Anaphylactic reactivity to streptokinase
K. G. McGrath and R. Patterson
Streptokinase is used worldwide as a thrombolytic agent. Allergic reactions
have been observed to streptokinase; however, the immunologic mechanisms
have not been described. In a case of an anaphylactic reaction to
intravenously administered streptokinase during the evolution of a
myocardial infarction, the patient had elevated specific IgE and IgG levels
to this agent demonstrated by in vitro methods. In vivo testing
demonstrated cutaneous immediate-type hypersensitivity with a typical wheal
and flare reaction. Critically ill patients receive short-term treatment
with streptokinase. Because of the potential danger of anaphylaxis in these
patients, we provide an approach that may identify those at risk. The
urgency of the requirement for immediate administration of streptokinase is
such that an in vitro test cannot be used; thus, results of appropriate
skin testing must be evaluated.
