IgE-mediated anaphylaxis to Thiomucase®, a mucopolyssacharidase: allergens and cross-reactivity.

Background: Thiomucase® is a mucopolysaccharidase obtained from ovine tissues mainly used to facilitate the diffusion of local anaesthetics and in the treatment of cellulitis. A patient with an anaphylaxis in relation to the intramuscular administration of Thiomucase® is reported. Objective: To investigate Thiomucase® allergens and their possible relationship with dander allergens and animal albumins. Material and methods: Skin prick tests (SPT) and serum-specific IgE were performed with Thiomucase® and danders. Thiomucase® SDS-PAGE immunoblotting was performed in order to study allergens. RAST/CAP inhibition and SDS-PAGE immunoblotting inhibition were carried out to study the cross-reactivity. Results: Skin prick tests (SPT) were positive to Thiomucase®, animal dander (cat, dog, sheep, other), bovine serum albumin (BSA), and echinococcus. Specific IgE was also positive to Thiomucase®, animal dander (cat, dog, sheep, other), BSA and echinococcus. In the RAST-CAP inhibition assays BSA was nearly completely inhibited by Thiomucase®, Thiomucase® was partially inhibited by BSA and cat and Echinococcus granulosus was partially inhibited by sheep and Thiomucase®. In the Thiomucase® SDS-PAGE immunoblotting several proteins fixed IgE, ranging from 20 kDa to > 94 kDa, the strongest with 43 kDa. The IgE fixation to BSA, cat and sheep in the SDS-PAGE immunoblotting was completely inhibited by the preincubation of the serum with Thiomucase®. Conclusions: An IgE-mediated anaphylaxis to Thiomucase® is documented. Multiple allergens are recognized in Thiomucase® by the patient serum, the main with 43 kDa. Partial cross-reactivity with BSA, cat dander and sheep dander is documented. [ABSTRACT FROM AUTHOR]