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Anaphylactic shock caused by haemocoagulase injection in China.

ABSTRACT: Haemocoagulase injection is a mixture of purified enzymes isolated from the venom of Bothrops atrox, which is used for the prevention and treatment of haemorrhage. It is a relatively safe pharmacological agent that does not require a skin test prior to administration. However, following a literature search, 14 reported cases of anaphylactic shock caused by haemocoagulase injection were identified, including one lethal case in China. Using SDS-PAGE and protein identification, four primary components in haemocoagulase injection were characterized, including one metalloproteinase, which may be a thromboplastin-like enzyme, and two serine proteinases, which may be thrombin-like enzymes. Administering concentrated haemocoagulase injections failed to provoke a positive skin reaction in allergic patients. Basophil activation tests revealed that haemocoagulase injections did not upregulate cluster of differentiation 63 or C-C chemokine receptor type 3 expression. These findings suggest that haemocoagulase injection may cause fetal anaphylaxis. Although it is difficult to determine a clear conclusion without being able to evaluate the patients that underwent haemocoagulase injection-induced shock, it is unlikely that the venomous components of haemocoagulase injection cross-react with common allergens in allergic patients. It is possible that haemocoagulase injection-induced anaphylaxis is caused by its additive components, such as mannitol and succinylated gelatin.

SUBMITTER: Yang H

PROVIDER: S-EPMC5377524 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Anaphylactic shock caused by haemocoagulase injection in China.

Yang Haiwei H Yang Liming L Wang De-Wang DW Wei Ji-Fu JF He Shaoheng S

Experimental and therapeutic medicine 20170214 4

Haemocoagulase injection is a mixture of purified enzymes isolated from the venom of <i>Bothrops atrox</i>, which is used for the prevention and treatment of haemorrhage. It is a relatively safe pharmacological agent that does not require a skin test prior to administration. However, following a literature search, 14 reported cases of anaphylactic shock caused by haemocoagulase injection were identified, including one lethal case in China. Using SDS-PAGE and protein identification, four primary ...[more]

PMID: 28413507

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Project description:BackgroundTwo health concerns primarily related to triatomine bugs are transmission of Trypanosoma cruzi through infective feces, and allergic reactions induced by triatomine bites. In the Southwestern United States, reduviid bugs bites commonly cause insect allergy. In South China, four cases of anaphylactic shock have been reported after this bite exposure. To further classify the species of these bugs and confirm the sensitization of the triatomine saliva, we caught triatomine bugs from the region where the bites occurred and performed phylogenetic and immunohistochemical (IHC) analysis.MethodsTriatomine bugs were collected in Donghai Island of Zhanjiang City in South China. The genomic DNA was extracted from three legs of the bugs. The fragments of mitochondrial 16S rRNA, cytochrome c oxidase subunit I (COI) gene and nuclear ribosomal 18S and 28S rRNA genes were obtained by PCR and sequenced. A phylogenetic tree was constructed based on the sequence of 16S rRNA gene using a maximum likelihood method with MEGA 7.0 software. Trypanosomal specific fragments and vertebrate COI genes were amplified from the fecal DNA to detect the infection of trypanosomes and analyze the blood feeding patterns, respectively. Paraffin-embedded sections were then prepared from adult triatomines and sent for IHC staining.ResultsWe collected two adult triatomine bugs in Donghai Island. Morphological and molecular analyses indicated that the triatomines were Triatoma rubrofasciata. No fragments of T. cruzi or other trypanosomes were detected from the fecal DNA. Mitochondrial gene segments of Homo sapiens and Mus musculus were successfully amplified. The allergens which induced specific IgE antibodies in human serum were localized in the triatomine saliva by IHC assay.ConclusionsThe two triatomine bugs from Donghai Island were T. rubrofasciata. They had bitten humans and mice. Their saliva should contain the allergens related to the allergic symptoms and even anaphylactic shock of exposed residents. Great consideration should be given to this triatomine bugs due to their considerable distribution and potential threat to public health in South China.

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Anaphylactic shock caused by haemocoagulase injection in China.

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Anaphylactic shock caused by haemocoagulase injection in China.

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