Larramendi Carlos H, Marco Francisco M, García-Abujeta José L, Mateo Máxima, de la Vega Ana, Sempere José M
Unidad de Alergia, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
Pediatr Allergy Immunol. 2006 May;17(3):230-3. doi: 10.1111/j.1399-3038.2005.00373.x.
A child allergic to cow's milk developed a mild systemic allergic reaction after the first dose of Ferplex 40 (iron proteinsuccinylate). Skin tests and in vitro studies were performed in the child, in three cow's milk-allergic controls and in a non-allergic control. Milk, casein and iron proteinsuccinylate (Ferplex 40) were used for skin tests, specific immunoglobulin E (IgE) determination, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting and enzyme allergo sorbent test (EAST) inhibition. A review of the drug information sheet and contact with the manufacturer were also performed. Although proteinsuccinylate is indeed a succinylated casein (each dose containing about 575 mg of casein) there was no indication of the milk protein content in the prescribing information provided by the manufacturer. Skin tests and specific IgE were positive in the case and in all allergic controls, except for EAST to iron proteinsuccinylate in one control. In EAST, iron proteinsuccinylate in solid phase was 100% inhibited by casein and casein in solid phase was inhibited 74% by iron proteinsuccinylate. SDS-PAGE of iron proteinsuccinylate showed a broad 46 kDa band and a blur of aggregated material. On immunoblot, the patient's IgE reacted to this heavily aggregated material and in the native casein extract recognized a 35-kDa band. The allergenicity of succinylated casein (proteinsuccinylate) among milk-allergic children is demonstrated. The protein source used in drug-protein conjugates should always be indicated by the manufacturer (as it should be in foods) to avoid potential risks to allergic patients.
一名对牛奶过敏的儿童在首次服用Ferplex 40（琥珀酸亚铁蛋白）后出现了轻度全身过敏反应。对该儿童、三名牛奶过敏对照者和一名非过敏对照者进行了皮肤试验和体外研究。使用牛奶、酪蛋白和琥珀酸亚铁蛋白（Ferplex 40）进行皮肤试验、特异性免疫球蛋白E（IgE）测定、十二烷基硫酸钠-聚丙烯酰胺凝胶电泳（SDS-PAGE）、免疫印迹和酶联免疫吸附试验（EAST）抑制试验。还查阅了药品说明书并与制造商进行了联系。尽管琥珀酸亚铁蛋白确实是一种琥珀酰化酪蛋白（每剂含有约575毫克酪蛋白），但制造商提供的处方信息中没有牛奶蛋白含量的说明。该病例以及所有过敏对照者的皮肤试验和特异性IgE均呈阳性，但一名对照者对琥珀酸亚铁蛋白的EAST试验除外。在EAST试验中，固相中的琥珀酸亚铁蛋白被酪蛋白100%抑制，固相中的酪蛋白被琥珀酸亚铁蛋白抑制74%。琥珀酸亚铁蛋白的SDS-PAGE显示出一条宽的46 kDa条带和一团聚集物质的模糊带。在免疫印迹中，患者的IgE与这种高度聚集的物质发生反应，并在天然酪蛋白提取物中识别出一条35 kDa的条带。证实了牛奶过敏儿童中琥珀酰化酪蛋白（琥珀酸亚铁蛋白）的致敏性。药物-蛋白质偶联物中使用的蛋白质来源应由制造商始终标明（就像在食品中一样），以避免对过敏患者造成潜在风险。
