Anaphylaxis to Gelofusine^® confirmed by in vitro basophil activation test: a case series*

Abstract

Summary The plasma expander Gelofusine® (succinylated gelatin) is a recognised cause of peri‐operative anaphylaxis. Current diagnosis of Gelofusine sensitivity is by skin testing, a procedure that itself carries a risk of allergic reaction. We evaluated the reliability of the in vitro basophil activation test as a diagnostic assay for Gelofusine sensitivity in subjects with a clinical history highly suggestive of Gelofusine allergy. Six patients with peri‐operative anaphylaxis clinically attributed to Gelofusine were skin tested to confirm sensitivity. Control subjects included three healthy subjects and five subjects allergic to a neuromuscular blocking drug, all negative on Gelofusine skin testing. Whole blood basophil activation to Gelofusine was analysed by flow cytometry for CD63 surface expression. All of the Gelofusine sensitive patients and one of the control allergic subjects showed positive basophil activation to Gelofusine. In this series of subjects, the basophil activation test for Gelofusine allergy had a sensitivity of 100% and a specificity of 87.5%. Our findings suggest that basophil activation testing is a safe and reliable in vitro assay for prediction or confirmation of Gelofusine sensitivity in patients with high clinical suspicion of Gelofusine‐induced anaphylaxis.

Anaphylaxis during anaesthesia: diagnostic approach

“…It seems obvious to avoid gelatinebased colloids in patients with known gelatine allergy (147). Diagnosis from IgE-mediated gelatine allergy is generally established upon quantification of sIgE (Phadia c74) (151), appropriate skin tests (48,148,152,153) or basophil activation assays such as histamine release tests (152,154) and flow assisted quantification of in vitro activated basophils (154).…”

Anaphylactic Reactions to Methylprednisolone and Gelofusine™ During Liver Transplant: Lesson Learnt

“…However, severe anaphylaxis with Gelofusine is rare (0.007%), and these reactions are also type I, IgEmediated. There may be production of antibodies through prior sensitization, although in many cases antibodies may even occur without any previous documented exposure [15,16]. IgE levels of our patient were raised after the event in absence of prior exposure to Gelofusine.…”

“…Anaphylaxis due to Gelofusine and other plasma expanders is reported in literature with an estimated incidence of 0.066%-0.146% [12][13][14]. However, severe anaphylaxis with Gelofusine is rare (0.007%), and these reactions are also type I, IgEmediated.…”

Infusion solutions of gelatin derivates

“…Jos veiksmingai slopinamos antihistamininiais vaistais. Minėtos reakcijos profilaktika kortikosteroidais neįro-dyta (16,17). Beje, įrodyta, jog antikūnai gali formuotis ne tik prieš želatinos tirpalus, bet ir prieš hidroksietilkrakmolo darinius (6,18).…”