Three Part Question
[In patients with documented egg anaphylaxis], is [the use of propofol as a sedative/anaesthetic agent] likely to result in an [allergic/anaphylactic reaction]?
As you prepare one of your patients for conscious sedation in the emergency department she tells you that she has been allergic to eggs since childhood. Your colleague states that a documented egg allergy is a contraindication for the use of propofol but you have your doubts. You wonder if there is any published evidence or whether this is another medical myth.
Ovid MEDLINE(R) 1946–October week 3 2012: (propofol.mp) OR (exp propofol/)] AND [(allergy.mp) OR (exp hypersensitivity/) OR (allerg$.mp) OR (exp anaphylaxis/) OR (anaphylaxis.mp) OR (anaphyl$.mp) OR (egg allergy.mp). OR (exp egg hypersensitivity/)]. Limit to English language and humans only.
Embase 1980–2012 week 42: [exp propofol/] AND [(exp egg allergy/) OR (exp food allergy/) OR (exp allergy/) OR (exp anaphylaxis/) OR (exp allergic reaction/)]. Limit to English language and humans only.
Cochrane Library Issue 10 of 12, October 2012: MeSH descriptor: (Egg Hypersensitivity) explode all trees.
Ninety-two papers were found in Medline using the stated search strategy, of which two were relevant. Ninety-five papers were found in Embase and 17 in the Cochrane Library.
|Author, date and country
||Study type (level of evidence)
|Hofer et al,|
|Single Infant||Case report||Anaphylaxis ||Case report that implies that the observed anaphylactic reaction was attributable to a pre-existing allergies|
|Murphy et al,|
|28 Egg allergic children (aged 1–15 years) with 43 propofol administrations identified through an 11-year retrospective review. Two children had had egg anaphylaxis, the rest had a positive skin prick test to egg white ||Case series||Anaphylaxis||0||Retrospective study|
|Allergic reaction||One—in a child with previous egg anaphylaxis|
The main triggers for egg anaphylaxis are the ovoalbumin, ovomucoid and conalbumin proteins contained in the egg white. Propofol contains a purified egg phosphatide but is not thought to be problematical for patients who are allergic to eggs. Reactions to propofol have been shown to be triggered by the iso-propyl or phenol groups rather than the lipid vehicle itself (De Leon-Casasola et al, Laxenaire et al).
Clinical Bottom Line
The use of propofol in patients with simple egg allergy is likely to be safe. A previous egg anaphylaxis is traditionally taught to be a contraindication. The final decision remains at the discretion of the physician after a cautious risk–benefit assessment.
- Hofer KN. McCarthy MW. Buck ML et al. Possible anaphylaxis after propofol in a child with food allergy. Annals of Pharmacotherapy. 2003;37(3):398-401.
- Murphy A, Campbell DE, Baines D, et al. Allergic reactions to propofol in egg allergic children. Anesth Analges 2011;113:140–4.
- De Leon-Casasola OA, Weiss A, Lema MJ. Anaphylaxis due to propofol. Anesthesiology Anesthesiology 1992;77:384–6.
- Laxenaire MC, Mata-Bermejo E, Moneret-Vautrin DA, et al. Life threatening anaphylactoid reactions to propofol (Diprivan). Anesthesiology 1992;77:275–80.