Propofol is a safe, well-tolerated drug whose use has expanded worldwide over the last decade from solely an anesthetic agent to one of the most preferred sedative–hypnotic agents in outpatients procedures, especially in gastrointestinal endoscopy, due to its safety and favorable side effect profile.
However, propofol is labeled as contraindicated in patients with egg or soy allergy. This contraindication is based on low-quality isolated clinical observations but has become increasingly problematic given the rising incidence of food allergy and eosinophilic esophagitis (EoE). However, there is still disagreement on this matter and recent evidence-based research has put into question the warnings on using this drug in patients with food allergy. The Association of Anaesthetists of Great Britain and Ireland has recently claimed that there is no evidence to avoid propofol in egg- or soy-allergic patients; in fact, egg allergy is not included in warning labels in the UK.
The specific use of propofol in patients with EoE sensitized to soy/legumes and egg has been assessed in two recent studies.
The first one was carried out in a multicentre series of adult EoE patients undergoing esophagogastroduodenoscopy with propofol sedation. Food-specific serum IgE and skin prick tests for egg, soy, peanut, and cross-reactant foods were performed in all patients. Fifty-two patients (86%) were sensitized to either egg, soy, or peanut. Out of them, eighteen patients (28%) already had a history of allergic reactions to egg, legumes, and nuts and strictly avoided these foods. After performing a total of 404 upper endoscopies under propofol sedation, no allergic adverse events were reported.
Very recently, a retrospective series of children with EoE and explored with endoscopy sedated with propofol has been also published. Over a 1.5-year period, propofol was given to 141 children with EoE, of which sixty four had a documented allergy to egg or soy, while other 115 children were sedated with other drugs. No differences in the number of adverse reactions were found among the two groups of patients. Additionally, this series included 15 procedures performed on 12 patients with a history of anaphylaxis to egg; propofol was used in 6 of these with no complications documented.
After these results, it can be clearly stated that sedation for endoscopy in patients with EoE who also present food allergy to egg, soy or legumes presents the same safety and effectiveness than in non-allergic patients. Because of that, there is no reason at the present to limit the use of propofol in patients with EoE who associate food allergies, thus depriving them of one of the sedative drugs with a better safety, efficacy and satisfaction profile in gastrointestinal endoscopy.