OVERT AND SUBCLINICAL REACTIONS TO STREPTOKINASE IN ACUTE MYOCARDIAL-INFARCTION

The aims of this study were (1) to assess the possibility of predictin g allergic reactions to streptokinase (SK) by measuring pretreatment a ntibody titers and by intradermal skin testing, and and (2) to determi ne if Sh is associated with subclinical changes in renal function. Spe cific anti-SK immunoglobulin G (IgG) and subclass IgG1 were assessed b y enzyme-linked immunosorbent assays, and renal function was assessed by measurement of serum urea and creatinine in 204 patients with acute myocardial infarction. Twenty-six patients had 24-hour proteinuria lo ss and creatinine clearance assessed at presentation. Median IgG titer at presentation was 6 (range 0 to 10,000), and increased to 60 (range 0 to 18,000; p <0.0001) on day 6. Fifteen of 180 patients (8.3%) had minor allergic reactions to SK; the median titer on admission for thes e patients was 5 (range 0 to 60), identical to those who tolerated SK uneventfully. No change was seen in serum urea or creatinine; for thos e treated with SK, the median value for proteinuria loss at day 0 was 0.45 g/liter (range 0.1 to 2), and decreased by day 5 to 0.1 g/liter ( range 0.1 to 0.8; p = 0.0027). No significant proteinuria was seen in those who did not receive SK. The reactions to SK were minor, and coul d not be predicted on the basis of IgG titers at presentation. Signifi cant proteinuria was found in the first 24 hours in SK-treated patient s, but not in those who did not receive SK, and it resolved by day 5.