Life-threatening intraoperative anaphylaxis to gelatin in Floseal during pediatric spinal surgery

Agarwal, Navneet; Spalding, Collette; Nassef, Mervat

doi:10.1016/j.jaip.2014.05.010

Cited by 32 publications

(20 citation statements)

References 9 publications

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“…Gelatin based hemostatic products. Topical gelatin-based hemostatic products have been shown to induce allergic reactions in children during spinal surgery, dental treatment, and liver biopsy [46,47,48,49]. Even in patients who could tolerate gelatin-containing food and vaccines, a severe allergic reaction can develop due to the different route of administration [49].…”

Section: Gelatinmentioning

confidence: 99%

Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy

et al. 2019

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Childhood food allergies are a growing public health problem. Once the offending food allergens have been identified, a strict elimination diet is necessary in treatment or prevention of most of the allergic reactions. Accidental food ingestion can lead to severe anaphylaxis. Food- derived substances can be used in medications at various stages of the manufacturing process. In this review, the possible roles of medications which may contain egg, red meat, gelatin, and fish allergens on allergic reactions in children with food allergy were evaluated.

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Section: Gelatinmentioning

confidence: 99%

Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy

et al. 2019

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“…The gelatins cross-react extensively, and this has given rise to anaphylactic reactions to vaccines containing gelatin. 64 Most recently, we have seen a case reporting delayed reactions to mammalian products, including cow’s milk and beef, who was negative to alpha-gal. In this case the dominant assay result was to milk, and the specific protein was BSA.…”

Section: Role Of Ige Assays In the Diagnosis Of Different Forms Of Fomentioning

confidence: 99%

IgE in the diagnosis and treatment of allergic disease

Platts-Mills

Schuyler

Erwin

et al. 2016

Journal of Allergy and Clinical Immunology

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Traditionally, the concept of allergy implied an abnormal response to an otherwise benign agent (eg, pollen or food), with an easily identifiable relationship between exposure and disease. However, there are syndromes in which the relationship between exposure to the relevant allergen and the “allergic” disease is not clear. In these cases the presence of specific IgE antibodies can play an important role in identifying the relevant allergen and provide a guide to therapy. Good examples include chronic asthma and exposure to perennial indoor allergens and asthma related to fungal infection. Finally, we are increasingly aware of forms of food allergy in which the relationship between exposure and the disease is delayed by 3 to 6 hours or longer. Three forms of food allergy with distinct clinical features are now well recognized. These are (1) anaphylactic sensitivity to peanut, (2) eosinophilic esophagitis related to cow’s milk, and (3) delayed anaphylaxis to red meat. In these syndromes the immunology of the response is dramatically different. Peanut and galactose α-1,3-galactose (alpha-gal) are characterized by high- or very high-titer IgE antibodies for Ara h 2 and alpha-gal, respectively. By contrast, eosinophilic esophagitis is characterized by low levels of IgE specific for milk proteins with high- or very high-titer IgG4 to the same proteins. The recent finding is that patients with alpha-gal syndrome do not have detectable IgG4 to the oligosaccharide. Thus the serum results not only identify relevant antigens but also provide a guide to the nature of the immune response.

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“…The underlying factor behind the found effusion is elusive; it could be associated with the surgical intervention or due to the presence of Floseal™ in the middle ear. Care should be taken in the use of Floseal™ in patients with atopy, particularly in those with a known allergy to gelatin products as this may lead to a life-threatening anaphylactic reaction [11]. …”

Section: Discussionmentioning

confidence: 99%

Can floseal™ be applied safely during otologic surgery? Assessment of ototoxicity in a chinchilla animal model

Nhan

Bezdjian

Alarfaj

et al. 2017

J of Otolaryngol - Head & Neck Surg

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BackgroundIn otologic surgery good visualization is paramount, and patients with bleeding diatheses or who need to be anti-coagulated can present a significant challenge. Here, we determine whether Floseal™, a hemostatic matrix, is ototoxic in a validated animal model.MethodsNine chinchillas housed in the animal care facilities of the Montreal Children’s Hospital Research Institute were used for the study. After a myringotomy incision was made in each tympanic membrane, baseline auditory brainstem response measurements were performed at 8, 20, and 25 kHz. In each animal one ear was randomized to receive Floseal™ to the middle ear cavity, whereas the other ear served as the control and received 0.9% sodium chloride. Outcome measures included early (day 7) and late (day 30) auditory brainstem response, clinical evidence of facial nerve or vestibular disturbance and histological evidence of ototoxity.ResultsThere was no significant hearing threshold shift on auditory brainstem response across all tested frequencies for both experimental and control ear. No animals receiving Floseal™ developed facial or vestibular nerve dysfunction and there was no histological evidence of ototoxicity.ConclusionBased on the preliminary ototoxicity assessment on nine chinchillas, transtympanic Floseal™ does not appear to be ototoxic. More studies are warranted to assess the safety and applicability of the product in humans.

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Life-threatening intraoperative anaphylaxis to gelatin in Floseal during pediatric spinal surgery

Cited by 32 publications

References 9 publications

Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy

Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow’s Milk Allergy

IgE in the diagnosis and treatment of allergic disease

Can floseal™ be applied safely during otologic surgery? Assessment of ototoxicity in a chinchilla animal model

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