Hypersensitivity reaction to parenteral nutrition after severe hypersensitivity reaction to paclitaxel: a case report

Paclitaxel, an anti-microtubule chemotherapeutic agent, is known for hypersensitivity reactions. Hypersensitivity reactions associated with paclitaxel may be secondary to its vehicle, Cremophor EL rather than the paclitaxel itself. In contrast, hypersensitivity reactions to parenteral nutrition are uncommon. Both the lipid component and multivitamin have been implicated in hypersensitivity reactions to parenteral nutrition. Similar to paclitaxel, the vehicle for IV vitamins, polysorbate 80, may be the source of reaction rather than the vitamin, itself. We present a case report of a patient who had a severe hypersensitivity reaction to paclitaxel and also a hypersensitivity reaction to the multivitamin component of parenteral nutrition, as well as to vitamin K administered separate from parenteral nutrition. To our knowledge this is the first case report describing a potential cross-hypersensitivity to these agents.