Immunology of streptokinase in human subjects.

Streptokinase is an effective thrombolytic agent used in various thrombotic diseases. Until recently, allergic reactions have not been well characterized. We report the clinical and immunologic correlations of three types of reactions to streptokinase (S) in man. These include IgE antibody to S which mediates anaphylaxis and immediate-type skin reactivity to S. This skin test may be predictive of those at risk for anaphylaxis. IgG antibody and S form antigen-antibody complexes which result in toxic immune complex disease including skin, renal and joint symptoms. This human response simulates the animal model of immune complex disease reported over two decades ago. Lymphocyte mediated reactions include local delayed cutaneous reactions with systemic malaise correlating with in vitro lymphocyte reactions to S. An immune response of rising IgE, immediate-type skin reactivity and rising IgG antibody occurred in two physicians volunteering for skin test analysis to S.