THE FIRST REPORT OF ANGIOEDEMA AND ANAPHYLAXIS WITH TEMPORAL ASSOCIATION TO SEMAGLUTIDE

Abstract

<h3>Introduction</h3> Semaglutide is an injectable glucagon-like peptide (GLP-1) agonist used for diabetes and weight loss. IgE-mediated reactions have been reported in other GLP-1 agonists, however none have been reported with semaglutide. This case highlights the peculiar timing of anaphylaxis related to subcutaneous semaglutide administration. <h3>Case Description</h3> A 59-year-old woman presented to clinic for evaluation of intermittent angioedema and one episode of anaphylaxis one month after starting semaglutide. Weekly, she developed progressive tongue swelling two days after administration, that resolved within hours. Five months later, she developed anaphylaxis seventeen hours after medication administration. Symptoms included pruritic palmar erythema, lip and tongue angioedema, loss of consciousness, and bowel continence. In the emergency department she was hypotensive with leukocytosis and anion gap lactic acidosis. That morning, she ate foods she has tolerated since, and denied any insect stings, NSAID use, alcohol, and exercise. Within three months of stopping semaglutide, the patient has had only one episode of hour-long mild tongue swelling and palmar erythema. <h3>Discussion</h3> This patient presented with angioedema consistently two days after semaglutide administration. This culminated in anaphylaxis 17 hours after administration. This timing is atypical of type I hypersensitivity reaction. With the medication's peak plasma time of 1-3 days, the consistent timing of the reaction in relation to medication administration, minimal symptoms since stopping semaglutide, and without alternate explanation, this reaction may be explained by drug metabolism with reaction to unknown metabolites. This case highlights the first report, to our knowledge, of angioedema and anaphylaxis with temporal association to semaglutide administration.