Organ-specific immune-mediated reactions to polyethylene glycol and polysorbate excipients: three case reports

Olga Rogozina; Carmen Ruiz-Fernández; Susana Martín-López; Ibtissam Akatbach-Bousaid; Miguel González-Muñoz; Elena Ramírez

doi:10.3389/fphar.2023.1293294

Organ-specific immune-mediated reactions to polyethylene glycol and polysorbate excipients: three case reports

Front Pharmacol. 2024 Jan 3:14:1293294. doi: 10.3389/fphar.2023.1293294. eCollection 2023.

Authors

Olga Rogozina¹, Carmen Ruiz-Fernández², Susana Martín-López¹, Ibtissam Akatbach-Bousaid², Miguel González-Muñoz², Elena Ramírez¹

Affiliations

¹ Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
² Immunology Department, La Paz University Hospital-IdiPAZ, Madrid, Spain.

Abstract

Drug-related acute pancreatitis (AP), acute interstitial nephritis (AIN) and drug-induced liver injury (DILI) are rare but serious adverse drug reactions (ADRs) that can have life-threatening consequences. Although the diagnosis of these ADRs can be challenging, causality algorithms and the lymphocyte transformation test (LTT) can be employed to help with the diagnosis. In this report, we present 3 cases of drug-related AP, AIN and DILI. The first case involved a patient with AP to lacosamide and to the excipient polysorbate 80 in pantoprazole. The second case involved a patient with DILI secondary to polyethylene glycol (PEG) excipients and amoxicillin-clavulanate. In case 3, AIN was considered to be the result of sensitization to excipients. Diagnoses were made using causality algorithms and the LTT. The LTT is a useful tool for helping diagnose drug-related AP and DILI, and it can be used to identify the specific drug or excipient causing the ADR. These cases highlight the importance of considering PEG and polysorbate excipients in the causality diagnosis of ADRs.

Keywords: CD69 upregulation; adverse drug reactions; case report; causality algorithms; delayed hypersensitivity reactions; excipients; lymphocyte transformation test.

Publication types

Case Reports

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the Instituto de Salud Carlos III (ISCIII) under the project PI21/01159 and co-funded by the European Union.