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\begin{document}

\title{Polyethylene glycol hypersensitivity, patient outcomes in a seven year
retrospective study.}



\author[1]{Oyindamola Stephanie Kayode}%
\author[2]{Alla Nakonechna}%
\author[1]{Leonard Siew}%
\author[3]{Magdalena Dziadzio}%
\author[1]{Lucinda Kennard}%
\author[1]{Krzysztof Rutkowski}%
\author[4]{Rita Mirakian}%
\author[1]{Annette Wagner}%
\affil[1]{Guy's and St Thomas' NHS Foundation Trust}%
\affil[2]{University of Liverpool}%
\affil[3]{Royal National ENT and Eastman Dental Hospitals}%
\affil[4]{Cambridge University Hospitals NHS Foundation Trust}%


\vspace{-1em}



  
  \date{May 21, 2024}


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\begin{abstract}
Background: Immediate IgE-mediated hypersensitivity reactions to
polyethylene glycol (PEG) are rare. Our understanding of PEG
hypersensitivity reactions is limited. We evaluate the clinical
characteristics and investigation outcomes of the largest cohort of PEG
allergic patients reported so far. Method: 44 patients investigated for
suspected PEG allergy across four UK tertiary allergy centres between
October 2013 and December 2020 were studied. Clinical characteristics,
details of index reaction, and approaches to and outcomes of allergy
investigations were analysed. Results: PEG hypersensitivity was
confirmed in 42 of 44 cases. Macrogol laxatives were the most common
index drugs reported (23\%), followed by depo-medroxyprogesterone
(19\%), oral penicillin V (10\%), and depo-methylprednisolone (10\%).
61\% experienced grade III anaphylaxis. Intradermal testing (IDT)
increased the diagnostic sensitivity from 51\% to 85\%. Five patients
experienced systemic reactions during IDT. Of the five patients, two
were skin prick test (SPT)-positive to a high molecular weight (MW) PEG.
Seven PEG-allergic patients reported tolerance to H1 antihistamines
containing PEG. Administration of mRNA COVID-19 (n=5) or AZ COVID-19
vaccines (n=14) was tolerated in 16 patients. Conclusion: PEG
hypersensitivity is an uncommon cause of drug-induced anaphylaxis. Four
index drugs accounted for two-thirds of cases and reactions to these
drugs should prompt PEG hypersensitivity investigations. PEG IDT
increases diagnostic yield. The role of SPT with higher MW PEGs requires
further attention. We observed no correlation in PEG dose and
concentration between the implicated and tolerated PEG-containing drugs.
Further studies are required to understand PEG thresholds and PEG
equivalent doses of various administration routes. COVID-19 vaccines
were tolerated by all exposed.%
\end{abstract}%



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\textbf{Hosted file}

\verb`PEG manuscript Allergy.docx`  available at \url{https://authorea.com/users/752921/articles/723431-polyethylene-glycol-hypersensitivity-patient-outcomes-in-a-seven-year-retrospective-study}

\textbf{Hosted file}

\verb`Figure 1 Index drugs reported.docx`  available at \url{https://authorea.com/users/752921/articles/723431-polyethylene-glycol-hypersensitivity-patient-outcomes-in-a-seven-year-retrospective-study}

\textbf{Hosted file}

\verb`Figure 2 Investigation results.docx`  available at \url{https://authorea.com/users/752921/articles/723431-polyethylene-glycol-hypersensitivity-patient-outcomes-in-a-seven-year-retrospective-study}

\textbf{Hosted file}

\verb`Table 1 Demographics and Index reaction.docx`  available at \url{https://authorea.com/users/752921/articles/723431-polyethylene-glycol-hypersensitivity-patient-outcomes-in-a-seven-year-retrospective-study}

\textbf{Hosted file}

\verb`Table 2 Index drugs reported for each patient.docx`  available at \url{https://authorea.com/users/752921/articles/723431-polyethylene-glycol-hypersensitivity-patient-outcomes-in-a-seven-year-retrospective-study}

\textbf{Hosted file}

\verb`Table 3 DPT-positive patient details.docx`  available at \url{https://authorea.com/users/752921/articles/723431-polyethylene-glycol-hypersensitivity-patient-outcomes-in-a-seven-year-retrospective-study}

\textbf{Hosted file}

\verb`Table 4 Comparison of PEG MW and quantities between index drugs and PEG drugs tolerated.docx`  available at \url{https://authorea.com/users/752921/articles/723431-polyethylene-glycol-hypersensitivity-patient-outcomes-in-a-seven-year-retrospective-study}

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