ORIGINAL ARTICLE GASTROINTESTINAL DISEASES Propofol administration is safe in adult eosinophilic esophagitis patients sensitized to egg, soy, or peanut J. Molina-Infante 1 , A. Arias 2 , D. Vara-Brenes 1 , R. Prados-Manzano 1 , J. Gonzalez-Cervera 3 , M. Alvarado-Arenas 4 & A. J. Lucendo 5 1 Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres; 2 Research Unit, Hospital Alcazar de San Juan, Ciudad Real; 3 Department of Allergy, Hospital General de Tomelloso, Ciudad Real; 4 Department of Allergy, Hospital San Pedro de Alcantara, Caceres; 5 Department of Gastroenterology, Hospital General de Tomelloso, Ciudad Real, Spain To cite this article: Molina-Infante J, Arias A, Vara-Brenes D, Prados-Manzano R, Gonzalez-Cervera J, Alvarado-Arenas M, Lucendo AJ. Propofol administration is safe in adult eosinophilic esophagitis patients sensitized to egg, soy, or peanut. Allergy 2014; DOI: 10.1111/all.12360. Keywords egg; eosinophilic esophagitis; peanut; propofol; soy. Correspondence Javier Molina-Infante, Department of Gastroenterology, Hospital San Pedro de Alcantara, C/ Pablo Naranjo s/n 10003, Caceres, Spain. Tel.: +0034-627430248 Fax: +0034-927621545 E-mail: xavi_molina@hotmail.com Guarantor of the article: Alfredo J. Lucendo Accepted for publication 14 December 2013 DOI:10.1111/all.12360 Edited by: Hans-Uwe Simon Abstract Background: Sedation might improve tolerability and adherence to endoscopic procedures in patients with eosinophilic esophagitis (EoE). Propofol administra- tion is often contraindicated in patients with hypersensitivity to egg, soy, or peanut. Objective: To investigate the safety of propofol administration for procedural sedation in EoE patients sensitized/allergic to egg, soy, peanut. Methods: A retrospective observational study in adult EoE patients undergoing esophagogastroduodenoscopy with propofol sedation was conducted between January 2009 and March 2013. Food-specific serum IgE and skin prick tests for egg, soy, peanut, and cross-reactant foods were performed in all patients. Results: Sixty EoE adult patients, mostly on food elimination diets (91%), were evaluated (age: 28 years (14–56), male gender (90%)). Atopy was present in 88% of patients, being the most prevalent comorbidities rhinoconjunctivitis (78%) and asthma (67%). Fifty-two patients (86%) were sensitized to either egg, soy, or pea- nut. Eighteen patients (28%) had a history of allergic reactions to egg, legumes, and nuts and strictly avoided these foods. A total of 404 upper endoscopies were performed under propofol sedation. No allergic adverse events were reported, except a transient bronchospasm after orotracheal intubation in an asthmatic adolescent receiving multiple drugs for anesthesia, in whom no sensitization to either propofol or its lipid vehicle was confirmed. Conclusions: Propofol was safely administered for procedural sedation in a large series of adult EoE patients multisensitized to egg, soy, peanut, showing one-third clinical allergy to these foods. Propofol (2,6-diisopropylphenol) has gained popularity as an agent for both induction and maintenance of anesthesia. Its use has expanded worldwide over the last decade from solely an anesthetic agent to one of the most preferred sedative– hypnotic agent drugs in the intensive care unit and outpa- tients procedures, by either anesthesiologists and, lately, nonanesthesiologists (1). Propofol-related anaphylactoid reac- tions in the early 1980s across Europe, mostly related to the surfactant ‘Cremophor EL’ (2), promptly changed to a differ- ent lipid solvent. This fatty emulsified formulation, which is the current mainstay of propofol delivery, contains egg leci- thin (12 mg/ml) and soybean oil (100 mg/ml). This emulsion was specifically designed to avoid allergic reactions in egg- or soy-allergic patients, considering that soybean oil is highly refined with almost nonallergenic content after the refining process and egg lecithin comes from egg yolk, being the most allergenic proteins contained in egg white (3). Over the last 25 years, several cases of anaphylaxis or allergic adverse events after propofol administration have been reported (4– 20), presumably related in most cases to cross-reactivity with food allergies. Abbreviations EoE, eosinophilic esophagitis; SFED, six-food elimination diet; SPT, skin prick test. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Allergy