title: Anaphylaxis after treatment with recombinant factor VIII.
abstract: BACKGROUND
  Treatment of hemophilia patients with recombinant factor VIII concentrates has not previously been associated with anaphylaxis.
  
  
  METHODS
  A 5-week-old boy with severe hemophilia A developed dyspnea, cyanosis, hypotension, and a diffuse urticarial rash following treatment with a recombinant factor VIII (Recombinate). To identify the cause of anaphylaxis in this patient, the vial lot was examined for the presence of endotoxin, and a checkerboard immunoblotting technique was used to test serum and/or plasma samples from the patient and mother for the presence of antibodies (IgA, IgG, IgE, and IgM) to Recombinate-related antigens (recombinant factor VIII, von Willebrand factor, human serum albumin, Chinese hamster ovary proteins, bovine serum albumin, mouse monoclonal anti-human factor VIII, polyethylene glycol 3350), and to ethylene oxide, the agent used to sterilize the infusion equipment.
  
  
  RESULTS
  No immune response directed against the Recombinate-related antigens or ethylene oxide that could be associated with the anaphylactic reaction was identified. Endotoxin was not present upon rabbit pyrogen testing of the therapeutic product.
  
  
  CONCLUSIONS
  These studies failed to show any association between Recombinate and the onset of the allergic reaction. This seems to be the first reported case of anaphylaxis following the infusion of a recombinant form of factor VIII concentrate.
authors.affiliation: Department of Hematology, New England Hemophilia Center, Medical Center of Central Massachusetts, Worcester, USA.
authors.forename: R I
authors.initials: RI
authors.lastname: Shopnick
authors.forename: M
authors.initials: M
authors.lastname: Kazemi
authors.forename: D B
authors.initials: DB
authors.lastname: Brettler
authors.forename: C
authors.initials: C
authors.lastname: Buckwalter
authors.forename: L
authors.initials: L
authors.lastname: Yang
authors.forename: G
authors.initials: G
authors.lastname: Bray
authors.forename: E D
authors.initials: ED
authors.lastname: Gomperts
mesh_terms: D000707:Anaphylaxis / Q000209:etiology* / Q000276:immunology; D000941:Antigens / Q000276:immunology; D005169:Factor VIII / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011994:Recombinant Proteins / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use
chemical_list: D000941:Antigens; D011994:Recombinant Proteins; C078147:F8 protein, human; D005169:Factor VIII