{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:41:21Z","timestamp":1772851281357,"version":"3.50.1"},"reference-count":7,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Allergy"],"abstract":"<jats:p>We present a rare case of severe IgE-mediated hypersensitivity to carboxymethylcellulose (CMC) following an intraarticular knee injection with triamcinolone acetonide (Triamcort\u00ae). The patient experienced a grade IV anaphylactic reaction shortly after administration. Diagnostic workup, including skin prick testing and basophil activation test, confirmed sensitization to CMC. Importantly, the patient tolerated medications containing crosscarmellose and microcrystalline cellulose without adverse reactions, suggesting no clinically relevant cross-reactivity. This case highlights the need to consider excipients such as CMC as potential triggers of severe allergic reactions especially in cases of unexplained anaphylaxis to injectable medication and underscores the importance of thorough allergological assessment to ensure safe future treatments.<\/jats:p>","DOI":"10.3389\/falgy.2025.1663395","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:27:19Z","timestamp":1761283639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Severe IgE-mediated hypersensitivity to carboxymethylcellulose with tolerance to crosscarmellose and microcrystalline cellulose"],"prefix":"10.3389","volume":"6","author":[{"given":"Rhea","family":"Schreiber","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole","family":"Guillet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e656","DOI":"10.1111\/1346-8138.17784","article-title":"Intralesional carmellose sodium injection-induced urticaria","volume":"52","author":"Kikuchi","year":"2025","journal-title":"J Dermatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1186\/s13256-021-03180-y","article-title":"Carboxymethylcellulose excipient allergy: a case report","volume":"15","author":"Townsend","year":"2021","journal-title":"J Med Case Rep"},{"key":"B3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.2500\/aap.2021.42.200091","article-title":"Skin testing and drug challenge in the evaluation of drug hypersensitivity reactions","volume":"42","author":"Wolfson","year":"2021","journal-title":"Allergy Asthma Proc"},{"key":"B4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ijbiomac.2019.04.079","article-title":"Carboxymethyl cellulose-based oral delivery systems","volume":"133","author":"Javanbakht","year":"2019","journal-title":"Int J Biol Macromol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e05047","DOI":"10.2903\/j.efsa.2018.5047","article-title":"Re-evaluation of celluloses E 460(i), E 460(ii), E 461, E 462, E 463, E 464, E 465, E 466, E 468 and E 469 as food additives","volume":"16","author":"Younes","year":"2018","journal-title":"EFSA J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"100337","DOI":"10.1016\/j.jacig.2024.100337","article-title":"Carboxymethylcellulose: a hidden culprit in immediate hypersensitivity reactions after triamcinolone injections","volume":"3","author":"Yan","year":"2024","journal-title":"J Allergy Clin Immunol Glob"},{"key":"B7","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1159\/000070958","article-title":"Anaphylaxis to the carbohydrate carboxymethylcellulose in parenteral corticosteroid preparations","volume":"207","author":"Bigliardi","year":"2003","journal-title":"Dermatology"}],"container-title":["Frontiers in Allergy"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/falgy.2025.1663395\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:27:20Z","timestamp":1761283640000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/falgy.2025.1663395\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":7,"alternative-id":["10.3389\/falgy.2025.1663395"],"URL":"https:\/\/doi.org\/10.3389\/falgy.2025.1663395","relation":{},"ISSN":["2673-6101"],"issn-type":[{"value":"2673-6101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]},"article-number":"1663395"}}