history of anaphylaxis or multiple food allergies, and suggest that alternative anesthetics may be considered in these cases 4, 7.
• Pharmacists can play an important role in evaluating the risk vs benefit of propofol avoidance in patients with reported food allergies, and in selecting alternative therapy when necessary 6.

Key Findings

• Propofol is not contraindicated in patients with egg allergies, despite the presence of egg products in the formulation 3, 6.
• The risk of an allergic reaction to propofol is low, even in patients with a history of food allergies 3, 4, 5.
• Alternative anesthetics, such as midazolam and dexmedetomidine, may be considered in patients with egg allergies or a history of anaphylaxis 7.
• Further testing is recommended to definitively identify the specific trigger in patients who experience allergic reactions following administration of propofol 6.