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Polyethylene Glycol (PEG)-Induced Anaphylactic Reaction During Bowel Preparation.

Gachoka D - ACG Case Rep J (2015)

Bottom Line: Polyethylene glycol (PEG) is usually the bowel preparation of choice.Few allergic reactions from this product have been reported; these include urticaria, angioedema, and anaphylaxis.Reactions are thought to result from a small amount of PEG crossing the intestinal mucosa, which, in some patients, is sufficient to provoke an anaphylactic reaction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Toledo, Toledo, OH.

ABSTRACT
Barium enema is used to screen patients with gastrointestinal bleeding who do not want to undergo colonoscopy. Polyethylene glycol (PEG) is usually the bowel preparation of choice. Few allergic reactions from this product have been reported; these include urticaria, angioedema, and anaphylaxis. Reactions are thought to result from a small amount of PEG crossing the intestinal mucosa, which, in some patients, is sufficient to provoke an anaphylactic reaction.

No MeSH data available.


Related in: MedlinePlus

(A) Prominent epiglottis suggesting edema. (B) Laryngeal edema with airway narrowing.
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Figure 1: (A) Prominent epiglottis suggesting edema. (B) Laryngeal edema with airway narrowing.

Mentions: On presentation, his temperature was 36.4º C, pulse 102 bpm, blood pressure 102/65 mm Hg, and oxygen saturation 93% on room air. Physical exam revealed anicteric eyes, clear chest bilaterally, mild regular tachycardia, normal abdomen, and normal integument. X-ray showed a prominent epiglottis suggesting edema; followup contrast CT of the neck showed laryngeal edema with airway narrowing (Figure 1). He was given empiric treatment with albuterol and decadron, followed by methylprednisolone and cetirizine, with intravenous saline resuscitation; however, his blood pressure continued to drop, with persistent upper airway symptoms. An arterial blood gas on 2 L of oxygen via nasal cannula revealed pH 7.39, partial pressure of carbon dioxide 38 mm, and partial pressure of oxygen 89 mm Hg. He was given an epinephrine injection and inhaled racemic epinephrine, which improved his symptoms and normalized his vital signs within 7 minutes. He was admitted for observation with standby repeat epinephrine injection if his symptoms rebounded. His symptoms completely resolved overnight, and he proceeded with the barium enema the following day.


Polyethylene Glycol (PEG)-Induced Anaphylactic Reaction During Bowel Preparation.

Gachoka D - ACG Case Rep J (2015)

(A) Prominent epiglottis suggesting edema. (B) Laryngeal edema with airway narrowing.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508945&req=5

Figure 1: (A) Prominent epiglottis suggesting edema. (B) Laryngeal edema with airway narrowing.
Mentions: On presentation, his temperature was 36.4º C, pulse 102 bpm, blood pressure 102/65 mm Hg, and oxygen saturation 93% on room air. Physical exam revealed anicteric eyes, clear chest bilaterally, mild regular tachycardia, normal abdomen, and normal integument. X-ray showed a prominent epiglottis suggesting edema; followup contrast CT of the neck showed laryngeal edema with airway narrowing (Figure 1). He was given empiric treatment with albuterol and decadron, followed by methylprednisolone and cetirizine, with intravenous saline resuscitation; however, his blood pressure continued to drop, with persistent upper airway symptoms. An arterial blood gas on 2 L of oxygen via nasal cannula revealed pH 7.39, partial pressure of carbon dioxide 38 mm, and partial pressure of oxygen 89 mm Hg. He was given an epinephrine injection and inhaled racemic epinephrine, which improved his symptoms and normalized his vital signs within 7 minutes. He was admitted for observation with standby repeat epinephrine injection if his symptoms rebounded. His symptoms completely resolved overnight, and he proceeded with the barium enema the following day.

Bottom Line: Polyethylene glycol (PEG) is usually the bowel preparation of choice.Few allergic reactions from this product have been reported; these include urticaria, angioedema, and anaphylaxis.Reactions are thought to result from a small amount of PEG crossing the intestinal mucosa, which, in some patients, is sufficient to provoke an anaphylactic reaction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Toledo, Toledo, OH.

ABSTRACT
Barium enema is used to screen patients with gastrointestinal bleeding who do not want to undergo colonoscopy. Polyethylene glycol (PEG) is usually the bowel preparation of choice. Few allergic reactions from this product have been reported; these include urticaria, angioedema, and anaphylaxis. Reactions are thought to result from a small amount of PEG crossing the intestinal mucosa, which, in some patients, is sufficient to provoke an anaphylactic reaction.

No MeSH data available.


Related in: MedlinePlus