An immediate, allergic skin reaction to aprotinin after reexposure to fibrin sealant.
BACKGROUND
The safety of fibrin tissue adhesives has been a concern since they entered wide clinical application. Most commercially available kits contain the proteolytic inhibitor, aprotinin, to stabilize the fibrin clot. A bovine protein, this substance has an allergenic potency.


METHODS
This case report presents a patient who had a generalized allergic skin reaction, probably triggered by aprotinin upon reexposure to fibrin sealant injected subgaleally to achieve closure of a liquor fistula after neurosurgical treatment. The serologic investigation revealed aprotinin-specific IgE and IgG. From 1990 through 1998, reports of five allergic reactions following 1 million exposures to fibrin sealant were made to the manufacturer. The clinical relevance of allergic reactions to aprotinin contained in fibrin sealants and measures to avoid them are discussed.


CONCLUSIONS
These hypersensitivity reactions are extremely rare (incidence, 0.5/100,000 for all reactions and 0.3/100,000 for serious reactions), but they must be kept in mind as possible adverse events after repeated applications of fibrin sealants within a few weeks.
Beierlein
W
W
Division of Thoracic, Cardiac and Vascular Surgery, Department of Surgery, Tübingen University Hospital, Tübingen Germany.
Scheule
A M
AM
Antoniadis
G
G
Braun
C
C
Schosser
R
R
D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D000918:Antibody Specificity; D007611:Aprotinin / Q000009:adverse effects* / Q000276:immunology; D003876:Dermatitis, Atopic / Q000139:chemically induced*; D004797:Enzyme-Linked Immunosorbent Assay; D005076:Exanthema / Q000139:chemically induced* / Q000276:immunology; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects*; D005455:Fluorescent Antibody Technique; D006801:Humans; D007124:Immunoenzyme Techniques; D007073:Immunoglobulin E / Q000276:immunology; D008875:Middle Aged; D013997:Time Factors
D000888:Antibodies, Anti-Idiotypic; D015718:Fibrin Tissue Adhesive; C026408:anti-IgE antibodies; D007073:Immunoglobulin E; D007611:Aprotinin