ArticleAllergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology2025
Perflutren lipid microspheres for echocardiogram contrast: a clinical case of anaphylaxis not caused by PEG.
Article in Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPerflutren lipid microsphere suspension, sold under the brand name Definity®, is a microbubble ultrasound contrast agent. The microspheres contain octafluoropropane (C CASE PRESENTATION: Our patient is a healthy 54-year-old female, who underwent an exercise stress transthoracic echocardiogram using Definity® as an enhancing agent. She experienced anaphylaxis within 15 min of injection. Symptoms resolved after she was treated with diphenhydramine and epinephrine, followed by a systemic corticosteroid and ondansetron in the Emergency Department. The patient underwent allergy testing at our clinic for Definity® and various PEG-containing substances. While all PEG products tested negative, she had positive intradermal tests to Definity®. She also had negative skin prick testing to PEG 8000 and passed an oral challenge to PEG 3350, thus ruling out PEG as the causative agent of anaphylaxis.
conclusionsOur case report highlights a previously undocumented instance of anaphylaxis to Definity® not caused by PEG. We suspect the reaction to be an IgE-mediated response to a non-PEGylated component of Definity®. An alternative explanation for the reaction could be a complement activation-related pseudoallergy. This report provides critical information to physicians on the potential risks of using Definity® and contributes to growing research surrounding the profile of Definity®.
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