Pilot Study Tests Brief Survey for PEG Allergy Screening

Researchers at multiple institutions have developed a brief screening survey designed to identify patients with suspected allergies to polyethylene glycol, a common component in ultrasound enhancing agents. The study, published in Echo Research & Practice, represents a pilot multicenter effort to address a clinical gap where no existing tools were available to screen for PEG allergy in echocardiography laboratories. The primary finding indicates that a positive response to at least two of the first four questions on the survey identified all patients with proven PEG allergy in the pilot cohort, though the authors note that further clinical validation is required before widespread adoption.

Polyethylene glycol is a key ingredient in several ultrasound enhancing agents used during echocardiograms. However, it has been recognized as a contributor to anaphylactoid reactions, leading to new contraindications for its use in individuals with known or suspected PEG allergy. Despite these safety recommendations, clinicians in echocardiography settings lacked a standardized method to quickly assess which patients might be at risk. This absence of a clinical tool created a challenge for ensuring patient safety while administering these diagnostic agents.

To address this issue, the research team developed a screening survey aimed at identifying patients with potential PEG allergy. The study was conducted as a prospective pilot implementation between June and July 2025. The investigators enrolled two distinct groups of participants to test the survey’s accuracy. The first group consisted of eight patients who had confirmed PEG allergy through skin prick testing. The second group included fifty patients who were prospectively enrolled for clinically indicated echocardiography and did not have a known PEG allergy.

The study design involved administering the screening survey to all enrolled patients. The team focused on the responses to the first four questions of the survey as the primary screening mechanism. By comparing the survey results against the known allergy status of the participants, the researchers could calculate the diagnostic performance of the tool. All patients in the pilot study completed the survey, allowing for a complete analysis of the data collected during the two-month implementation period.

The results demonstrated that the screening survey performed with high accuracy in this small pilot group. A positive response to at least two of the first four questions yielded a sensitivity of 100%, with a 95% confidence interval ranging from 67.6% to 100%. The specificity was also 100%, with a 95% confidence interval from 92.9% to 100%. These metrics suggest that the survey did not miss any of the confirmed allergy cases in this specific sample, nor did it incorrectly flag any of the non-allergic patients as having an allergy.

Additionally, the positive predictive value and negative predictive value were both calculated at 100%. The positive predictive value had a 95% confidence interval of 67.6% to 100%, while the negative predictive value had a 95% confidence interval of 92.9% to 100%. These values indicate that in this pilot cohort, a positive survey result correctly identified patients with PEG allergy, and a negative result correctly identified those without. The high predictive values underscore the potential utility of the tool in a clinical setting, provided the sample size limitations are considered.

The authors conclude that the brief screening survey successfully identified all patients with proven allergy to PEG in this pilot multicenter study. They suggest that the tool may have utility in identifying individuals with potential PEG allergy who would benefit from the use of a non-PEGylated ultrasound enhancing agent. By allowing clinicians to quickly flag at-risk patients, the survey could help prevent adverse reactions and ensure that appropriate alternative agents are selected for diagnostic procedures.

However, the researchers emphasize that this was a pilot study with a relatively small sample size, comprising only fifty-eight patients in total. The eight patients with confirmed allergy and the fifty patients without known allergy limit the generalizability of the findings.

Subject of Research: Development and pilot testing of a screening survey for PEG allergy in echocardiography patients

Article Title: Development of a screening checklist to identify individuals with suspected allergy to polyethylene glycol

Article References: Strom, J. B., Spetko, N., Song, Y., Angell-James, C. E. M., Cassidy, M. A., Stout, J. L., Winburn, M. L., Lee, R., & Stone, C. A., Jr. (2025). Development of a screening checklist to identify individuals with suspected allergy to polyethylene glycol. Echo Research & Practice, 12(1), Article 36. https://doi.org/10.1186/s44156-025-00100-4

Image Credits: AI Generated

DOI: 10.1186/s44156-025-00100-4

Keywords: PEG allergy, echocardiography, ultrasound enhancing agents, screening survey, pilot study, patient safety, anaphylactoid reactions, clinical validation, Development, screening, checklist, identify