ReviewThe journal of allergy and clinical immunology. In practice2021
Hidden Dangers: Recognizing Excipients as Potential Causes of Drug and Vaccine Hypersensitivity Reactions.
Review in The journal of allergy and clinical immunology. In practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
34 citing papers in PubMed, 86 citations in OpenAlex.
- Adverse Reactions Identified after Approval of Novel Medicines: Analysis of 339 New Molecular Entities and Therapeutic Biologics.Clinical pharmacology and therapeutics · 2026Article
- Enhancing Bioavailability of Ultra-High Concentration Antibody Formulations Using Ionic Liquids.Advanced healthcare materials · 2026Article
- Therapeutic botulinum toxin preparations: an update.Journal of neural transmission (Vienna, Austria : 1996) · 2026Review
- Article
- Basophil Activation Test for the In Vitro Diagnosis of Tocilizumab Hypersensitivity.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Article
- [Drug Excipients. Necessary, but not Harmless].Farmaceuticos comunitarios · 2025Review
- Evaluating vaccination dosing strategies for SARS-CoV-2 in patients at high-risk for allergic reactions: Insights from vaccination campaign.The World Allergy Organization journal · 2025Article
- Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance.Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society · 2025Review
- Perflutren lipid microspheres for echocardiogram contrast: a clinical case of anaphylaxis not caused by PEG.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2025Article
- Challenges for switching central nervous system and psychiatric medication products: A review of the literature.Journal of psychopharmacology (Oxford, England) · 2025Review
- Urticaria-Like Hypersensitivity Reaction Following Botulinum Toxin Injection: A Case Report of Possible Interaction with β-Lactam Antibiotics.International medical case reports journal · 2025Article
- Carboxymethylcellulose: A hidden culprit in immediate hypersensitivity reactions after triamcinolone injections.The journal of allergy and clinical immunology. Global · 2024Article
- Inconsistent excipient listings in DailyMed: implications for drug safety.Naunyn-Schmiedeberg's archives of pharmacology · 2024Article
- Polyethylene glycol and immunology: aspects of allergic reactions and their mechanisms, as well as ways to prevent them in clinical practice.Immunologic research · 2024Review
- An immune-adrenergic pathway induces lethal levels of platelet-activating factor in mice.Communications biology · 2024Article
- Bridging the Gap: A Comparative Investigation of Pharmaceutical Excipient Regulations.Therapeutic innovation & regulatory science · 2024Review
- The dark side of beauty: an in-depth analysis of the health hazards and toxicological impact of synthetic cosmetics and personal care products.Frontiers in public health · 2024Review
- Rare causes of pediatric anaphylaxis due to obscure allergens.Frontiers in allergy · 2024Review
- Perioperative implications of patients with alpha gal allergies.Journal of clinical anesthesia · 2023Review
- Feasibility of a drug allergy registry-based excipient allergy database and call for universal mandatory drug ingredient disclosure: the case of PEG.Frontiers in allergy · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 3 countries.
Funding
Abstract
Excipients are necessary as a support to the active ingredients in drugs, vaccines, and other products, and they contribute to their stability, preservation, pharmacokinetics, bioavailability, appearance, and acceptability. For both drugs and vaccines, these are rare reactions; however, for vaccines, they are the primary cause of immediate hypersensitivity. Suspicion for these "hidden dangers" should be high, in particular, when anaphylaxis has occurred in association with multiple chemically distinct drugs. Common excipients implicated include gelatin, carboxymethylcellulose, polyethylene glycols, and products related to polyethylene glycols in immediate hypersensitivity reactions and propylene glycol in delayed hypersensitivity reactions. Complete evaluation of a suspected excipient reaction requires detailed information from the product monograph and package insert to identify all ingredients that are present and to understand the function and structure for these chemicals. This knowledge helps develop a management plan that may include allergy testing to identify the implicated component and to give patients detailed information for future avoidance of relevant foods, drugs, and vaccines. Excipient reactions should be particularly considered for specific classes of drugs where they have been commonly found to be the culprit (eg, corticosteroids, injectable hormones, immunotherapies, monoclonal antibodies, and vaccines). We provide a review of the evidence-based literature outlining epidemiology and mechanisms of excipient reactions and provide strategies for heightened recognition and allergy testing.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.