Greenberger P A, Patterson R, Tobin M C, Liotta J L, Roberts M
Department of Medicine, Northwestern University Medical School, Chicago 60611.
Am J Med Sci. 1989 Aug;298(2):104-8. doi: 10.1097/00000441-198908000-00006.
Immediate type-generalized reactions to protamine sulfate are uncommon but may be fatal. The mechanisms of severe or fatal reactions are unknown in most cases. One theory is that contaminating fish (salmon) proteins present in protamine solutions induce anaphylaxis in salmon-sensitive subjects. A second hypothesis is that protamine interacts with anti-salmon IgE to cause anaphylaxis. We assessed these hypotheses by establishing an indirect amplified enzyme-linked immunosorbent assay (ELISA) for IgE to salmon. Sera obtained from two subjects anaphylactically sensitive to salmon demonstrated high binding to salmon that was not inhibited by preincubation of sera with 500 or 1000 micrograms of protamine or Aspergillus fumigatus. Serum from a patient who experienced anaphylactic shock from protamine was indistinguishable from control sera in the ELISA for IgE to salmon. Anti-protamine IgE could not be demonstrated in separate experiments. The assays prove that 1) serum IgE to salmon is not inhibited by protamine and 2) serum from a patient experiencing a severe reaction to protamine did not contain IgE to salmon or protamine. The experiments do not support the notion that there is cross-reactivity between IgE to salmon and protamine sulfate in the cases evaluated.
对硫酸鱼精蛋白的速发型全身性反应并不常见，但可能致命。在大多数情况下，严重或致命反应的机制尚不清楚。一种理论认为，鱼精蛋白溶液中存在的污染性鱼类（鲑鱼）蛋白会在对鲑鱼敏感的受试者中引发过敏反应。另一种假设是鱼精蛋白与抗鲑鱼IgE相互作用导致过敏反应。我们通过建立一种针对鲑鱼IgE的间接扩增酶联免疫吸附测定（ELISA）来评估这些假设。从两名对鲑鱼过敏的受试者获得的血清显示出与鲑鱼的高结合力，这种结合力不会被血清与500或1000微克鱼精蛋白或烟曲霉预孵育所抑制。在针对鲑鱼IgE的ELISA中，一名因鱼精蛋白发生过敏性休克的患者的血清与对照血清没有区别。在单独的实验中未检测到抗鱼精蛋白IgE。这些测定证明：1）血清中针对鲑鱼的IgE不会被鱼精蛋白抑制；2）一名对鱼精蛋白发生严重反应的患者的血清中不含有针对鲑鱼或鱼精蛋白的IgE。在评估的病例中，实验不支持针对鲑鱼的IgE与硫酸鱼精蛋白之间存在交叉反应的观点。
