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Peanut Allergy and Propofol — FRCA Final MCQ

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ModeratePreoperative AssessmentPeanut Allergy and PropofolFRCA Final

A 30-year-old man with a confirmed peanut allergy and previous anaphylaxis after eating peanuts is scheduled for elective arthroscopy. He has undergone two general anaesthetics without perioperative hypersensitivity, although the drugs administered are unknown. Intravenous induction is planned. According to current UK licensed product information, what is the most appropriate management?

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Correct answer: D — Proceed, but select a non-propofol induction technique without routine allergy premedication

The correct answer is D. Current UK propofol SmPCs state that formulations containing refined soya oil should not be used in patients hypersensitive to peanut or soya; an alternative induction technique therefore follows licensed product information. This does not require cancellation, because the patient has no history of perioperative hypersensitivity. Previous uneventful anaesthetics are reassuring but do not establish propofol tolerance when the drugs used are unknown. Routine skin testing of all intended drugs is neither indicated nor reliably predictive. Antihistamines and corticosteroids do not remove a contraindication or reliably prevent perioperative anaphylaxis. Although NAP6 and published evidence question the biological rationale for food-allergy-based propofol avoidance, that evidence conflicts with current UK product labelling; the revised stem makes the required standard explicit.

Reference: Aspen, Propofol 10 mg/ml (1%) emulsion for injection or infusion, Summary of Product Characteristics, section 4.3 Contraindications, updated 3 November 2025. https://www.medicines.org.uk/emc/product/5492/smpc