Single doses of intravenous protamine result in the formation of protamine-specific IgE and IgG antibodies.

BACKGROUND: Protamine reactions are a well-recognized and serious complication of intravenous protamine administration. IgE-mediated anaphylaxis occurs after initial sensitization and subsequent re-exposure to antigens. Subcutaneous protamine in insulin preparations is associated with protamine-specific IgE and IgG antibody production. In contrast, the influence of intravenous protamine administration on protamine-specific IgE and IgG antibody formation has never been investigated. METHODS: Sera from 93 patients were analyzed for protamine-specific IgE and IgG antibodies both before and 4 to 6 weeks after exposure to single doses of intravenous protamine. Specific clinical variables were assessed by univariate and multivariate analyses to determine independent predictors of protamine-specific antibody production. RESULTS: In patients who were previously seronegative, intravenous protamine administration resulted in protamine-specific IgE and IgG antibody production in 17 of 93 (18%) and 15 of 93 (16%) patients, respectively. As determined by multivariate analysis, male gender (p = 0.06) and insulin-dependent diabetes mellitus (p = 0.002) were associated with protamine-specific IgG but not IgE antibody production. CONCLUSION: Single-dose intravenous protamine resulted in protamine-specific IgE and/or IgG antibody production in 26 of 93 (28%) of patients. Seroconversion was associated with male gender and insulin-dependent diabetes mellitus. Patients responding immunologically to protamine may be at increased risk for experiencing reactions on subsequent exposure.

Cornstarch powder on latex products is an allergen carrier.

Allergic reactions of the upper respiratory tract during use of powdered latex rubber gloves have been recently associated with sensitivity to latex. We have studied the ability of cornstarch powder to bind latex proteins and evaluated allergenic properties of the bound protein. Allergenicity was determined by competitive inhibition of human anti-latex IgE binding to solid-phase latex antigen. Cornstarch extracted from powdered latex products and clean cornstarch exposed to latex protein extracts were evaluated in comparison with clean unexposed cornstarch. Both exposed cornstarch preparations inhibited specific binding of anti-latex IgE antibodies to latex proteins in a dose-response manner. Latex-exposed cornstarch diluted 50% vol/vol produced complete inhibition, whereas greater dilutions exhibited variable levels of inhibition, depending on the source of cornstarch-bound proteins, insolubilized latex proteins, and IgE antibody-containing human serum used. Cornstarch not exposed to latex had no inhibitory activity. The study demonstrates that cornstarch indeed binds allergenic latex proteins and supports the causative relationship between allergic reactions in individuals with latex sensitivity and the exposure to airborne particles from powdered latex products.

High-titer protamine-specific IgG antibody associated with anaphylaxis: report of a case and quantitative analysis of antibody in vasectomized men.

PIP: A vasectomized man reacted to intravenous protamine with shock; IgG and IgE antibodies against protamine were then measured in a group of 55 vasectomized men and compared to 55 age-matched controls. The index case was a 63-year old vasectomized man who, while having mitral valve repair and cardiopulmonary bypass, reacted to intravenous protamine with severe hypotension and pulmonary hypertension. protamine is the standard drug given to reverse the anticoagulatory effects of heparin used in cardiac procedures. He had another episode of bradycardia and hypotension 2 weeks later during heparin and protamine infusion as part of a follow-up studies. To document the presence of antibodies against protamine, a solid phase radioimmunoassay of protamine-IgG and -IgE was developed and performed on the subject's serum. This test was also applied to vasectomized men aged 21-45 years and 50 age-matched controls. The subject had a protamine-specific IgG level of 53 mcg/ml at the time of the 1st reaction, 667 at the 2nd, and 79 mcg/ml 3 months later. 16 (29%) of the vasectomized men also had protamine-specific IgG. None of the controls had protamine IgG. None of the men studies showed protamine-specific IgE in their sera. Before this case, diabetics receiving protamine-insulin were considered at risk for reactions to iv protamine, but only one other case of a vasectomized man succumbing to shock after protamine infusion has been reported.^ieng

Longitudinal psychological assessment in tetralogy of Fallot.

To determine whether preoperative psychological testing in children with cyanotic heart disease could provide an accurate estimate of adult performance, we studied 21 subjects (mean age, 30.3 +/- 4.8 years) who had undergone surgical repair for tetralogy of Fallot between 1958 and 1966 (mean age, 8.7 +/- 3.9 years); 17 received childhood preoperative testing (mean age, 8.9 +/- 4.2) and four had early postoperative testing. Follow-up psychological tests administered in 1983 included Wechsler Adult Intelligence Scale Revised, Jackson Personality Research Form E, Rosenberg Self-Esteem Scale, and a questionnaire-interview on educational, occupational, and psychosocial status. Adult IQ (x = 93.4 +/- 15.6) and child IQ (x = 97.5 +/- 14.6) scores were highly correlated (r = 0.87, p less than 0.01), revealing considerable stability across 22.3 +/- 2.2 years. On 17 of 22 Jackson personality scales, the subjects (S) were within the normal range. Scoring below the 16th percentile were 11/21 S on intellectual curiosity, 9/21 S on adaptability to change, and 8/21 S on leadership skills. Scoring above the 84th percentile were 8/21 S on harm avoidance and 8/21 S on giving nurturance to others. Univariate one-way ANOVAs indicated that those subjects with the higher IQ scores had the higher incomes, job levels, and educational attainments. We conclude that the results of perioperative psychological testing in children with tetralogy of Fallot are congruent with postoperative adult intellectual and psychosocial status.