If my patient has an egg allergy do I need to get a preoperative anesthesia evaluation?

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I have heard that an egg allergy can cause a problem receiving propofol. I sent patients for preoperative evaluations which proved unnecessary in one case. Is this a waste of time for the patient or could it be important?

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According to this reference egg allergies are usually to the proteins. But propofol emulsions contain egg lecithin, a fatty substance. Therefore protein exposure is minimal and they suggest it is clearly not a contraindication to propofol administration. [Soy-allergic and Egg-allergic can Receive Anesthesia | AAAAI]

There is one case report of a child with an egg allergy (among many other food allergies) receiving propofol and a subsequently significant allergic reaction. Despite acknowledging the significant allergy list in their patient and the same argument noted above, they suggest that a complicated allergy history may warrant allergy/immunology workup. In this case it seems difficult to me to correlate the reaction to the egg allergy specifically, but as they say a significant allergy history may mean there are other factors that would cause an allergic reaction (aside from the egg allergy). [My patient is allergic to eggs, can i use propofol? A case report and review.]

It is again suggested here that egg allergy is generally not thought to contribute to propofol reactions [A Case of propofol-induced oropharyngeal angioedema and bronchospasm].

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This case reports an allergic reaction and concludes propofol is a contraindication. But this case involves a child who presented with respiratory problems and was administered a muscle relaxant (a category of drugs that has a higher rate of allergic reactions). Considering all this I don’t think this is an indication of causation between the egg allergy and the reaction. [Possible anaphylaxis after propofol in a child with food allergy.]

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