Polyethylene Glycol Allergy Implicated in Lubricant Intolerance

Abstract

PEG is an active ingredient in bowel prep, and found in commonly utilized products. Rarely, cases of PEG allergy have been reported, which can be difficult to elucidate, given the seemingly unrelated products utilizing these chemical polymers. 30 y/o female with history of asthma, hypothyroidism and multiple allergies, including Glycolax (polyethylene glycol (PEG)), presented to her gastroenterologist for evaluation of heartburn symptoms. EGD revealed Grade A reflux esophagitis and longitudinal furrows in mid and lower esophagus. Post-procedure, she reported retrosternal pain and sore throat. Pathology revealed squamous epithelium with increased intraepithelial eosinophils (>50/HPF) consistent with eosinophilic esophagitis (EoE). High dose omeprazole was prescribed, which she discontinued. She returned in 8 months with recurrent symptoms. EGD revealed Eosinophilic Esophagitis Endoscopic Reference Score (EoE-EREFS) of Edema Grade 0, Rings Grade 1, Exudates Grade 0, Furrows Grade 1 and Stricture 0. Post-procedure, she complained of sore throat and retrosternal pain. She was treated with six food elimination diet. Follow-up EGD demonstrated decrease in the EoE-EREFS score to 1, significant decrease in eos/HPF. Again, post-procedure, she complained of retrosternal pain and sore throat. In consultation with her allergist, it was determined that lubricant containing PEG may have been the cause for her post-procedures symptoms. Subsequent EGD was performed without lubricant. Post procedure, she experienced no retrosternal pain or discomfort. PEGs function as the active ingredients in laxatives and bowel prep. Exposure happens in a variety of settings, including gels, lubricants and pills. Due to minimal absorption, side effects are rare. Compromised mucosa may increase the absorption of high MW PEGs, relevant given the patient's underlying eosinophilic esophagitis. Non-standardization of product labeling and lack of awareness can lead to overlooking these substances as potential causes of allergic reaction [1]. It is important to have suspicion of PEG hypersensitivity for patients with severe reaction to seemingly unrelated products, such as GoLytely and lidocaine gel in this case. Physicians should be aware of the allergic potential of macrogels and the possible implication in a PEG adverse reaction.