Evaluation and management of adverse reaction associated with albumin infusion
Question:
8/18/2017
A patient has been referred to us for evaluation of albumin allergy. This is a 51 year old male with Cirrhosis and needs albumin infusion with his paracentesis on a frequent basis. Developed generalized hives within 30 minutes of receiving albumin infusion. No reactions in the past with infusions and has not received further infusions. Any suggestions about testing and further management.
Answer:
I consulted Mariana C Castells, M.D. Ph.D., Director of the Drug Hypersensitivity and Desensitization Center at Brigham and Women’s Hospital and Professor in Medicine at Harvard Medical School. Dr. Castells provided the following reply:
I have not seen a case of human albumin allergy and there is only one study which investigated this. I do not believe that human albumin is allergenic but the packaging might be.
Human albumin is typically administered as a 5% solution Protein, of which 96% is human albumin and the rest:
Sodium
Potassium N-acetyl-DL-tryptophan Caprylic acid
Water for Injections
I recommend skin testing with the preparation that induced the reaction with prick undiluted and ID at 1/1000, 1/100 and 1/10. If negative pre-medicate (using a RCM protocol) and use a different preparation and if positive you can desensitize with our protocol and we will be happy to provide a personalized protocol to the target dose and premedications. For the personalized protocol, you may contact Marlene_Garcia-Neuer@DFCI.HARVARD.EDU or Donna-Marie Lynch, dlynch@bwh.harvard.edu.
Brown, J. S., et al. (1985). "An investigation of possible immunologic reactions to human serum albumin used as a stabilizer in allergy extracts." J Allergy Clin Immunol 76(6): 808-812.
Two hundred fifteen patients who had received allergy immunotherapy for at least 1 year with an extract preparation containing 0.03% human serum albumin (HSA) were tested for evidence of an immunologic reaction to HSA by immediate skin testing. Sera from 39 of these subjects and from control subjects were studied in a microtiter enzyme-linked immunosorbent assay for anti-HSA antibodies. The 39 subjects' sera were examined by immunoelectrophoretic analysis for evidence of "tailing albumin" indicative of HSA bound to immunoglobulins. All studies were negative. We conclude that in these patients HSA-containing allergy extracts used in immunotherapy failed to induce the production of specific antibodies against HSA. This suggests that HSA was a safe extract stabilizing agent for allergy extracts in these representative allergic patients.
Jacqueline A. Pongracic, MD, FAAAAI