Hypersensitivity to Intravenous Lipid Emulsions and Food Allergies: a Systematic Review of Case Reports.

PURPOSE OF THE REVIEW: Intravenous lipid emulsion (ILE) is essential for patients with prolonged intestinal failure but may contain potential allergens. Unnecessary avoidance of ILE in patients with food allergies could limit nutritional options. Therefore, we systematically reviewed the evidence on ILE use in patients with and without food allergies, including those who experienced hypersensitivity reactions. Searches were conducted in Medline, Scopus, Web of Science, Google Scholar, and the Canada Vigilance Adverse Reaction Database through April 30, 2025. RECENT FINDINGS: Twenty-eight individual cases (from 25 reports) met the inclusion criteria, involving 10 pediatric and 18 adult patients. The median time to hypersensitivity reaction was 5 min (IQR 0–45) in children and 60 min (IQR 15–120) in adults. The median cumulative exposure before reaction was 1.5 days (IQR 1–11) in children and 1 day (IQR 1–1) in adults. Anaphylaxis (50.0%) and cutaneous manifestations (42.9%) were the most common reactions. Of the 28 patients, 5 (17.9%) had known food allergies and experienced hypersensitivity to ILE. Among all patients, 4 of 6 (66.7%) who underwent skin testing had negative results; however, 3 of these 4 reacted upon ILE rechallenge. ILE-associated hypersensitivity reactions can occur in both food-allergic and non–food-allergic patients, particularly within the first day of administration. Skin testing for ILE allergy has limited reliability, and diagnostic confirmation is uncommon due to the lack of a standardized allergy evaluation. Individualized risk assessment and selective use of lipid formulations are essential to minimize risk. ILE rechallenge should be performed under the supervision of an immunologist.