title: IgE-mediated anaphylaxis to Thiomucase, a mucopolyssacharidase: allergens and cross-reactivity.
abstract: BACKGROUND
  Thiomucase is a mucopolysaccharidase obtained from ovine tissues mainly used to facilitate the diffusion of local anaesthetics and in the treatment of cellulitis. A patient with an anaphylaxis in relation to the intramuscular administration of Thiomucase is reported.
  
  
  OBJECTIVE
  To investigate Thiomucase allergens and their possible relationship with dander allergens and animal albumins.
  
  
  METHODS
  Skin prick tests (SPT) and serum-specific IgE were performed with Thiomucase and danders. Thiomucase SDS-PAGE immunoblotting was performed in order to study allergens. RAST/CAP inhibition and SDS-PAGE immunoblotting inhibition were carried out to study the cross-reactivity.
  
  
  RESULTS
  Skin prick tests (SPT) were positive to Thiomucase, animal dander (cat, dog, sheep, other), bovine serum albumin (BSA), and echinococcus. Specific IgE was also positive to Thiomucase, animal dander (cat, dog, sheep, other), BSA and echinococcus. In the RAST-CAP inhibition assays BSA was nearly completely inhibited by Thiomucase, Thiomucase was partially inhibited by BSA and cat and Echinococcus granulosus was partially inhibited by sheep and Thiomucase. In the Thiomucase SDS-PAGE immunoblotting several proteins fixed IgE, ranging from 20 kDa to > 94 kDa, the strongest with 43 kDa. The IgE fixation to BSA, cat and sheep in the SDS-PAGE immunoblotting was completely inhibited by the preincubation of the serum with Thiomucase.
  
  
  CONCLUSIONS
  An IgE-mediated anaphylaxis to Thiomucase is documented. Multiple allergens are recognized in Thiomucase by the patient serum, the main with 43 kDa. Partial cross-reactivity with BSA, cat dander and sheep dander is documented.
authors.affiliation: Allergy Service, University Hospital La Paz, Madrid, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Caballero
authors.forename: A
authors.initials: A
authors.lastname: Alonso
authors.forename: S
authors.initials: S
authors.lastname: De Miguel
authors.forename: M
authors.initials: M
authors.lastname: Martín-Esteban
authors.forename: B
authors.initials: B
authors.lastname: Varga
authors.forename: C Y
authors.initials: CY
authors.lastname: Pascual
authors.forename: M C
authors.initials: MC
authors.lastname: López-Serrano
mesh_terms: D000707:Anaphylaxis / Q000209:etiology*; D003429:Cross Reactions; D005966:Glucuronidase / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D008190:Lyases / Q000276:immunology*; D008970:Molecular Weight
chemical_list: D007073:Immunoglobulin E; C021812:mucopolysaccharidase; D005966:Glucuronidase; D008190:Lyases