Initiation, Advancement, and Acute Complications of Parenteral Nutrition


Allergic Reactions to Parenteral Nutrition Components


Although relatively uncommon, allergic reactions to PN components have been published in case reports. Reactions to ILE and/or IV multi- vitamin preparations can result in urticaria, dyspnea, pruritus, and anaphylaxis.54-56


Depending on the ILE formulation and the degree of


the patient’s sensitivity, allergic reactions could arise from the oil con- tent (soy, fish, olive, or coconut). Due to significant filtration, this is not certain across all patients with known sensitivities, but the risks cannot be eliminated. The degree and nature of the patient’s allergy should be evaluated, along with the circumstances before deciding whether or not to provide lipids. Peanut allergies may be triggered with soy-containing lipids because of primary sensitization or cross-reactivity between soy- beans and peanuts.57


Patients allergic to egg (yolk or white) may react to


ILE because of the egg yolk phospholipid present in ILE.55-57 Treatment of an allergic reaction depends on its severity and symp-


toms. In patients with dyspnea or anaphylaxis, appropriate medical treatment and discontinuation of the PN solution is advised. In less severe reactions, antihistamines can be administered. In either case, it is important to identify the PN component causing the reaction. This can be done by removing a PN component known to cause reactions, such as ILE or multivitamins, and performing a trial infusion while monitoring for the reaction. Skin-prick testing is another method to determine the etiology of the reaction.55


References


1. Worthington P, Balint J, Bechtold M, et al. When is parenteral nutrition appropriate? JPEN J Parenter Enteral Nutr. 2017;41(3):324-377. doi:10 . 1177 / 0148607117695251


2. Koretz R, Lipman T, Klein S; American Gastroenterological Association. AGA technical review on parenteral nutrition. Gastroenterology. 2001;121(4):970-1001. doi:10 . 1053 / gast . 2001 . 28031


3. Mays A, Ayers P, Monczka J, Cober MP. Safety in parenteral nutrition compounding. Nutr Clin Pract. 2023;38(6):1253-1262. doi:10 . 1002 / ncp . 11064


4. Derenski K, Catlin J, Allen L. Parenteral nutrition basics for the clinician caring for the adult patient. Nutr Clin Pract. 2016;31(5):578-595. doi:10 . 1177 / 0884533616657650


5. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211. doi:10 . 1177 / 0148607115621863


6. Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition—an ESPEN consensus statement. Clin Nutr. 2015;34(3):335-340. doi:10 . 1016 / j . clnu . 2015 . 03 . 001


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