Aprotinin allergic reactions

As might be expected with a bovine protein, allergic reactions can occur, and repeated exposure can even result in anaphylactic reactions. In view of this, some have advocated a strategy of using aprotinin only if excessive bleeding is a problem after surgery (23). 

Health and Welfare, most concerning patients treated for pancreatitis (27). Although these patients survived, fatal anaphylaxis has been reported (28). Other apparently allergic reactions reported include erythema, urticaria, bronchospasm, nausea and vomiting, diarrhea, muscle pains, and blood pressure changes (29). A case of allergic pancreatitis attributed to aprotinin has also been reported (30). 

There is evidence that severe allergic reactions to aprotinin are mediated by IgE, and preoperative screening for the presence of aprotinin-specific IgE antibodies can be of value in identifying patients at risk (31,32). 

Allergic reactions, including anaphylaxis, can occur on re-exposure to aprotinin. The incidence rates of aprotinin-related reactions are 2.7% in re-exposed adults (5/183) and 1.2% in children (3/354), with an overall incidence of 1.8% (8/437). The following advice has been given to reduce the risk and severity of these reactions (1,2) ... 

Immunologic Allergic reactions to intravenous aprotinin continue to be reported, as in the case of a 67-year-old man who had been treated with an aprotinin-contain-ing fibrin sealant and 3 years later had an anaphylactic reaction after intravenous administration of aprotinin, associated with aprotinin-speciiic IgG and IgE antibodies [207 ], and a 66-year-old man who had anaphylactic shock within 2 minutes of a rapid infusion of aprotinin 4 million units following two previous infusions of 2 million units each [208 ]. 

Aprotinin may be harmful by inhalation, ingestion, or skin absorption. It may also cause allergic reactions. Exposure may cause gastrointestinal effects, muscle pain, blood pressure changes, or bronchospasm. Wear appropriate gloves and safety glasses and use only in a chemical fume hood. Do not breathe the dust. 

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