Albumin, human, anaphylaxis

Mackensen, A., Drager, R., Schlesier, M., Mertelsmann, R., and Lindemann, A. 2000. Presence of IgE antibodies to bovine serum albumin in a patient developing anaphylaxis after vaccination with human peptide-pulsed dendritic cells. Cancer Immunol Immunother 49(3) 152-156. 

Immunological reactions to human serum albumin tend to be non-IgE-mediated anaphylactic reactions (0.011% of cases treated), about a third of which are life-threatening (9). A case in which the mechanism seemed to be IgE-mediated anaphylaxis against native albumin has been reported (10). 

Stafford CT, Lobel SA, Fruge BC, Moffitt JE, Hoff RG, Fadel HE. Anaphylaxis to human serum albumin. Ann Allergy 1988 61(2) 85-8. 

Anaphylaxis has been observed after the administration of epoetin that contained bovine gelatine as a stabilizer (2). Antibovine gelatine IgE antibodies were found. No anaphylactic reaction was observed after the administration of epoetin that contained human serum albumin as a stabilizer in the same patient. 

Protein colloids contain larger molecules and have a longer intravascular residence time than crystalloids, but eventual fluid loss to the extravascular space does occur. Protein colloids, such as albumin and PPF, are prepared from pooled human blood and, therefore, carry with them a risk of transmission of viral infection or induction of anaphylaxis. The PPF is a 5% mixture (5 g of protein in 100 ml of 0.9% NaCI solution) of proteins that is osmotically equivalent to human plasma. The composition of the protein mixture is 83 to 90% albumin. Albumin typically is administered as either a 5 or 25% solution. By definition, albumin preparations must be composed of a protein mixture that is more than 90% albumin. Generally, PPF is favored over albumin for fluid resuscitation, because albumin appears to cause more interstitial edema. 

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