Anaphylactic reaction aprotinin

Aprotinin. Aprotinin is a naturally occurring serine protease inhibitor, has found widespread applications either by the intravenous route or as a component of biological sealants, because of its ability to decrease blood loss, and, as a consequence, transfusion requirements. Anaphylactic reactions are mediated by IgG and IgE antibodies. The risk of anaphylactic reactions has been estimated between 0.5 and 5.8% when used intravenously during cardiac surgery, and at 5 for 100,000 applications when used as a biologic sealant [25]. Patients previously treated with this drug present an increased risk and any new administration should be avoided for at least 6 months following an initial exposure [25]. 

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). 

Kon NF, Masumo H, Nakajima S, Tozawa R, Kimura M, Maeda S. [Anaphylactic reaction to aprotinin following topical use of biological tissue sealant.] Masui 1994 43(10) 1606-10. 

Dietrich W, Spath P, Ebell A, Richter JA. Prevalence of anaphylactic reactions to aprotinin analysis of two hundred forty-eight reexposures to aprotinin in heart operations. J Thorac Cardiovasc Surg 1997 113(1) 194-201. 

Cohen DM, Norberto J, Cartabuke R, Ryu G. Severe anaphylactic reaction after primary exposure to aprotinin. Ann Thorac Surg 1999 67(3) 837-8. 

Proud G, Chamberlain J. Anaphylactic reaction to aprotinin. Lancet 1976 2(7975) 48-9. 

Wuthrich B, Schmid P, Schmid ER, Tornic M, Johansson SG. IgE-mediated anaphylactic reaction to aprotinin during anaesthesia. Lancet 1992 340(8812) 173-4. 

An anaphylactic reaction occurred after the use of bovine fibrin glue as a sealant after mastectomy, probably due to the presence of bovine aprotinin (14). 

Kober BJ, Scheule AM, Voth V, Deschner N, Schmid E, Ziemer G. Anaphylactic reaction after systemic application of aprotinin triggered by aprotinin-containing fibrin sealant. Anesth Analg 2008 107(2) 406-9. 

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 ]. 

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