title: Anaphylactoid-like reactions in a patient with HyperLp(a)lipidemia undergoing LDL apheresis with dextran sulfate adsorption and herbal therapy with the spice turmeric.
abstract: Elevated Lipoprotein (a) (Lp(a)) levels are associated with atherosclerosis and are independent risk factors for coronary artery disease and stroke [Ariyo et al., N Engl J Med 2003;349:2108–2115; Price et al., Atherosclerosis 2001;157:241–249]. Low-density lipoprotein (LDL)-apheresis is the most effective therapy for reducing Lp(a) levels [Parker, Chem Phys Lipids 1994;67–68:331–338; Stefanutti et al., Transfus Apher Sci 2010;42:21–26]. Dextran sulfate-cellulose adsorption (Liposorber®) removes both LDL and Lp(a) particles with minimal effect on high-density lipoprotein levels. During the procedure, high levels of bradykinin are generated as the kallikrein-kinin system is activated by contact with the negatively charged dextran-sulfate cellulose [Krieter et al., Artif Organs 2005;29:47–52]. Bradykinin is a potent vasodilator and a substrate of the angiotension converting enzyme (ACE). ACE inhibitors are contraindicated for apheresis procedures because these drugs prevent bradykinin degradation, which causes anaphylatoid reactions characterized by hypotension, bradycardia, dyspnea, and flushing [Owen and Brecher, Transfusion 1994;34:891–894]. Turmeric is a yellow spice that is used as an herbal remedy to treat a myriad of conditions ranging from abdominal pain to pulmonary infections. Scientific investigations of the ethnomedicinal properties of curcumin, the major derivative of turmeric, suggest that this compound has anti-inflammatory, antioxidant, and antineoplastic properties [Lobo et al., J Pharm Pharmacol 2009;61:13–21]. We report a case of a patient undergoing Liposorber® therapy for treatment of hyperLp(a)lipidemia who had three episodes of anaphylactoid-like reactions after starting therapy with the spice turmeric.
authors.affiliation: Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Adamski
authors.forename: Lita
authors.initials: L
authors.lastname: Jamensky
authors.forename: Joyce
authors.initials: J
authors.lastname: Ross
authors.forename: Don L
authors.initials: DL
authors.lastname: Siegel
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Sachais
mesh_terms: D000327:Adsorption; D000707:Anaphylaxis / Q000209:etiology*; D001781:Blood Component Removal / Q000379:methods*; D030024:Curcuma / Q000009:adverse effects*; D016264:Dextran Sulfate; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy / Q000009:adverse effects*
chemical_list: D017270:Lipoprotein(a); D008077:Lipoproteins, LDL; D016264:Dextran Sulfate