Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance

Abstract Excipients are important inactive components in drug formulations that ensure stability, bioavailability, and patient compliance. However, emerging evidence suggests that certain excipients, once considered inert, can cause hypersensitivity reactions in certain individuals. Such reactions i...

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Main Authors: Ruba Malkawi, Lora Altahrawi
Format: Article
Language:English
Published: Springer 2025-07-01
Series:Saudi Pharmaceutical Journal
Subjects:
Online Access:https://doi.org/10.1007/s44446-025-00004-8
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author Ruba Malkawi
Lora Altahrawi
author_facet Ruba Malkawi
Lora Altahrawi
author_sort Ruba Malkawi
collection DOAJ
description Abstract Excipients are important inactive components in drug formulations that ensure stability, bioavailability, and patient compliance. However, emerging evidence suggests that certain excipients, once considered inert, can cause hypersensitivity reactions in certain individuals. Such reactions include mild erythema due to systemic anaphylaxis and create clinical challenges that are difficult to handle. This review presents a systematic review of the existing literature on excipient hypersensitivity, with specific attention paid to commonly implicated excipients such as polyethylene glycol (PEG), parabens, and tartrazine. Hypersensitivity mechanisms (immune-mediated [IgE, T-cell] and non-immune) are discussed, along with their clinical features and diagnostic challenges. In addition, geographic variations in reporting are discussed, which in turn focus on the role of pharmacovigilance in the reduction of risk. Geographic variations in excipient hypersensitivity reporting are also discussed, highlighting disparities in pharmacovigilance efforts across different regions. This review also discusses recent work, regulatory issues, and desensitization protocols for the control of hypersensitivity reactions. Persistent surveillance and individual strategies are needed to enhance patient safety in the context of excipient-induced hypersensitivity.
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spelling doaj-art-6d97eedc01e8489db8fd6ff0650f17ce2025-08-20T03:42:48ZengSpringerSaudi Pharmaceutical Journal1319-01642213-74752025-07-0133411410.1007/s44446-025-00004-8Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilanceRuba Malkawi0Lora Altahrawi1Jadara University, Pharmacy DepartmentLeicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort UniversityAbstract Excipients are important inactive components in drug formulations that ensure stability, bioavailability, and patient compliance. However, emerging evidence suggests that certain excipients, once considered inert, can cause hypersensitivity reactions in certain individuals. Such reactions include mild erythema due to systemic anaphylaxis and create clinical challenges that are difficult to handle. This review presents a systematic review of the existing literature on excipient hypersensitivity, with specific attention paid to commonly implicated excipients such as polyethylene glycol (PEG), parabens, and tartrazine. Hypersensitivity mechanisms (immune-mediated [IgE, T-cell] and non-immune) are discussed, along with their clinical features and diagnostic challenges. In addition, geographic variations in reporting are discussed, which in turn focus on the role of pharmacovigilance in the reduction of risk. Geographic variations in excipient hypersensitivity reporting are also discussed, highlighting disparities in pharmacovigilance efforts across different regions. This review also discusses recent work, regulatory issues, and desensitization protocols for the control of hypersensitivity reactions. Persistent surveillance and individual strategies are needed to enhance patient safety in the context of excipient-induced hypersensitivity.https://doi.org/10.1007/s44446-025-00004-8Excipients hypersensitivityPolyethylene glycol (PEG)PharmacovigilanceIgE-mediated reactionsT-cell mediated hypersensitivityAnaphylaxis
spellingShingle Ruba Malkawi
Lora Altahrawi
Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance
Saudi Pharmaceutical Journal
Excipients hypersensitivity
Polyethylene glycol (PEG)
Pharmacovigilance
IgE-mediated reactions
T-cell mediated hypersensitivity
Anaphylaxis
title Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance
title_full Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance
title_fullStr Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance
title_full_unstemmed Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance
title_short Excipients in pharmaceuticals: mechanisms of hypersensitivity and the role of global pharmacovigilance
title_sort excipients in pharmaceuticals mechanisms of hypersensitivity and the role of global pharmacovigilance
topic Excipients hypersensitivity
Polyethylene glycol (PEG)
Pharmacovigilance
IgE-mediated reactions
T-cell mediated hypersensitivity
Anaphylaxis
url https://doi.org/10.1007/s44446-025-00004-8
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