title: Lethal Anaphylactic Reaction to Intravenous Gelatin in the Course of Surgery.
abstract: Plasma volume expanders (PVEs) are widely used to increase circulating blood volume. Gelatins used as PVEs are heterogeneous mixtures of polypeptides, usually prepared by hydrolysis of bovine collagen containing large amounts of proline and hydroxyproline residues. It has been shown that gelatins can cause anaphylactic reactions. We describe the case of a 73-year-old man who during surgery for intestinal obstruction presented a lethal anaphylactic reaction after the administration of a PVE containing gelatin lysate. The reaction occurred 10 minutes after the start of plasma expander infusion. Then, patient became comatose, and he died without awakening after 76 days. Necroptic aspects and histologic evaluation suggested the occurrence of anaphylactic reaction. According to pharmacovigilance algorithm, the causality relationship between PVE administration and adverse reaction has been considered as probable. We described a new lethal adverse reaction caused by PVEs containing gelatin. It is currently considered a very rare event, but we believe that it represents an important signal suggesting for a critical surveillance comprising a complete evaluation of individual's allergic susceptibility.
authors.affiliation: 1Department of Biotechnology and Legal Medicine, Section of Legal Medicine, University of Palermo, Palermo, Italy; 2Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; 3Operative Unit of Clinical Pharmacology, Azienda Ospedaliera Universitaria Policlinico "G. Martino," Messina, Italy; 4Operative Unit of Allergy and Clinical Immunology, Azienda Ospedaliera Universitaria Policlinico "G. Martino," Messina, Italy; 5Department of Biomedical Sciences and Morphological and Functional Images, Section of Morphological Forensic and Locomotor System, University of Messina, Messina, Italy; and 6Institute of Clinical Physiology (IFC), Consiglio Nazionale delle Ricerche (CNR), Messina Unit, Messina, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Ventura Spagnolo
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Calapai
authors.forename: Paola L
authors.initials: PL
authors.lastname: Minciullo
authors.forename: Carmen
authors.initials: C
authors.lastname: Mannucci
authors.forename: Alessio
authors.initials: A
authors.lastname: Asmundo
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Gangemi
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced*; D003128:Coma / Q000209:etiology; D004342:Drug Hypersensitivity / Q000209:etiology*; D017809:Fatal Outcome; D005780:Gelatin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D008297:Male; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D010952:Plasma Substitutes; D005780:Gelatin