PROTAMINE-INDUCED FATAL ANAPHYLAXIS - PREVALENCE OF ANTIPROTAMINE IMMUNOGLOBULIN-E ANTIBODY

Abstract

Protamine is used widely to reverse the anticoagulant effects of heparin and to delay the absorption of insulin. Although adverse reactions to protamine are reported infrequently and are usually mild, the 1st fatal case of type I anaphylaxis resulting from protamine was observed. This patient had previously been sensitized to protamine during cardiac catheterization and had high levels of protamine-specific IgE in the serum. In a prospective study, 10 of 19 diabetic patients (53%) who had received protamine-containing insulin also had high levels of antiprotamine IgE. None of 27 nondiabetic healthy normal controls or 10 diabetics who had never received protamine or protamine-containing insulin had levels of antiprotamine IgE over background. This study underscores the risks of routinely administering protamine to susceptible individuals and the need for alternative therapies.