Journal article
Hidden Dangers: Recognizing excipients as potential causes of drug and vaccine hypersensitivity reactions
The Journal of Allergy and Clinical Immunology: In Practice, Vol.9(8), pp.2968-2982
2021
Abstract
Excipients are necessary as a support to the active ingredients in drugs, vaccines and other products and they contribute to their stability, preservation, pharmacokinetics, bioavailability, appearance and acceptability. For both drugs and vaccines these are rare reactions however for vaccines they are the primary cause of immediate hypersensitivity. Suspicion for these “hidden dangers” should be high in particular when anaphylaxis has occurred in association with multiple chemically distinct drugs. Common excipients implicated include gelatin, carboxymethylcellulose (CMC), polyethylene glycols (PEG) and products related to PEG in immediate hypersensitivity reactions (IHRs); and propylene glycol (PG), in delayed hypersensitivity reactions (DHRs). Complete evaluation of a suspected excipient reaction requires detailed information from the product monograph and package insert to identify all ingredients that are present and to understand the function and structure for these chemicals. This knowledge helps develop a management plan that may include allergy testing to identify the implicated component and to give patients detailed information for future avoidance of relevant foods, drugs and vaccines. Excipient reactions should be particularly considered for specific classes of drugs where they have been commonly found to be the culprit (e.g. corticosteroids, injectable hormones, immunotherapies, monoclonal antibodies, and vaccines). We provide a review of the evidence-based literature outlining epidemiology and mechanisms of excipient reactions and provide strategies for heightened recognition and allergy testing.
Details
- Title
- Hidden Dangers: Recognizing excipients as potential causes of drug and vaccine hypersensitivity reactions
- Authors/Creators
- M.L. Caballero (Author/Creator) - Hospital Universitario La PazM.S. Krantz (Author/Creator) - Vanderbilt University Medical CenterS. Quirce (Author/Creator) - Hospital Universitario La PazE. Phillips (Author/Creator) - Vanderbilt UniversityC.A. Stone Jr. (Author/Creator)
- Publication Details
- The Journal of Allergy and Clinical Immunology: In Practice, Vol.9(8), pp.2968-2982
- Publisher
- Elsevier
- Identifiers
- 991005540146807891
- Copyright
- © 2021 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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