Agammaglobulinaemia and Anaphylactic Shock A case report and investigation of the mechanism

Abstract

Summary A patient with congenital agammaglobulinaemia received I.M. commercial gammaglobulin for therapeutic purposes which produced cyanosis, unconsciousness and a momentarily impalpable pulse. There was no evidence of humoral antibody against IgG or IgA. There was no evidence of detectable IgE in this patient. Lymphocyte transformation suggests that delayed type hypersensitivity to exogenous gammaglobulin did not exist. Abnormal histamine release on exposure of washed leucocytes to IgG aggregates was demonstrated. It is likely that this anaphylactoid reaction and other evidences of hypersensitivity to exogenous gamma globulin was mediated through interaction between complement and gamma globulin aggregates and that an active immune response to the gamma globulin was not involved.

Development of an Intravenous γ‐Globulin with Fc Activities

“…Protein concentrations were measured spcctrophotometrically by using the following values for E {Lk at 280 nm: G G and S-GG, 14; the heavy chain (H), 14.5; the light chain (L), 12. The molecular wcights werc assumed to be 16 x 104 for GG and S-GG, 5.5 x lo4 for the H and 2.3 x 104 for the L chain.…”

“…Intravenous administration of 7-globulin (GG) is highly desirable for producing the highest possible blood level of antibodies rapidly. But the intravenous use of standard GG frequently causes anaphylactic reactions which are due to GG aggregates [14]. Although attempts have been made to remove the aggregates and prevent reaggregation [ 11, there is no aggregate-free preparation available up to the present.…”

Development of an Intravenous γ-Globulin with Fc Activities

“…But the intravenous use of standard GG frequently causes anaphylactic reac tions which are due to GG aggregates [14], Although attempts have been made to re move the aggregates and prevent reaggrega tion [1], there is no aggregate-free prepara tion available up to the present.…”