Is Propofol Anesthesia Safe for People with Egg Allergies?

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Question: Is the anesthesia drug propofol safe for people who have egg allergies?

Answer: The drug, which is sold under the brand name Diprivan, contains both egg lecithin and soybean oil. Therefore, many doctors have been concerned that it might not be safe for people with allergies to those foods, especially egg allergy.

Studies have shown that propofol does appear to be safe in the majority of people who are allergic to eggs.

However, there have been isolated case reports of severe allergic reactions that have occurred following use of the drug in people with potentially anaphylactic allergies.

Propofol Uses in Anesthesia

Propofol is a powerful anesthetic makes you relax and sleep by slowing the activity of your brain and nervous system. It's given through a needle in your vein, and once you receive it, you probably won't remember anything — you'll fall asleep very quickly.

The drug also is used in intensive care units to sedate people who are on ventilators, and in emergency rooms as anesthesia for brief, painful procedures. It's not used outside of a hospital setting, as it's very dangerous without the proper monitoring and training. In fact, propofol was the drug that killed singer Michael Jackson.

Propofol has become one of anesthesiologists' preferred drugs to use, both in situations where the patient only needs to be asleep for a few minutes (for example, to have a painful procedure performed, like resetting a dislocated shoulder) and in situations where longer anesthesia is required.

It does require extremely careful monitoring, since it can make you stop breathing.

Propofol and Egg Allergies

As I said above, propofol does include egg lecithin in its current formula. Lecithin is a form of fat, not protein, and most egg allergies involve the protein, not the fat in the eggs.

However, propofol's drug insert does state that people with allergies to any of the drug's ingredient should not use the medication, and there have been several case reports of allergic reactions that might have been due to propofol.

That being said, physicians have looked at the use of propofol in people who are allergic to eggs, and have found it generally appears to be safe.

One Australian study reviewed the cases of 28 children with egg allergy, who cumulatively had 43 propofol uses between them. Two of the children had a history of anaphylactic reactions to eggs. There was one non-anaphylactic allergic reaction in a seven-year-old boy who was allergic to eggs, plus milk, nuts and sesame. The reaction occurred 15 minutes after the use of propofol, and the boy also reacted to a skin prick test with propofol. The authors concluded that propofol is likely to be safe in most people with allergies to eggs.

Another study looked at cases where adults with positive skin prick tests to eggs, soy or peanuts had propofol administered. It didn't find any links between allergic reactions and propofol.

The Bottom Line

Based on these research studies, propofol appears to be safe in the majority of people with egg allergy. However, you should talk with your doctor about it if you're allergic to eggs, especially if you've had anaphylactic reactions to eggs in the past.

Depending on the severity of your egg allergy, your doctor may recommend another anesthesia drug.

Sources:

Asserhøj LL et al. No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut. British Journal of Anesthesia. 2016 Jan;116(1):77-82.

Diprivan 1%. Diprivan Monograph provided by drug maker AstraZeneca. August, 2005.

Hepner, DL, MD and M.C. Castells, MD PhD. Anaphylaxis During the Perioperative Period. Anesthesia and Analgesia. Nov 2003. Vol. 97 No. 5.

Hofer K et al. Possible anaphylaxis after propofol in a child with food allergy. Annals of Pharmacotherapy. 37(3):398-401, 2003.

Murphy A et al. Allergic reactions to propofol in egg-allergic children. Anesthesia & Analgesia. 2011 Jul;113(1):140-4.

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