An immediate, allergic skin reaction to aprotinin after reexposure to fibrin sealant

BACKGROUND: The safety of fibrin tissue adhesives has been a concern since they entered wide clinical application. Most commercially available kits co ntain the proteolytic inhibitor, aprotinin, to stabilize the fibrin clot. A bovine protein, this substance has an allergenic potency. CASE REPORT: This case report presents a patient who had a generalized alle rgic skin reaction, probably triggered by aprotinin upon reexposure to fibr in sealant injected subgaleally to achieve closure of a liquor fistula afte r neurosurgical treatment. The serologic investigation revealed aprotinin-s pecific IgE and IgG. From 1990 through 1998, reports of five allergic react ions following 1 million exposures to fibrin sealant were made to the manuf acturer. The clinical relevance of allergic reactions to aprotinin containe d in fibrin sealants and measures to avoid them are discussed. CONCLUSION: These hypersensitivity reactions are extremely rare (incidence, 0.5/100,000 for all reactions and 0.3/100,000 for serious reactions), but they must be kept in mind as possible adverse events after repeated applica tions of fibrin sealants within a few weeks.