Peterson R G, Handschumacher R E, Mitchell M S
J Clin Invest. 1971 May;50(5):1080-90. doi: 10.1172/JCI106579.
In a series of 40 patients treated with L-asparaginase for various neoplastic diseases, 6 patients had generalized anaphylactic reactions to L-asparaginase. Each of these reactors had antibodies detectable by passive hemagglutination, but precipitins were detectable in only one of this group of six patients. That patient had received two courses of the enzyme. 1 wk after the anaphylactic reaction, complement-fixing antibodies were present in all the patients that were studied. Specific reagin antibodies (IgE) were demonstrated in one patient by the release of histamine from his leukocytes after incubation in vitro with L-asparaginase. Binding of L-asparaginase to serum antibodies after incubation in vitro was detected by selective precipitation of the complexes with 30% ammonium sulfate or by ultracentrifugation. Total inactivation of the enzyme did not occur even at optimal proportions or at antibody excess. Passive hemagglutinating antibodies to L-asparaginase were present in all patients who had an allergic reaction at least 1 day before the reaction occurred, when that sample was available, and were absent in all patients who did not manifest clinical allergy. Titration of antibodies by passive hemagglutination may thus provide a means of predicting impending anaphylaxis in this system, particularly when coupled with a sudden decrease in circulating levels of L-asparaginase activity.
在一组40例接受L-天冬酰胺酶治疗各种肿瘤疾病的患者中，6例对L-天冬酰胺酶发生全身性过敏反应。这些发生反应的患者每例都有可通过被动血凝反应检测到的抗体，但在这6例患者中只有1例可检测到沉淀素。该患者接受过两个疗程的这种酶治疗。过敏反应1周后，在所有接受研究的患者中均出现了补体结合抗体。通过在体外用L-天冬酰胺酶孵育后其白细胞释放组胺，在1例患者中证实了特异性反应素抗体（IgE）。通过用30%硫酸铵选择性沉淀复合物或通过超速离心，检测体外孵育后L-天冬酰胺酶与血清抗体的结合。即使在最佳比例或抗体过量时，该酶也不会完全失活。在所有至少在过敏反应发生前1天出现过敏反应的患者（当有该样本时）中均存在抗L-天冬酰胺酶的被动血凝抗体，而在所有未表现出临床过敏的患者中均未检测到。因此，通过被动血凝反应滴定抗体可能提供一种预测该系统中即将发生过敏反应的方法，特别是当与L-天冬酰胺酶活性循环水平突然下降相结合时。
