The full range of allergic reactions to Total Parenteral Nutrition (TPN) remains unknown. Additionally, beyond individual allergens, there may be other factors contributing to TPN hypersensitivity reactions. We present a case of a patient with negative skin testing to common TPN allergens who had recurrent urticarial reactions to TPN. Her skin reactions resolved once TPN was stopped. Following a literature review, we postulated that the reactions could be due to the high osmolality of her TPN. Consequently, lowering her TPN from 2785 to 1928 mOsm/kg and premedicating with cetirizine resulted in resolution of her urticaria. When looking at patients who have hypersensitivity reactions to TPN, one must consider that their reactions may be due to factors other than allergens. More studies are needed to clarify the relationship between high osmolality TPN infusions and non-IgE mediated hypersensitivity reactions.

中文翻译：

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对高渗透压全胃肠外营养的超敏反应：病例报告

对全肠外营养 (TPN) 的全部过敏反应仍然未知。此外，除了个别过敏原外，可能还有其他因素导致 TPN 超敏反应。我们报告了一例对常见 TPN 过敏原皮试阴性的患者，该患者对 TPN 反复出现荨麻疹反应。一旦停止 TPN，她的皮肤反应就会消失。在文献回顾之后，我们假设这些反应可能是由于她的 TPN 的高渗透压。因此，将她的 TPN 从 2785 降低到 1928 mOsm/kg 并预先用西替利嗪治疗导致她的荨麻疹消退。在观察对 TPN 有超敏反应的患者时，必须考虑到他们的反应可能是由于过敏原以外的因素造成的。