[Anaphylactic reaction to aprotinin following topical use of biological tissue sealant].

Biological tissue sealant is used for facilitation of intra-operative hemostasis. It is composed of cryoprecipitated fibrinogen, bovine-thrombin and bovine-aprotinin. In this report, we describe a 38-yr-old woman in whom severe anaphylactic shock occurred immediately after the topical use of biological tissue sealant on the completion of modified radical mastectomy. The patient's past history and pre-operative laboratory values were unremarkable except for mild nasal allergy. Postoperative prick tests for bovine-serum, bovine-thrombin and bovine-aprotinin were positive. Total IgE level was normal. By the radioallergosolbent tests (RAST), specific IgE antibodies for aprotinin were elevated to the class 2 level. Drug induced lymphocyte stimulation tests (DLST) were negative. These indicated that the case was an aprotinin-induced anaphylaxis during general anaesthesia. The level of CH50, C4, C1q and C5 decreased in the serum sample immediately after the shock, but C3 was unchanged. It was considered to be a direct degradation of the complement by the proteolytic enzymes. Biological tissue sealant should be used cautiously bearing in mind the possibility of anaphylactic complication.